Some weeks ago, this writer visited with a friend who had been admitted to an inpatient psychiatric unit of a New York hospital. The friend had been there for a few weeks. Other patients have been there for longer.

After spending approximately an hour with his friend, this writer was not allowed to leave the unit at the conclusion of his visit. It wasn't until 15 minutes later that one of the hospital staff unlocked the door and allowed him to depart. On the way to the elevator bank, he casually asked a healthcare provider when the patients - some of whom had been there for weeks - were allowed to go outside. To his astonishment, he was told they are not allowed to leave until they are formally released.

Unlike the most hardened criminals - convicted murderers and rapists, amongst others, housed at maximum security prisons - no patient on this particular psychiatric unit at this New York hospital is permitted to go outside under any circumstances. Ever. Patients are confined 24 hours a day, seven days a week to a relatively crowded and chaotic living space. These patients have no access to natural sunlight or fresh air, ever. Too often, this policy amounts to cruel and unusual treatment.

Last week, The National Football League (NFL) released a memo outlining its COVID-19 policy for the upcoming season. The NFL will not be forcing players and coaches to get vaccinated; however, it is incentivizing them to do so.

Specifically, if a contest is cancelled because of a COVID outbreak and cannot be rescheduled, the team with infected players will forfeit the game, assume all costs associated with the cancelation, and players on both squads will not be paid that week.

Following the NFL’s memorandum, a cohort of furious players voiced their displeasure. Arizona Cardinals star receiver DeAndre Hopkins tweeted: “Never thought I would say this, but being put in a position to hurt my team because I don’t want to partake in the vaccine is making me question my future in the NFL.” Thereafter, Hopkins tweeted that his girlfriend’s brother “had heart problems” after being inoculated.

LA Rams cornerback Jalen Ramsey tweeted: “The NFL is pressuring/ influencing guys to get the vaccine. They are saying if there is an outbreak, the team will be penalized heavily…I know 2 people right now who got the vaccine but are covid positive.”

LA Raiders running back and anti-vaxxer Jalen Richard said unvaccinated players will be “playing in jail” this year.

Buffalo Bills receiver Cole Beasley who’s spoken regularly against receiving the jab tweeted, “nothing has changed, I’m still livin freely.”

New England Patriots linebacker Matthew Judon simply said, “The NFLPA (NFL Players Association) f–king sucks.”

Our View

At TQC, we often concur with libertarians on a myriad of issues. We believe in a smallish government and that individuals should do as they please so long as they abide by the law and do not impose their will on anybody by means of coercion or fear of reprisal. However, in extraordinary circumstances, we think there is a place for policymakers to enact and enforce sensible rules and regulations to protect public health and/or their own employees, so long as they are not onerous to abide by. The coronavirus global pandemic qualifies as such. Hence, we agree with the NFL’s COVID policy; it makes prudent sense.

On September 16, an altercation took place at the famous New York eatery, Carmines, on Manhattan’s Upper West Side. A newly employed hostess was enforcing NYC’s recently enacted mandate that all people aged 12 and older show proof of vaccination to dine indoors when a group of tourists from Texas – three men and three women – attempted to secure a table inside the eatery. The women, who showed up before their male counterparts, were inoculated and permitted entry. The men – who were unvaccinated - showed up shortly thereafter and were not allowed inside. That prompted the women to leave. An argument between the tourists and the hostess ensued.

Video footage obtained from the restaurant shows the group of women, who are black, attacking the hostess, who is Asian. The women were subsequently arrested and charged with assault. They claim the hostess used a racial slur during the argument, which prompted the physical assault. The hostess denies this, as does Carmines’ owner Jeff Bank, who said:

“Three women brutally attacked our hosts without provocation, got arrested and charged for their misconduct, and then, over the last several days, had their lawyer falsely and grossly misrepresent their acts of wanton violence in a cynical attempt to try to excuse the inexcusable.”

The organization Black Lives Matter (BLM) came to the tourist’s defense, initially accusing Carmines of withholding additional video footage that would substantiate the women’s claims. In response, Carmines released all videos related to the incident. There was no audio. The only people who will ever know if a racial slur was uttered are the individuals involved. However, what is indisputable is what happened a few days later:

On Monday September 20, a protest took place outside Carmines. Demonstrators were joined by Chivona Newsome, the BLM co-founder of Greater New York. Newsome & Co demanded that NYC’s vaccine mandate be rescinded because its “racist.” The logic behind her argument: a smaller percentage of NYC’s black residents are vaccinated than then their white and Asian counterparts, hence NYC’s vaccine mandate is prejudiced against black people. Said Newsome, accompanied by a group of protestors, “72 percent of black people in this city from ages 18 to 44 are unvaccinated…So what is going to stop the Gestapo, I mean the NYPD, from rounding up black people, from snatching them off the train, off the bus? ...The vaccination passport is not a free passport to racism…” Newsome went so far as to call for a national uprising over NYC’s vaccine mandate.

The United States is facing an acute COVID outbreak, fueled by the new highly infectious, Omicron variant. Countrywide, more than 200,000 cases per day are now being logged. In addition, record rates of infections are being reported across major metropolitan areas including New York City, the epicenter of the first large COVID outbreak at the beginning of the pandemic in America. Nationally, hospitalizations are up ~50% since November, albeit from a low base. In locations where vaccination rates lag, many hospitals are quickly becoming overwhelmed (the United States has a good healthcare system, but very little spare capacity). Regrettably, the rolling 7-day average for deaths is 1,656 per day.

Indeed, as the number of positive COVID cases goes parabolic, fear has gripped the nation. People can be found snaked around corners in cities across America, waiting to be tested. Holiday parties have been canceled, colleges have closed campuses and migrated back to remote learning, businesses have told their employees to work remotely, Broadway has shuttered its curtains - again - and Christmas excursions have been shelved. Might all this be…good news?

Before arguing why we believe the answer is “yes,” we want to preface our arguments by clearly stating that we take COVID seriously. We encourage all Americans to get inoculated, be prudent around higher- risk citizens and wish those who are ill a swift recovery. Our thoughts go out to the unfortunate victims who succumbed to COVID.

