Debunking the Latest “Truth the Government Doesn’t Want You to Know” Video.

Last night a friend sent me the latest viral COVID-19 misinformation video. You can view it below, though once it is inevitably removed from YouTube I won’t bother to re-link to it; I am sure it will be popping up on your Facebook feed soon enough (if it isn’t already).

This is the worst one yet.

Having recently spent considerable time attempting to help bring some clarity to the PlanDemic Documentary (26 minutes long) and the interview with the two Bakersfield Urgent Care Doctors (55 minutes long), I was glad that this video was fairly brief; the clip above is very short, but even the full-length video is a mere 3 minutes and 32 seconds. Still, it has over 680 million views, and that degree of viral spread, only equaled by SARS-CoV-2, deserves a response.


Claim #1: Never Gonna Give You Up

It’s hard to know to whom exactly this promise is being made. This was originally written in 1987, and Mr. Astley did not meet his wife, film producer Lene Bausager, until the song was already incredibly popular in 1988. Though I don’t have specific information on his personal life beforehand, it is reasonable to conclude that he did in fact ‘give up’ any former paramours prior to their relationship becoming serious.


Claim #2: Never Gonna Let You Down

The website KnowYourMeme defines the Rickrolling internet phenomenon as:

“A bait-and-switch prank that involves posting a hyperlink that is supposedly relevant to the topic at hand in an online discussion, but re-directs the viewer to the music video of “Never Gonna Give You Up,” a 1987 dance pop single by English singer-songwriter Rick Astley.”

With this working definition, the song Never Gonna Give You Up has itself ‘let people down’ millions of times, as they click on a link to an article, resource, or opinion piece they believe will be relevant or useful and instead are directed to the video, enjoyable as it is. Though Mr. Astley could not possibly have known this in 1987 when he first recorded the single, “never gonna let you down” has nevertheless proven to be a wildly inaccurate statement since.


Claim #3 Never Gonna Run Around and Desert You

While I cannot comment on Mr. Astley’s exercise habits, it is a well known fact that he left producers Stock Aitken Waterman shortly after his first World Tour in 1989. This was largely due to negative press associated with the production company, and in fairness to Mr. Astley may have been a very warranted decision. While it is difficult to assess in retrospect, and from such as distance, whether such a decision could be considered a ‘desertion’, it is at least evident that claims of never leaving are a misrepresentation of the options he considered as viable pathways for the future.


Claim #4 Never Gonna Tell a Lie

Notwithstanding the above claims, I cannot specifically note any instance of Mr. Astley’s having been known to lie. However, I believe it is a truism that all of us have been prone to resorting to untruths on occasion, sometimes justifiable and sometimes not. To claim that he would never tell a lie seems at best lyrical hyperbole (all too common in this era of imprecise musical lyrics) and at worst demonstrates poor introspection regarding his own personal standards of veracity, which even if superior could not be expected to be actually perfect.


Claim #5 Never Gonna Say Goodbye

Mr. Astley actually says “Goodbye” no fewer than 5 times in this song alone.


“A full commitment’s what I’m thinking of, you wouldn’t get this from any other guy.”

This has always struck me as one of the most absurd claims of this misinformation video, and there is solid empirical evidence that Mr. Astley is here mischaracterizing the level of commitment of other guys. As this article from Psychology Today examines in detail, data from Pew Research Center indicates that levels of desired relationship commitment in men, include levels of ‘full commitment’, differ very little from that in women. According to the author,

83 percent of men and 88 percent of women report being “completely” or “very” committed to their partner. Even in the early twenties, well before the average age of marriage, men (and women) report high levels of commitment and often anticipate lifelong unions. 

Elizabeth Aura McClintock Ph.D.

This evidence would suggest that, barring unknown or unusual circumstances, it would be inaccurate (and bordering on emotional manipulation) for Mr. Astley to suggest that no other guy would be interested in a full commitment to the intended recipient of his addresses.