From Pandemic To Endemic

With the risk of ending up with an egg on our face, we believe COVID cases will peak in the United States over the next few weeks and then drop precipitously. Even more encouraging, though far from experts on virology, from what we can discern, COVID is behaving similarly to other viruses that have morphed from pandemic to endemic: it is becoming more infectious but less deadly.

According to the National Institute for Communicable Diseases in South Africa where the Omicron variant was first identified, patients are 80% less likely to be hospitalized if they catch the Omicron compared with other strains. In a recent Scottish Study, Omicron hospital risk was ~66% lower than Delta. Another study from the U.K showed similar results.

Over the next 12-24 months, we suspect mortality rates for COVID and how we co-exist with COVID will converge with that of another endemic virus, the flu.

A Good Host

Unlike bacterial infections, viruses need a host - animal or human - to survive. When the host dies, the virus dies. Some viruses, including other coronaviruses like SARS (mortality rate ~10%) and MERS (mortality rate 40%), do not tend to become pandemics because they are too deadly. Specifically, too many hosts die before the viruses can reach escape velocity and infect hordes of people. Other coronaviruses, such as the common cold, are not thought of as pandemics because while they are highly infectious – every year, hundreds of millions of people “catch a cold” - most cases are mild.

Throughout history, the miracle of medicine has been politicized.

In the mid-1800s, a Hungarian physician named Ignaz Semmelweis plied his trade in a Vienna hospital. Dr. Semmelweis was baffled why a disproportionate number of mothers were dying of puerperal fever in one particular maternity ward. (Puerperal fever, or childbed fever, is a bacterial infection of the female reproductive tract.) Semmelweis observed that ~15% of all new mothers became sick and later died vs. only 1-2% of mothers in the hospital’s other maternity ward.

Determined to find out why Dr. Semmelweis worked feverishly (excuse the pun) and took copious notes on a vast number of potential factors between the two maternity wards. All his findings were unremarkable. In fact, after exhaustive research, the only difference Dr. Semmelweis noted was that doctors staffed the maternity ward with the abnormally high mortality rate; the other maternity ward was staffed by midwives.

Doctor Semmelweis excluded all potential determinants aside from who was delivering babies. Eventually, he unearthed what he believed was the cause of the disparity. In addition to delivering babies, physicians on the maternity ward were also dissecting cadavers with their bare hands. On numerous occasions, a doctor would dissect a cadaver and then later deliver a baby. By doing so, the doctor would unknowingly expose the mother to infectious bacteria. Conversely, midwives’ only duty on their ward was to deliver babies; bacteria were not introduced from cadaver to hands and thus onto the mother.

To prove his hypothesis, Dr. Semmelweis instructed all doctors and midwives to wash their hands with chlorinated lime before entering a delivery room. (In the 1850s, handwashing was an afterthought to both the medical community and the general populace. The consensus at the time was that germs spread via malicious odors in the air.) Semmelweis took special care to implore and ensure all doctors who had recently touched a dead body to wash their hands.

Astonishingly, as Dr. Semmelweis expected the mortality rate on the maternity ward staffed by physicians quickly converged to that on the ward staffed by midwives. Indeed, a simple hygienic step that almost everyone now takes for granted – handwashing - saved thousands of mothers and millions of lives thereafter.

Politicization & Ostracization

Dr. Semmelweis’ reward for applying rigorous science to answer one of the most head-scratching questions of his time? Ridicule. Colleagues called him crazy. How dare he claim that fellow physicians were the ones responsible for the deaths of so many women? Was he in cahoots with the makers of the chlorinated lime solution to earn outsized profits (might that sound similar to modern-day conspiracy theories regarding the pharmaceutical companies who manufacture COVID vaccines and tests?).

In the United States, over 100,000 people are waiting for an organ transplant; many will die – including over 6,000 patients this year alone - before they are lucky enough to receive one.

Researchers are working diligently to alleviate the organ shortage. For example, doctors are experimenting by transplanting genetically modified pig organs into brain-dead humans. Another tantalizing possibility is lab-grown organs. However, these and other research into the field is preliminary and yet to enter clinical trials, and fraught with ethical issues.

This then begs the question: can and should anything be done today to remedy the deadly supply/demand imbalance for human organs? In our view, the answer is yes.

A market-based system to buy and sell certain body parts would help correct an imbalance that kills ~6,000 Americans per year. Horrified at this suggestion? Prima facie, we were too.

There are certainly moral and “ick” factors that surface. But after removing emotion from the calculus, we concluded that buying and selling certain body parts was indeed an appropriate solution. Before we argue the merits for an organ exchange, let us introduce a few interesting facts about organ transplantation in America:

Key Facts

• According to the United Network for Organ Sharing (UNOS), in 2021, 41,354 organ transplants were performed in America.

• When an organ becomes available, primary deciding factors regarding allocation are need, location and compatibility.

• Since data collection began in 1988, ~850,000 organ transplants have been performed.

• In 1954, the kidney was the first organ to be successfully transplanted, followed by the liver (‘67), heart (’68), and lung (’83).

• Organ “rejection” was – and still is – a primary concern for recipients. The first effective medicine to combat rejection (by suppressing the immune system) was Cyclosporine, introduced in 1983.

• According to the American Transplant Foundation, “organs that can be donated after death are the heart, liver, kidneys, lungs, pancreas, small intestines, hands, face and uterus. Tissues include corneas, skin, middle ear veins, heart valves, tendons, ligaments, bones, and cartilage.”

• The most bestowed organ from living donors are kidneys. Other organs that living donors can offer are portions of lungs, livers, pancreas, and intestines.

• ~6,500 living organ donor transplants are performed each year, ~33% of recipients are not related to the donor.

• Kidneys are the most transplanted organ, followed by livers, and hearts.

• The cornea is the most transplanted tissue, over 40,000 transplants take place per year.

Organ Exchanges

Organs can lawfully be purchased for research. A market for organs that can be donated by the living does not exist and is currently outlawed in the United States (and everywhere else except Iran). This should not be.

The thought of an exchange to buy and sell organs certainly has an “ick” factor, but the indisputable facts are these: There is an acute shortage of organs in America. This translates into over 100,000 people currently on a waitlist for a transplant; with ~5 needy people added each hour.

Worse, ~6,000 Americans die annually – and in our view unnecessarily - or ~17 everyday, waiting for an organ transplant. See the table below for a snapshot of mismatches for key organs:

If the title of this article is meant to shock or be misconstrued, it is neither. This week’s topic of discussion is not about American youth and sexually transmitted diseases (STDs), rather we will delve into an unheeded demographic where STDs are becoming evermore prevalent: the elderly. Unfortunately, senior citizens in our society are too often overlooked and sometimes outright ignored. Nowhere might this be more apparent than in the lack of focus, education and care for the aged who are becoming infected with STDs at an alarming rate. This must change.

While older people tend to be mindful of their blood sugar, blood pressure, cardiac care and more; many are startlingly ignorant of the epidemic that’s taken hold of their communities. STDs? Why would those even apply to them if they are not of child rearing or producing age? One reason is the lack of basic education and effective communication by health care providers. Another impetus is societal neglect. Simply put, older people are marginalized when it comes to many relevant public service health campaigns. As a result, they do not consider themselves a high-risk group for STDs. This false sense of immunity coupled with the fact that older people tend to have more compromised immune systems, increases the probability that the elderly will acquire a sexually communicated disease.

Needn't we forget that many senior citizens are products of the Baby Boomer Generation. They came of age during the sexual revolution. Their attitudes towards sex combined with the use of drugs like Viagra & Cialis have made an the active sex life well into retirement all but commonplace.

In late 2018, the US News & World Report published an article that encompassed some sobering statistics: "A recent analysis of patients on Athenahealth's network found that patients over age 60 account for the biggest increase of in-office treatments for sexually transmitted infections. The report found that in adults over age 60, diagnosis rates for herpes simplex, gonorrhea, syphilis, hepatitis B, trichomoniasis and chlamydia rose 23 percent between 2014 and 2017.” In 2014, Psychology Today published a piece with the following lead in sentence: “According to the Center for Disease Control, among our senior citizen population sexually transmitted diseases (STDs) are spreading like wildfire. Since 2007, incidence of syphilis among seniors is up by 52 percent, with chlamydia up 32 percent." The examples above were published in the mainstream press. And while there has been much written on this particular phenomenon, the stories tend to be buried in the back pages of a newspaper or relegated to the preserve of medical journals.

Ironic indeed that the very message Anti-vaxxers are conveying – not to vaccinate children – increases the probability of what are trying to prevent: their child being afflicted with a life-long disability or even death. - TQC

Below is a sampling of serious diseases coupled with some corresponding symptoms. All are preventable by vaccine.

Measles: Death, Pneumonia, Encephalitis (swelling of the brain).
Mumps: Deafness, Encephalitis, Meningitis (swelling of the spinal cord and brain).
Diphtheria: Death, Nerve Damage, Myocarditis (damage to the heart muscle).
Pertussis: Death, Coughing Fits.
Polio: Paralysis in the arms and or legs.

As a result of a herculean nationwide effort to inoculate children based on a scientifically managed, strict effective schedule, these and other debilitating illnesses were all but eradicated in the United States. Unfortunately, because of scaremongering and misinformation underpinned by pseudo-science spread by Anti-vaxxers, these and other serious but preventable diseases are making a comeback.

Anti-vaxxers have been particularly effective in communicating a falsehood, namely that vaccinations cause autism and other developmental problems in children. Ironic indeed that the very message Anti-vaxxers are conveying – not to vaccinate children – increases the probability of what are trying to prevent: their child being afflicted with life-long disability or even death. Despite misguided warnings, there is not a shred of credible, objective scientific evidence that depicts a causal link between vaccinating children and autism. On the flip side, however, there is exhaustive scientific evidence and hard data that demonstrate vaccines are a safe and effective means of preventing diseases that can cause permanent disabilities or even death.

Not only are anti-vaxxers being reckless with their children by not vaccinating them, they are putting entire communities at risk. Vaccinations are most effective when over 90% of people are vaccinated. “This type of protection is known as “community immunity” or “herd immunity.” When enough of the community is immunized against a contagious disease, most other members are protected from infection because there’s little opportunity for the disease to spread.” Once the number of inoculated individuals drops below 90%-95%, a vaccine becomes materially less effective. Thus, a small minority of parents are putting entire communities at risk, not just their own children. This is selfish, misguided and dangerous.

In November 2018, The Quintessential Centrist’s inaugural issue covered the opioid crisis and the efficacy of fast acting antidotes such as Narcan and Evzio to counter overdoses. At the time of publication, there had been plenty of ongoing media coverage as to the role of Purdue Pharma in perpetuating the opioid epidemic. Purdue’s legal troubles began in 2001 when the company was sued by the state of West Virginia, which was effectively ground zero for the opioid crisis. The state claimed that Purdue inappropriately marketed their drug, OxyContin, and hid “from doctors the extent to which OxyContin's morphinelike qualities could lead to addiction.”

At the Quintessential Centrist, we have sometimes been a vocal critic of the government for regulatory and judicial overreach, which, we believe can stifle economic growth, innovation and job creation. But with respect to Purdue Pharma and its role in propagating the opioid epedemic, both state and federal governments are right to prosecute the company to the full extent of the law.

According to the CDC, 400,000 people perished from opioid overdoses between 1999 and 2017. Beyond just the death toll, the economic and social costs have been stunning. An article penned in 2016 in The Science Daily approximated the economic cost of the opioid crisis at over $78 billion dollars. The numbers are certainly much higher today. The social costs have been equally if not more enormous as the nuclei of tens of thousands of families have been hallowed out, the fabric of entire communities shredded.