The Paradoxes of PlanDemic


Final Thoughts

I know this seems like a strange place to add my final thoughts (one might have expected them somewhere near… the end), but I want to honor the long tradition of TL;DR that has come before me. PlanDemic has been a fairly unique experience among COVID-19 misinformation videos so far. The production quality is much higher and the narrative, tied to the experiences (questionable though their veracity may be) of an individual scientist, is gripping. The story telling here is far, far better than any of the webcam style videos we have looked at so far, or even the interviews of Dr. Erickson or Dr. Ayyadurai. It’s actually hard to know how to categorize this video; is it an anti-Medicine conspiracy video capitalizing on COVID-19 fears and controversies, or is it a COVID-19 medical misinformation video set in a conspiracy theory narrative? Probably both, but I lean toward the former because while the conspiracy theory is well established and consistent, a brief version of the story Dr. Mikovits has been giving as her own interpretation of the events of her arrest and discreditation for years, the actual arguments surrounding the COVID-19 pandemic are piecemeal and self-contradictory, pulling from any and all vogue COVID-19 misinformation sources rather than forming any new or unified thesis. Still, given the popularity of this video, I will not be surprised if we begin to see more and more of these high production quality misinformation/conspiracy theory pieces; it seems to be an effective amalgamation.

I hope my reflections below prove helpful. My hope is that even if you do not have time to read this entire post (and I can’t blame you there; I don’t have time to read it either), you will be able to navigate to the analyses of one or two of the points from the video that you have particular questions about. If I don’t cover the points you are particularly interested in, feel free to comment below; or better yet, keep digging- I’m sure someone else has done a more thorough debunking on that point than I would have anyway. Thank you to those who have found this analysis relevant enough to share with friends and loved ones who are convinced by or sympathetic to the PlanDemic film; I hope that this information, combined with their affection and trust for you, is enough to open their eyes to the falsehoods being shared so widely, and to convince them to continue exercising caution against this terrible virus.


The link to the video that I originally shared is dead. It is still easy enough to find if you really want to watch it.

First Impression: The production quality here is going to be awesome. (00:04)


Learn about your sources before watching, and then watch critically. (00:10)

This is just good general advice; we trust far too much to our gut feelings (read: confirmation bias) when trying to decide on the veracity of new information. When I wrote about navigating medical misinformation during the pandemic, the first piece of advice I gave was to know your source. I would never argue that arguments can be discounted because of the source; but knowing something about the source is incredibly useful when engaging internally with the arguments, especially when choosing what degree of scrutiny to apply to them. This is especially true with a video like this one. The excellent production quality, the artistic filming and intentional choice of background music, the cinematography and editing, all of it is designed to be emotive and to render the content convincing. That’s not a bad thing; they want you to believe their message, presumably because they strongly believe it themselves. But when all of these features have the net effect of lending credibility to the speakers in the video, we may find ourselves attributing to them a certain expertise or background that may or may not fit. Knowing where they are coming from, who they are, and what they stand for before the emotive music begins gives you some context for weighing their claims outside of how those claims make you feel, or how much you would like to believe them.

By the way, this is the same advice I would give to someone visiting a church for the first time; don’t rely on your gut feeling as a guide to truth; emotive music and a well crafted stage presence can be incredibly convincing.

With that in mind, here are a few links to the main people involved in the video:


Dr. Judy Mikovits is a former researcher who holds a PhD in Biochemistry and Molecular Biology from George Washington University. She published a since-retracted study in Science in 2009 that eventually lead to the legal action she discusses in the video. You can read more about her on her wikipedia page or on the blog Retraction Watch, if it is ever back up again (I believe the viral video has crashed the site multiple times). Since then she is mainly known as a frequent speaker at anti-vaccine events.

Mikki Willis is founder of Elevate, the production company that released the documentary. Their prior work tends to be focused on spiritual energy and positive vibrations (they have a short video talking about restoring your frequency to protect against COVID-19), but this seems to be their first foray into medical misinformation viral videos. You can check out his facebook page here. Before this I believe their biggest documentary was Neurons to Nirvana: Understanding Psychedelic Medicines. Also, as someone who has been interested in televangelists and pseudo-christian faith healers for years, he strikes me as the non-religious, spiritualist version of the young, good looking charismatic faith leader.