Purdue Pharma is certainly not the only company to produce opioids; publicly listed firms such as Johnson & Johnson (JNJ), Teva Pharmaceuticals and Allergan are involved in the space. Indeed, every pharmaceutical company found to be complicit in monetizing the opioid crisis should be held accountable. Recently, Teva quietly settled a related lawsuit while JNJ continues to fight in court; next month a ruling is expected. The outcome should be carefully watched as it will set precedent. But Purdue, a private company controlled by the prominent Sackler family, is disproportionately to blame for this societal disaster. From their unscrupulous marketing tactics, refusal to accept responsibility and then to plan to profit from the very crisis they spawned, their actions are reprehensible.

Ever since high school, I have taken a keen interest in physical fitness, worked out consistently, read different books and periodicals and consulted with many fitness pros to broaden my knowledge base on the subject. I have logged thousands of hours in the gym testing out numerous weight lifting (anaerobic), aerobic, stretching and dieting routines, using myself as a human guinea pig. Since then, I have tailored many strength training and conditioning programs, stretching routines, and given copious amounts of nutritional advice to family, friends and fellow gym rats. When I was in my twenties and early thirties, a disproportionate amount of inquiries that came my way were about lifting weights and stretching. Once I turned 40, the majority of questions I received had more to do with diet and weight loss.

Mythos

Does a “diet” exist that people with an average amount of willpower can actually stick to over the long term, does not deprive them of their favorite foods and is well-balanced? The short answer is “no.” Indeed, the number of get slim quick gimmicks, get lean fast fads, and other enticing offers that conveniently find their way into our inboxes (talk about “junk” mail), mailboxes, across our computer screens or in books and magazines is mind boggling, can be overwhelming and most importantly, are of little long term practical value. The notion of the term “diet” is temporary, which is why they often fail; it inherently implies a short-term solution to eating and lifestyle choices that will revert to the mean. Below is a sampling of three of the most famous diets:

The South Beach Diet: In this diet, the subject must eliminate “bad carbs” derived in part from sodas, candy and cookies and eat protein, whole grains, fruits, vegetables, and “good carbs” derived in part from brown rice, corn and legumes.

The Paleo Diet: Commonly referred to as the “caveman diet.” Only foods that existed hundreds and thousands of years ago before the advent of modern food processing technology, are allowed to be consumed. Meat, fish, nuts and vegetables are permissible. All grains and processed foods are not.

The Atkins Diet: The most famous of all fads. The original Atkins Diet simply instructed its participants to avoid all carbohydrates; fried eggs and bacon where fine. The new Atkins Diet is “healthier.” It includes leaner protein and “good carbs.” However, whole grains are not allowed until later, once the dieter enters the “maintenance phase.”

All three of these diets are rigid, not particularly well balanced, and close to impossible to stick to over the long term. The primary reason is because they all deprive of us of some of our favorite foods. That is no fun and tends to put people in rotten moods.

In accordance with Jewish custom, when a newborn boy is 8 days old, he is circumcised. Traditionally, a mohel, a Jewish person trained in the practice of "brit milah,” or circumcision, performs this religious and cultural rite of passage. The procedure is typically done in the home, followed by a celebration over Jewish-style cuisine, drinks, and conversation. When asked why, many Jewish parents say they circumcise their sons simply because it is “tradition.” Specifically, the ritual of circumcision is a rite of passage, a symbol of “total obedience to God’s will.” At the ritual's onset, it was also believed that circumcision provided a way of distinguishing a Jewish boy or man from others, particularly those who might seek to inflict harm on, or "pose as Jews." Today, circumcision is widely practiced outside Judaism - for religious, cultural and health reasons.

Tradition or Barbarism, or Both?

Religious traditions can be wonderful in drawing communities and families closer; they create an innate bond and sense of identity. But when do we reach an inflection point where a cultural or religious ritual that’s historically been socially acceptable, is considered barbaric and generally looked upon by society with disdain? For an example, look no further than the brit milah itself. In accordance with Jewish law, a mohel “must draw blood from the circumcision wound.” Up until the 1800's, the “m’tzitzah” or removal of the blood, was effected by the mohel who would suck the blood off the newborns penis. Centuries ago most Jews were unmoved by the thought, let alone the act, of a grown man putting his lips on an 8-day old’s penis to “clean” the wound. Of course, today all but the most regressive people cringe when they learn about this part of a bris that was formally commonplace.

In the ultra-religious Haredi sect, a mohel still removes the blood using his mouth. Regrettably, this abhorrent “custom” which most people would (now) argue is analogous to sexual assault, has resulted in multiple cases of an incurable sexually transmitted disease (genital HSV-1 or herpes) being communicated from mohel to baby. A newborn’s immune system is not fully developed. The herpes virus is usually an unpleasant annoyance for an adult; it can kill an infant. The Centers for Disease Control and Prevention (CDC) has documented cases of death resulting from herpes acquired via transmission from mohel to newborn.

Fortunately, today almost all mohels remove the blood with a suction device. But 100 years from now, might our descendants reflect back upon the present-day customs of the brit milah and cringe in a similar way to us when we learned about the related practices of the past?

Personal Experience

I am Jewish. I have attended a few brit miloht (plural for brit milah) in years past. While I remain malleable and welcome a respectful debate, my current position is that I will not attend any more of these "celebrations." I cannot in good faith – excuse the pun – take part in any social, cultural or religious gathering consuming Jewish fare, drinking wine and conversing, to celebrate a newborn boy’s religious rite of passage that involves his penis being handled by a grown stranger. In my view, doing so would be perverted and tantamount to child abuse.

The 2019-nCoV, known as the Wuhan Virus is a coronavirus, one of a group of viruses that originate in animals. Coronaviruses are not typically passed from animals to humans but occasionally the virus mutates and humans can become susceptible. An infected human can communicate the virus to other people.

There are seven (known) human coronaviruses. Four strains: HCoV-229E, -eL63, -OC43, and -HKU1 are always percolating among us. These typically cause common colds. Sometimes, a more severe coronavirus can cause pneumonia and on rare instances, can prove deadly.

The Wuhan coronavirus is the third known strain of human coronavirus that can cause acute symptoms. The other two are SARS-Cov better known as SARS (severe acute respiratory syndrome) and MERS-Cov better known as MERS, (Middle East respiratory syndrome, or camel flu).