The Minions of Big Pharma (O0:38)

This is my first red flag in the video. “For exposing their deadly secrets, the Minions of Big Pharma waged war on Dr. Mikovits, destroying her good name, career, and personal life.” Now, “Minions of Big Pharma” may mean a lot of things; he might be referring to actual lawyers who work for pharmaceutical companies, or to all pharmaceutical employees (although it’s hard to see how drug reps could ruin her personal life), or to some other group altogether. But in the alternative health world this typically refers to doctors and scientists (nurses are generally excluded because as a society we actually like them, so it’s dangerous to the alt-health narrative to loop them in on conspiracy theories)(oh, and happy Nurses Week to my brilliant and beautiful wife!).

Now, I can’t comment much on Scientists working in the lab, since that hasn’t been a major part of my life, but I pretty strongly suspect that they have little to no interest in ruining anyone’s career (and if stereotypes are anything to go off of the only personal lives they are ruining are their own! Bazinga!). I know scientists who have worked for Universities and for major corporations and their main interest has been, unsurprisingly, Science. They love talking about their experiments and research, and their ideas about what might happened next with their project. Remember that these are not nameless and faceless people doing experiments in some hidden lab; these are often the sciency kids that you went to high school with who genuinely loved experiment day in Chemistry class and who were probably reading Lord of the Rings before it was cool. And it’s these science nerds, according to this video, that have now all been recruited into a world wide conspiracy. Tony Fauci calls up one of them and says, ‘we need to discredit a virologist because we don’t like her conclusions about retroviruses; publish a fake study that says she’s wrong.’ It’s really, really far fetched. In fact, if you want evidence of the standards of veracity that scientists generally hold each other’s research to, look no further than Dr. Mikovits’s retracted paper in Science, which was retracted not because she was rocking some boat or bucking some system, but because the methodology was flawed and the results were not reproducible. If you’ve forgotten everything else about those Science Fair geeks from high school, remember this; we loved proving people wrong. The peer review process capitalizes on that, and the conspiracy that there’s a top-down cabal determining what gets published and what doesn’t ignores that one overarching character flaw.

What I can tell you, with no shadow of a doubt, is that your doctor doesn’t work for Big Pharma. In fact, the relationship between your average Physician and the drug reps they interact with range from the politely tolerant to the openly antagonistic.

Though there are beautiful exceptions.

And this is the case for any part of the medical industry that is primarily profit driven, whether it’s the pharmaceutical companies, fly-by-night medical supply companies, pharmacies, or the insurance companies. Because Physicians are not primarily profit driven; we are driven by a desire to help people. We are driven by a desire to help people so much that it is dangerously cliche to even say so on a medical school admissions essay. We’ve taken on hundreds of thousands of dollars in debt, sacrificed our 20’s and 30’s, and worked thousands of hours of unpaid overtime in order to learn the science and the clinical skills that we need in order to do the grueling work of helping people heal physically, emotionally, and psychologically, and there are just much, much easier ways to make money.

So that creates conflict. Conflict ranging from an annoyed ‘I don’t think that’s accurate’ to a pushy drug-rep overselling the latest product, to absolute rage when the price of a life-saving medication skyrockets for artificial reasons and my patients suddenly have to go without. But while we generally regard for-profit pharmaceutical and insurance companies to be side effects of a deeply broken healthcare system, they are still fixtures that we have to work with; and I guess that looks a lot like collusion to the outside world. Once you’ve bought into the myth that those with the most money universally control the people they interact with and endure no dissent, it’s easy to see conspiracies everywhere; of course the scientists are told what results to report, look who signs the checks. Of course the doctors prescribe what they’re told, their education is controlled by big pharma.

But might I submit that maybe ancient, altruistic, and (let’s face it) fairly egotistical professions don’t just roll over quite so easily? That maybe high standards of truth telling and care for the wellness and suffering of human beings are still the honored core of both the clinical and research branches of Medicine? In fact, I don’t think it’s a stretch to say that, to whatever degree drug or insurance companies really have wanted something like autonomous control over healthcare, it has largely been conscientious Physicians who have fought them.

But you don’t get to see those types of interactions that often at your doctors office, and this leads to a lot of pretty demoralizing misunderstandings; for instance when a patient’s medication should be $5 and they end up paying $50 at their pharmacy and think that I prescribed a more expensive medication because I’m getting a cut (this is why I now say to each patient at the end of each visit where I’ve prescribed a medication, “if you get to the pharmacy and any of your medicines are more expensive than you expected, please don’t buy it yet and give us a call instead”). It also means that when it comes to profits being put above people, we’ve probably just about seen it all, and fought against it all. So when even we have to say, yeah this looks like some pretty crazy conspiracy theory stuff, you need to understand it’s coming not from “Big Pharma’s” willing subordinates, but some of it’s most diligent and ferocious watchdogs.

Tell me ZDoggMD is in the pocket of Big Pharma. I’ll Wait.

“The plague of corruption that places all human life in danger.” (00:54)

I think the narrator is just waxing eloquent here, setting us up to understand that the medical field is the real plague or something like that (and if so it’s a good bit of work), but I’ll at least give the video the credit of seeming to take COVID-19 very seriously during the first minute. If you turn this off after minute one, you will at least leave with the idea that 1. there is a plague, 2. human lives are in danger, and 3. it’s a big enough problem that the fate of nations hangs in the balance. That plus the excellent production quality may go a long way towards fighting some of the ‘less dangerous than the flu’ misinformation that is out there already. Way to go, Elevate!


Minute 1 to Minute 10

The bulk of the first 10 minutes of the documentary are spent on Dr. Mikovits’s personal history of maltreatment by the health industry/scientific community. I think people should be able to tell their stories from their perspectives, and I have no doubt that the demolition of her career has been a very difficult experience for her regardless of the circumstances that caused it. Still, it is important to remember that most stories have at least two sides that have to be considered, and other interpretations of those events are available widely on the internet. It’s a very dramatic story and someone other than me will need to dissect it. I will return to this section with a few observations once I have finished the analysis of the rest of the video, but for now my most immediate concerns are the statements related to COVID-19.

Update: Having finally finished this blog post 3 days later, I have had time to read through other articles and watch other videos debunking the claims of PlanDemic. Many do it much better than I can. A great many have focused specifically on the first 10 minutes of the video, and investigating the claims that Dr. Mikovits makes regarding her own history and the conspiracy against her; many have already been familiar with this history and her work in the anti-vaccine movement prior to PlanDemic. I will defer to them. Certainly I have no first hand knowledge of the events and no background in investigative journalism. If you are watching the video, there are 3 things I would point out in this section that I think should at least increase your level of suspicion that you are watching conspiracy theorist/misinformation propaganda. 1. When Dr. Mikovits is talking about her arrest (the video leaves you to assume it was a 5 year imprisonment; it was actually 5 days), they show presumably unrelated footage of SWAT teams and urban tanks in order to inspire fear. 2. The clear implication, towards the end of this section, is that Dr. Mikovits might be assassinated for doing this interview. The credulity people have towards this claim has been amazing, with so many comments along the lines of ‘this woman needs protection now’. Yet, is there any basis for believing that there has been or will be an attempt on her life? And for what? Sharing information about the COVID-19 pandemic that is almost entirely verifiably false? 3. Dr. Mikovits has a book out. I don’t think that this is her primary purpose in giving her interview, and my understanding is that she has been involved in trying to clear her name and garner support against the scientific establishment for years. But so far, financial motivations being tied to viral misinformation videos has been batting a thousand during this pandemic.

A friend on Facebook, supporting Dr. Mikovits’s video.
A commenter, accidentally giving a better rebuttal than anything I could ever come up with.

Is this an anti-vax video? (9:48)

Dr. Judy Mikovits: “And they will kill millions as they already have with their vaccines.”