SARS:

The SARS virus originated in Yunnan province, in Southern China. The initial outbreak occurred in late 2002 / early 2003. Most likely, SARS was initially communicated from a bat to a wild animal, possibly a civet. The virus then mutated and humans became vulnerable. Although Chinese authorities at first covered up the SARS outbreak, which of course contributed it to spreading, in total only ~8,000 people became infected. The vast majority of cases were contained to China and Hong Kong. Of those, ~10% succumbed to the disease. There were 27 reported SARS cases in the United States; nobody perished.

MERS:

Bats are believed to be carriers of the MERS virus but camels are suspected as being the agent that passes this particular coronavirus on to humans. While MERS is rare - only ~2,000 people worldwide are known to have contracted it - it is particularly lethal. ~40% of people who acquire it, die. Most MERS cases have been concentrated in Saudi Arabia and South Korea. There have been two reported cases of MERS in the US, both patients survived.

The Wuhan Coronavirus:

The Wuhan coronavirus originated in the Chinese city of Wuhan, in Hubei province, located between Chengdu to the west and Shanghai to the east. Specifically, the virus has been traced to a (since closed) wild animal market in Wuhan. Most likely, an infected civet hosting the disease passed it on to a human who in turn infected other unsuspecting peoples. Thus far, the vast majority of Wuhan virus patients are concentrated in mainland China.

The timing of the Wuhan outbreak is particularly suboptimal, the dangers magnified by the lunar New Year, a time period in which many rural migrants travel on the nation's network of bullet trains and buses to reunite with family; each passenger a potential host of, and agent to pass on, the Wuhan virus.

The Wuhan coronavirus is contagious when an infected person is symptomatic. Many new patients are healthcare workers who treated the initial batch of infected people without donning proper protective gear. Asymptomatic transmission (people who are infected but do not have noticeable symptoms) might be possible during the incubation period (~2 weeks). Travelers deemed high risk are being quarantined to help mitigate that threat. What is not yet clear is if Wuhan is transmitted via casual contact or from close or more intimate interaction. Furthermore, “Both SARS and MERS had ‘superspreaders’-patients with unusually high viral loads, who are exceptionally infectious. In South Korea in 2015 a patient with MERS infected 81 people during a 58-hour stay at a hospital emergency room.” It is unknown if any Wuhan patients share similar properties.

As of this writing, COVID-19 (the coronavirus) has spread to 118 countries. Approximately 165,000 people have been infected, ~6,300 have died and another ~5,600 are in serious condition (~76,000 have recovered).

In the United States, there are ~3,100 confirmed cases of coronavirus, 62 patients have died and eight have recovered. Unfortunately, the number of cases in the US (and possibly other nations) may be grossly understated as we are in the early stages of this pandemic. In part, this is a result of early inaction and complacence. Earlier this week an expert with the Harvard Global Health Institute, Ashish Jha, asserted that the United States government’s response to the coronavirus outbreak has been "much, much worse than almost any other country that's been affected…I still don't understand why we don't have extensive testing. Vietnam! Vietnam has tested more people than America has…Without testing, you have no idea how extensive the infection is…we have to shut schools, events, and everything down, because that's the only tool available to us until we get testing back up. It's been stunning to me how bad the federal response has been..."

Renowned virologist, HIV/AIDS expert and Director of the National Institute for Allergy and Infectious Diseases, Anthony Fauci made the following statement to lawmakers this past week: “The system is not really geared to what we need right now - what you’re asking for - that is a failing…It is a failing. Let’s admit it.”

He makes a valid point. As the human tragedy unfolded at the epicenter of the coronavirus outbreak in Wuhan, China in late 2019, government officials around the world were given a head start to prepare for and implement practical measures to help contain the spread of the virus. South Korea was exemplary. Given its proximately to China, COVID-19 quickly permeated its borders. However, South Korean authorities learned from China’s experience and took quick, decisive action. They moved swiftly and tested tens of thousands of people, isolated infected patients and aggressively disinfected public places around the country. They curtailed travel, shut public gathering places, closed schools and limited the number of people who could loiter together. The result: Data suggests the epidemic has already peaked there with ~8,200 cases, 75 confirmed deaths (a mortality rate of ~.01%) and 834 recovered.

In contrast, our government’s initial “response” was unconscionable. One of the basic functions of a government is to take all reasonable measures to keep its citizens safe. The US government fell well short of that responsibility. We had a 6-week head start to prepare (longer than South Korea) but instead took a lackadaisical approach. The fact that there aren’t even enough testing kits to go around after witnessing the outbreaks overseas is a gross abdication of responsibility to American citizens. Now Americans find themselves in a defensive, reactive stance.

No Slacking

Using back of the envelope math, if ~165,000 people are officially infected and 6,300 have died, that equates to an average mortality rate of ~4%. In nations whose demographics lean older and developing countries, many of which have underfunded and or rudimentary healthcare systems, the death rate might be higher. In many westernized nations, the mortality rate will probably be lower; but only if their respective healthcare systems are not overrun.

The United States has an excellent healthcare system, but very little spare capacity. And because we are playing catchup, the math tells a particularly disheartening story. Consider the following: there are ~950,000 hospital beds throughout the nation, 2/3rds of which are typically occupied at any one time. This leaves just ~300,000 beds available to be utilized. Measures can be enacted to help free up space including canceling all non-essential and elective surgeries. But the stark reality is that we have very little buffer to absorb an acute influx of patients. Furthermore, because of the infectious and highly contagious nature of this disease, coronavirus patients require a tremendous amount of medical resources. They must be isolated, many will require round the clock monitoring, ventilation machines and other medical gear, many of which are in short supply. Doctors, nurses and other healthcare professionals must take extra precaution to ensure they themselves are not infected (The hero doctor who rang the alarm bell in China was infected and subsequently succumbed to the virus).

A week after our last post on March 15th, this author became symptomatic and subsequently tested positive COVID-19. It was a relatively mild case. However, the adverse effects of the virus disrupted our schedule. We thank you for your patience during these unprecedented times.

In the weeks following the maelstrom caused by the coronavirus, we have been intently focused on the corresponding data. Many areas of America are only now beginning to see an exponential uptick in infections. But at the epicenter of the U.S. outbreak in New York City, and in other “hot spots” like Detroit and the state of New Jersey, evidence suggests that we have reached the peak in terms of infection rates, hospitalizations, intubations and casualties. Worth noting is that while death rates remain elevated, bear in mind that mortality is a lagging indicator. Indeed, in these parts of the country, we are cautiously optimistic that we have inflected towards recovery, albeit in nonlinear fashion.

In New York City, hospitals are operating at or near capacity and health care workers are short of protective gear. But unlike Italy where care has had to be rationed – when doctors pick who lives and who dies – it appears that NYC will get through the apex of its crisis with enough ventilators, ICU beds and other necessary equipment to avoid the unthinkable.

Below we highlight nine key themes that have emerged from the coronavirus pandemic:

The Victims

The coronavirus pandemic is a human tragedy. The speed and ferocity with which COVID-19 has claimed, and disrupted lives is unprecedented in recent history. As of April 12th, in New York City alone, over twice as many people have perished from the coronavirus than on 9/11. On a national level ~22,000 people have died in just ~2 months. To help put these numbers in perspective: over nine years (1965-1974) ~58,000 U.S. troops were killed in Vietnam. Regrettably, despite evidence of the “curve flattening,” we might eclipse that number in a matter of weeks.

Globally, the coronavirus has infected close to ~2,000,000 people (the true number is probably exponentially higher as many people are never tested and/or are asymptomatic) and killed ~114,000 in a few short months. Italy (~20,000 deaths) and Spain (~17,000 deaths) have suffered tremendously, especially in proportion to their overall populations. France (~14,000 deaths) has been hard hit, as has the U.K. (~11,000 deaths), who’s Prime Minister Boris Johnson was recently hospitalized with the virus.

At TQC, we empathize with those people who have been directly or indirectly affected by COVID-19, and with those who might be in the future.

The Healthcare Providers

Every evening at 7pm EST, New Yorkers have taken to clapping, cheering, banging on pots, pipes and pans, and playing music in recognition and appreciation of the healthcare workers who are risking their lives to care for COVID-19 patients. This exercise has been repeated in similar formats around the world.

Let us all join in and take a moment to express our gratitude to all the health care professionals - doctors, physicians’ assistants, nurses, nurses’ aides, EMTs, support staff, and all others who have and continue to put themselves at the greatest level of risk – sometimes without adequate protective equipment - caring for coronavirus patients. Hats off to you all.

Doctor Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, has proven himself to be a true leader and a face of reason, transparency and prudence, keeping Americans well informed about the coronavirus epidemic. Let us not forget, Dr. Fauci is nearing 80 years old and still on the front lines fighting tirelessly to keep the American public safe.

Recently, while discussing hygiene and disease, Dr. Fauci said, “I don’t think we should ever shake hands again.” If we ever get an opportunity to do so, we sincerely hope Doctor Fauci makes an exception for us. A handshake is the very least we could do to recognize his courageousness.

The Government’s Response

Our government’s initial “response” was lackluster to say the least. One of the basic functions of a government is to take all reasonable measures to keep its citizens safe. The US government fell well short of that responsibility. We had a 6-week head start to prepare but instead took a lackadaisical approach. President Donald Trump did not act swiftly enough. At first, he minimized the threat of COVID-19 likening the virus to the flu, contradicted the advice of Dr. Fauci, made no effort to secure more N95 masks, protective gowns and ventilators, and failed to invoke the Defense Production Act (DPA) in a timely manner. (The DPA was passed in 1950. It enables the Federal government to force private companies to manufacture specific products in the event of a war or national emergency). The fact that there were not even enough testing kits to go around – and they are still in short supply - after witnessing the outbreaks overseas was a gross abdication of responsibility to American citizens.

To be fair, in addition to Trump & Co, many people, including scientists, also did not take the threat of coronavirus seriously. Some experts believed the outcome would be analogous to the respective SARS & MERS epidemics, and remain mostly contained to China and the Middle East. (There were 27 reported SARS cases in the United States; nobody perished. There have been two reported cases of MERS in the US, both patients survived).

Furthermore, during Barrack Obama’s tenure in office, our nations’ stockpile of N95 masks and other protective gear was depleted and his administration did not take adequate steps to replenish it. According to USA Today: “There is no indication that the Obama administration took significant steps to replenish the supply of N95 masks in the Strategic National Stockpile after it was depleted from repeated crises. Calls for action came from experts at the time concerned for the country’s ability to respond to future serious pandemics. Such recommendations were, for whatever reason, not heeded."

There is no shortage of data that underpins what is painfully obvious, even to the untrained eye: as a result of COVID-19, this quarter will probably mark the worst contraction of America’s economy since the Great Depression in 1929.

Another corollary courtesy of the coronavirus is opaquer yet damaging nonetheless: its effect on Americans suffering from mental illness and the impact of those who are newly battling this silent epidemic.Quarantine, as prescribed by lawmakers for the sake of the greater good plays a prominent role. Uncertainty about the future, adjusting to the “new normal” and worries about economic security are also factors that contribute to the newly afflicted.

We know what some of you are already thinking -- Americans are over-diagnosed with mental ailments and over-prescribed medication. These are not empty arguments. But using conservative estimates to control for over-diagnoses, ~17% of Americans experience a mental illness at least once and ~4% of Americans live with a serious disease of the mind. Since COVID-19 reared its ugly head, rates of anxiety, depression, suicide (and domestic violence) have markedly increased.

Be “Mindful”

Anxiety disorders are the most common mental illness in the United States. They develop from a "complex set of risk factors, including genetics, brain chemistry, personality, and life events" and often co-exist with depression, a separate illness that carries its own (sometimes overlapping) set of symptoms and risk factors.