Mikki Willis: “So I have to ask you, are you anti-vaccine?”

Dr. Judy Mikovits: “Oh absolutely not!”

‘But see, she’s not anti-vaccine! This is totally mainstream stuff, not anti-vax propaganda at all!’

Rest assured that many people in both alternative health and the anti-vaccine movement see the pandemic as an opportunity to anchor their products and agendas more firmly in the mainstream. While this is often for financial profit or accumulation of power and influence (as has been the case with every single misinformation purveyor we’ve addressed on the blog so far), I still believe that here are many honest people who earnestly believe in these ideas, and merely have their facts and narratives skewed concerning vaccines specifically and the medical field in general. I know and really like some of them. In fact, a lot of friends whom you might call ‘vaccine wary’, medically suspicious, or crunchy and oily (their words!) have been incredibly supportive of me personally and other healthcare workers during this pandemic. They have struck a balance they are personally comfortable with that allows questioning their Physicians and arriving at different conclusions (which is a good thing in general) and still recognizing a bedrock of reliable truth telling regarding danger, disease, and treatment. I think all of us are looking forward to the day when we can just get back to arguing about tea tree oil in your belly button again (or was it thieves?), but with a real crisis like COVID-19 there is no question that we are all on the same side.

The problem is that as a counter-culture, these movements have overall tended to have a very low threshold for whom to trust, assigning credibility and reliability to almost anyone who is comfortable using the same verbiage and demonizing modern medicine. This means that while many people have found a balance that remains very safe for their families, many others who begin as simply cautious of certain chemicals or treatments (as likely as not because their doctor didn’t/couldn’t take the time to explain it to them very well) become entrenched in increasing (and increasingly dangerous) depths of falsehood. For some, this video, with it’s emotive music and deep state conspiracy theory, will be their next step. The leaders of these movements know this and see dollar signs, potential converts, or both; and the pandemic is a golden opportunity for them because we are all looking for answers. I’ve seen the fallout from this on the individual level in my own experiences caring for adults and children, and on a larger scale with measles and pertussis outbreaks that were totally avoidable. My fear is that, with something as dangerous as COVID-19, the suffering that occurs for the people believing these conspiracies could be the worst and most widespread yet.


Just past the ten minute mark, we finally get into a discussion of COVID-19.

Do you think this virus came from a lab? (10:21)

Dr. Mikovits is making claims that come off as extremely authoritative, but which nobody actually knows the answers to. Labs that have sequenced the genome of SARS-CoV-2 have said it appears to be a naturally occurring virus strain, but the idea of zoonotic transmission from meat sold in an open air market in Wuhan has seemed extremely speculative from the beginning. BBC has a good article discussing the difficulties in sorting through the origins of the virus. As a Physician my main concern is with the viral syndrome that it causes, not where it came from; but the idea of it being involved in any way with a research lab is extremely appealing to conspiracy theorists that would like this to be a Dr. Evil style attempt to conquer mankind.

But look what Dr. Mikovits is actually saying here; she doesn’t think this is a bioterrorism weapon that was designed or engineered, but that doesn’t matter because “You can’t say naturally occurring if it came by way of a laboratory.” Um… Why not? A few moments later she says ‘studied in a laboratory’ like it’s damning evidence. But the thing is… laboratories are exactly where you study things. She’s done a fair bit of it herself in the past. I spent a Summer studying Passalidae Beetles in a laboratory and they are pretty naturally occurring.

The REAL super-bug (and an important forest decomposer!)

What they are saying here, really, is that the origin of the virus doesn’t matter for their purposes; whether it had been engineered as a weapon, whether it was accidentally released from a lab, or whether it just happened to be transmitted from an animal that was being studied in a lab. What matters is the word “laboratory”, because with the degree of fear and paranoia about scientific processes already experienced by many of their target audience, combined with anxiety about the pandemic, that is enough to score points as one more piece of evidence of a global conspiracy.

Finally, at the end of this section Dr. Mikovits claims that SARS-CoV-2 must have undergone “accelerated viral evolution” because if it were naturally occurring, it would take 800 years to develop from SARS. First of all, that’s a pretty specific time frame without any further explanation, so I’m going to call ‘citation needed’ on this one. But the biggest problem with that claim is… Nobody thinks it evolved from SARS in the first place. There are a lot of Coronavirus species, and we don’t yet know (and may never know) the evolutionary history of this dangerous, novel virus. It is called ‘SARS-CoV-2’ because it is a Coronavirus (CoV) that causes Severe Acute Respiratory Syndrome (SARS), and it is the 2nd one identified that does this (because MERS is the Rodney Dangerfield of Coronaviruses; it gets no respect).


Ebola couldn’t infect humans until Dr. Mikovits taught it to in 1999. (12:04)

The first major known outbreaks of Ebola occurred in 1976, 23 years before Dr. Mikovits taught it how to infect humans. So this is pretty nonsensical. The CDC has a good article on the history of Ebola Virus, but I suppose if you have chosen to believe the claims in this video you will probably see this as propaganda? The conspiracy theorist world is a much more interesting world, when even fairly blandly written (though quite interesting, to me at least) and well hidden disease history pages on government websites are all deliberate and carefully crafted deceptions.

But if course, she’s not talking about Ebola virus here, not really; the implication of the video is that somebody had to teach the COVID-19 virus how to infect humans. Add this to the list of claims in the video that have zero empirical support, but that devotees will come away 100% believing.


The COVID-19 death toll is inflated (12:22)

The tabulating of deaths from COVID-19 has been written about time and again. I wrote about it here a month ago when these conspiracy theories about doctors faking death certificates and being told to call everything COVID-19 were already being circulated. It’s been debunked thoroughly and frequently, and our best guess is that the actual death toll has actually been underestimated. We’ll do a little more debunking here, yes, but honestly it’s getting a bit old.

But the first thing I want to point out is how this video, as a smorgasbord of COVID-19 conspiracy theories, ends up mixing it’s message and contradicting itself time and again. We just spent several minutes focusing on their belief that the virus was created in a lab, that it was intentionally taught to infect human cells, and that it is part of a government plan (I mean, that’s the name of the video, PlanDemic), and now we are talking about how it really isn’t that dangerous. This video would like to have its virus and eat it too; it wants the numbers to be inflated, but it also wants the deadly disease to be an evil plot. Now, you could come up with some scenario that fits both conspiracy theories; the virus was released by Scientists (the minions of Big Pharma) but wasn’t as deadly as they had hoped, so they have had Physicians (the other minions of Big Pharma) inflate the death numbers. Sure, if you add enough layers to your conspiracy theory you can account for apparently contradictory sub-plots; but you also have to involve more and more willing participants in the conspiracy, and at some point you have many millions of people colluding in order to… what? Get some people to take a vaccine? Credulity can only be stretched so far.

The other thing you need to recognize is that Dr. Mikovits is about to step firmly outside of her training and experience, which has nothing to do with clinical medicine. When she speaks about discerning the cause of death, the interaction of chronic diseases with acute infections, and the realities faced by doctors fighting this horrible virus, she is speaking entirely as a layperson.


COPD deaths are being counted as COVID-19 deaths?! (12:49)
  • I am sorry her husband has COPD. That really stinks.
  • COPD (Chronic Obstructive Pulmonary Disease) and Pulmonary Fibrosis are different types of lung damage (maybe her husband has both, which is absolutely possible)…
  • …and neither looks like SARS.

“But he has no evidence of infection”. Well, that’s a really wonderful thing; it’s also an important point on the natural history of COPD. Most COPD patients do not have thickened mucous, extreme shortness of breath, severe dyspnea, and prominent wheezing all the time. When those symptoms occur we call it a COPD Acute Exacerbation. And when you have an exacerbation, it absolutely is a sign of something acute happening, usually a viral or bacterial infection.