Prior to the coronavirus permeating America’s borders and forcing governors across the nation to institute shelter in place orders, according to the Anxiety and Depression Association of America (ADAA), the numbers of Americans suffering from the following mental illnesses were as follows:

• Generalized Anxiety Disorder (GAD) (~7 million)

• Panic Disorder (PD) PD (~6 million)

• Social Anxiety Disorder affected (~15 million)

• Obsessive-Compulsive Disorder (OCD) (~2.2 million)

• Post-traumatic Stress Disorder (PTSD) (~8.5-9 million)

• Major Depressive Disorder (MDD), the leading cause of disability for ages people aged 15 to 44, impacted more than 16 million people.

• Persistent depressive disorder (PDD), a form of depression lasting least two years or longer (~3 million)

• Bipolar disorder, which is not on the same spectrum as traditional depression or anxiety disorders, affected just over 2 million American adults.

*In depth explanations of each genre of anxiety and depression are nuanced and extremely complicated subjects to tackle. Their granularity goes well beyond the depth of this post. They can, and should be, topics of a separate TQC article, penned by an expert in the field.

As of this writing, the coronavirus has officially infected ~1.8 million Americans and claimed the lives of over 104,000. Though COVID-19 has touched every demographic in all 50 states, the virus has not preyed upon its victims uniformly. Americans over 65 years old have borne a disproportionate brunt of the coronavirus’ wrath.

Senior citizens represent ~15% of the nation’s population, but account for ~80% of all COVID-19 related deaths. Broken down by sub-sector, the mortality rate for patients in their 60’s is ~4%, doubles to ~8% for those between 70 and 79 and is most pronounced for octogenarians, where ~13% of those (officially) infected succumb to the disease.

During these treacherous times, we owe it to our seniors to take reasonable precautions to protect them. Below are 8 common sense ideas to help keep our most vulnerable citizens safer until the coronavirus pandemic abates. These proposals are certainly not a panacea, but they could make a difference at the margins, particularly as communities across America re-open for business and leisure.

1) Low(er) risk Americans should respect social distancing rules, wash hands frequently, and always wear a mask in public. At times, these temporary requirements can be frustrating and a bit of a nuisance. However, these sensible directives are not in place to infringe upon anyone's individual rights; they curb the spread of COVID-19 and help keep older Americans and other high(er) risk people healthy. (Unfortunately, some individuals are not adhering to the advice of medical experts. Their careless actions: partying on the beach, congregating in large groups, not wearing masks in public etc., is dangerous, selfish and leaves everybody – especially older Americans and those with pre-existing conditions - at heightened risk).

In the early morning of Friday October 2 President Donald Trump, after claiming in a debate the week prior that he “wears a mask when he needs to”, became one of ~8 million documented coronavirus victims in the United States. Per Trump’s usual means of communication, the president informed the public via Twitter that he had indeed tested positive for COVID-19.

President Trump’s heightened risk factors: being male, elderly (74), and overweight (Trump eschews tobacco and alcohol, but has a fondness for BigMacs) – put the odds of him dying or becoming critically ill at ~3% and ~12.5%, respectively (though these percentages are probably too high given the level of medical care available to the President of the United States vs the general population).

The day of his diagnosis, President Trump was transported to Walter Reed Medical Center. He was given supplemental oxygen, began a 5-day course of the antiviral drug remdesivir, pumped full of dexamethasone, a steroid typically administered in severe COVID cases, and supplied with an experimental antibody drug, compounded by a company called Regeneron.

Prior to being discharged, Trump – still contagious - left his hospital room to express his gratitude to supporters surrounding the facility. In doing so, he needlessly exposed secret service agents who were assigned to his limousine; Trump waived to his fans from the back seat. Then Trump (presumably) used taxpayer money to buy pizza pies for his well-wishers outside Walter Reed. Harmless enough, if not for the fact that enabling strangers to congregate while reaching for slices of pizza amid a viral pandemic communicated via close personal contact is irresponsible.

On October 5, President Trump was released from Walter Reed. He tweeted, “I will be leaving the great Walter Reed Medical Center today at 6:30 P.M. Feeling really good! Don't be afraid of Covid. Don't let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!”

Though less than a week removed from contracting the coronavirus, we cannot disprove the last sentence of that tweet. We can – and do – disapprove of Mr. Trump’s communication regarding the coronavirus pandemic, except for at the onset of it. We expand on this later in this post.

Tell Me Lies, Tell Me Sweet Little Lies

There is no shortage of outright lies that Donald Trump has propagated with regards to COVID-19. In late February, Mr. Trump said “one day, it’s like a miracle – it will disappear.” On March 6, just as the severity of the coronavirus pandemic was becoming apparent, President Trump said that if “somebody wants to be tested right now, they’ll be able to be tested.”

At the time, there was a national shortage of testing kits. Only the most acute patients were tested, and the results often took over a week. Later that month Trump said the FDA had approved hydrocholorquine to treat the coronavirus. This was untrue then and remains the case today. In March, no drug was approved specifically to treat COVID.

On Monday November 9, the pharmaceutical companies Pfizer and BioNTech announced positive Phase 3 results for their coronavirus vaccine candidate. Data suggests their vaccine is over 90% effective in preventing the transmission of COVID-19. This was better news than most experts had anticipated; virologists were hopeful for 70% efficacy and a growing consensus was that a 50% success rate would have cleared the bar for approval.

Additional safety data should be ready within two weeks. Assuming the vaccine is officially deemed safe – there have not been any major problems in trials involving tens of thousands of volunteers - Pfizer and BioNTech will apply for emergency use authorization from the Food & Drug Administration (FDA) by month-end. Immunizations could begin in December; there are 50 million doses (25 million vaccines) ready to be deployed. A vaccine requires two jabs. The firms aim to produce 1.3 billion doses in 2021.

Results from another biotechnology company called Moderna are expected imminently. Hopes are elevated for another dose of positive news; the properties of Moderna’s vaccine are similar to that of Pfizer and BioNTech’s.

A Dose Of History

Throughout history, some of the most important medical breakthroughs involved the successful development of vaccines that neutered an array of highly infectious diseases. Despite some misinformation or shall we say, “fake news,” spread by anti-vaxxers, approved vaccines are very safe and extremely effective.

Below is an abbreviated history coupled with interesting supplemental information on some of the most important vaccines ever developed.

1796: Smallpox. The smallpox virus was caused by two related pathogens, Variola major and Variola minor. Smallpox was one of the most infectious, debilitating, and deadly diseases known to mankind. ~30% of patients who became infected, died. Many of those who survived were left permanently disabled and or disfigured.

Although attempts at inoculation date back to the 1500s, the British physician Edward Jenner is credited with developing the first (albeit rudimentary) smallpox vaccine. Doctor Jenner observed that milkmaids infected with a mild virus called cowpox seemed to be immune from acquiring smallpox. To test his hypothesis, Jenner deliberately infected a small child with cowpox. He accomplished this feat by scratching the boy’s arm and introducing the open wound to the cowpox virus taken from the pustules of an infected milkmaid. A few months later, Doctor Jenner attempted to infect the boy with the deadly smallpox virus via pus taken from an existing smallpox victim. He was not successful. Jenner’s initial suspicion was correct; the cowpox virus had indeed conferred immunity to the deadly smallpox virus. Until a more efficient smallpox vaccine was developed in the mid 1850s, antibodies from the cowpox virus helped protect people against smallpox.

Unfortunately, mankind did not gain an upper hand on the smallpox virus until the back half of the 20th century, when a massive coordinated global inoculation effort resulted in the disease officially being declared eradicated in 1980 (the last naturally occurring case was documented in 1977; the last outbreak in the United States occurred in 1949). To this day, smallpox is the only disease that has officially been 100% eradicated; thank goodness. To put in perspective how deadly smallpox was, consider the following data: In the last 100 years of its existence – 1880 to 1980 - smallpox is thought to have killed ~500 million people. We had to triple check this estimate to ensure it was accurate.

Almost two years ago, TQC penned a blog post on Anti-vaxxers. Little did we, or the world for that matter, know how that debate would quickly resurrect itself at the forefront of global discussion. In that piece, we highlighted the misinformation spread by Anti-vaxxers, the destructive consequences of forgoing vaccination, and debunked the most common arguments against immunization. We were constructively critical of parents and their illogical refusal to inoculate their children against viruses including the mumps, measles and even a virulent disease like polio. In this week’s piece, we will focus on the growing number of adults who are eligible to receive a vaccine against COVID-19 but are refusing to get inoculated; and counter some outright lies and ½ truths that have permeated our society about COVID-19 vaccination.

Fallacies

The approved vaccines for COVID-19 are very safe and extremely efficacious, including against most mutations of the virus. Unfortunately, though data is patchy and has been subject to revisions, most polls indicate that ~20% of eligible American adults will refuse a jab. This is not surprising. Many of the same Anti-vaxx parents who are steadfast in refusing to inoculate their children, are making similar flawed arguments against protecting themselves against the coronavirus. In addition, Anti-vaxxers have been extremely effective (and strategic) at leveraging the anti-mask / anti-government cohort to help spread misinformation about COVID-19 and the vaccines approved to combat it.

Worryingly, the Anti-vaxx movement is growing. There are hundreds of Anti-vaxx themed accounts across various social media platforms. Estimates suggest they attract almost 60 million followers among them. Some ill-informed people believe and promote Anti-vaxx hogwash about COVID-19 vaccines being an experiment in DNA altering gene therapy, part of a government surveillance mechanism and or having dangerous adverse side effects. Many others do not. For them, a profit motive is behind their dubious actions. Some hawk “natural” remedies for ailments otherwise neutered by vaccines, including for COVID-19. Others profit from attracting advertising dollars to the sites they control that peddle these “remedies.”

One particularly persuasive Anti-vaxxer is a man named Del Bigtree, leader of an Anti-vaxx group called Informed Consent Action Network. In baseless assertions buttressed by little more than hot air, Mr. Bigtree has asserted to his ~350,000 social media followers that COVID-19 is no more harmful than a “cold,” wearing masks is hazardous to your health, and that the COVID-19 inoculation effort is an “experiment” that puts people’s lives in jeopardy. Unfortunately, Mr. Bigtree is not alone in spreading fallacies and having the audacity to solicit cash donations from the subjects he is spreading misinformation to.

It is not surprising that Anti-vaxx promoters have been so successful: It is materially easier (and profitable) to infect people with fear underpinned by sensationalism, than to educate people with knowledge underpinned by science.

Facts

There is exhaustive scientific evidence and hard data that demonstrate vaccines are a safe and effective means of preventing diseases that can cause permanent disabilities or even death. Throughout history, some of the most important medical breakthroughs involved the successful development of vaccines that crushed an array of highly infectious and lethal diseases including Smallpox, Bubonic Plague, HPV (Cervical Cancer), and Polio.

Remember the flu? The CDC and most epidemiologists agree that we are in “peak” flu season. By this time last year, almost 20 million Americans had contracted the Flu, ~200,000 had been hospitalized, and ~10,000 died, including ~100 children. In fact, in a typical year:

• Between 5% (~6,600,000) and 20% ( ~66,000,000) of American citizens contract the flu.

• ~250,000 Americans are hospitalized due to complications from the flu.

• ~35,000 Americans succumb to the flu.

This year is atypical. Though February usually marks the apex of the seasonal flu in America, remarkably, we have seen almost zero – you heard that correctly – close to zero documented influenza cases in the United States.

The Mayo Clinic conducted 20,000 flu tests between Dec 1st and Feb 1st, none came back positive. Of 800,000 samples tested by The Centers for Disease Control (CDC), just 1,500 were positive. Extrapolating these figures and applying them to a broad swath of America, in what is typically the most brutal time of year for influenza, just ~.02% of people are testing positive. Furthermore, thus far, just a few hundred people have been hospitalized and there has been only one documented fatality.

These figures are truly stunning, but are they surprising? Probably not.

Why?

The influenza virus shares some similarities to the coronavirus, including how it is communicated. According to the CDC, “People with flu can spread it to others up to about 6 feet away. Most experts think flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.” Sound familiar? Of course, it does. This is synonymous to how COVID-19, and other variants of the virulent coronavirus, are transmitted.