(13:10) No they absolutely wouldn’t. If he walked in with no evidence of infection, he shouldn’t be walking in at all; the ER is a dangerous place for him now more than ever. But if he comes in with acute worsening of his pulmonary symptoms, the worst COPD exacerbation he has had in his life, requiring high levels of oxygen and even intubation and ventilator support, with exposures to the COVID-19 virus or symptoms consistent with the disease in an endemic area, are you really saying that politically motivated incredulity about the virus’s infectivity and lethality trumps the doctor’s diagnostic skills? The thing they have been working their entire lives to develop?

My friend and classmate, and ER doc in New York, on the shortage of tests.

The Doctors are telling us the numbers are inflated. (13:15)

I know hundreds of doctors personally, maybe thousands, and have read or heard from even more. Some of them work in the front lines in places like New York that have been hit hardest (so far) by the pandemic. Throughout this crisis I have reconnected with classmates and friends I hadn’t talked to in years to touch base on how this whole thing is going for them, how they are holding up. None of us are being told to fudge numbers. Even if we were being told to, we wouldn’t. There are over a million doctors in the USA and I am convinced that almost every single one of them would blow the whistle and be on youtube tomorrow if the government was asking them to artificially inflate numbers or lie on death certs. This is ridiculous.

My ER Doctor Friend in New York, battling COVID-19 daily

But more to the point, the guidance that has come from the CDC has actually been really reasonable. Even the images shown in the video, which are supposed to be some sort of damning evidence, are reasonable:

What this is saying is that if it walks like a duck and quacks like a duck, but the COVID-19 test is negative or not available, it’s still reasonable for a Physician to rely on their clinical judgement to determine the diagnosis. This is the opposite of a top-down mandate, and more to the point, it’s already how we practice medicine anyway. If you have a sore throat, fever, red and swollen tonsils, and your son had strep, I don’t test you for strep throat, I treat you for it; you have it, regardless of what the test says. And that test has a much higher degree of reliability than the SARS-CoV-2 antigen test. If you have symptoms of the flu, and it’s flu season, I only test if it would actually help me make a treatment decision, which is fairly rare; the sensitivity of the test is only 50% to 70%, which means that up to half the time you have the flu your test is going to be negative. It’s too early to know exactly what the sensitivity of the COVID-19 test is, but early reports said somewhere around 70%; so doctors very wisely chose not to defer their clinical decision making to a test result.

Finally, there’s the case the doctor in the video discusses around the 13:40 mark: the 86 year old patient who dies from pneumonia, who wasn’t tested for COVID19, but her son later tested positive for the virus. The doctor asks, incredulously, whether it would be reasonable to list COVID-19 as a possible cause of death?

Every practicing clinician: Um, yeah, it would. In fact, these are the exact people we know are most susceptible to the virus, and the ones we are working our butts off to protect. Most of my 86 year old patients treat me like a grandson; we are treating this virus like it can kill them because it can.

13:50: Dr. Erickson owns Urgent Care Centers in a low-prevalence country in California. He is not being pressured to write COVID-19 on anything, and if he’s writing death certificates with any degree of frequency that is a big, big problem. He would like this pandemic to be not that big of a deal just like the rest of us, only in his case, it’s at least partially because his Urgent Care business is suffering right now. (Update: He has also released a statement saying he has no association with the PlanDemic video).


“You don’t die with an infection, you die from an infection.” (14:38)

While this is not technically true (people die with infections all the time. You can get hit by a bus on the way back from your abscess drainage), I actually completely agree with Dr. Mikovits here. This is the inverse of the common saying for Prostate Cancer, “most people die with prostate cancer, not from prostate cancer.” It’s a common form of cancer that grows slowly and often near the end of life; most people with it will die from something else. Contrast this to COVID-19, which is an incredibly dangerous virus that has killed 75,000 people as of today in the US alone, and even if you don’t believe those numbers has overwhelmed healthcare infrastructures, exhausted doctors and nurses (and driven some to take their own lives), and decimated entire countries. This is a dangerous virus. It increases risk of blood clots, it seems to be causing strokes, it shuts down the lungs; the idea that people are suddenly dying in large numbers from these types of syndromes and their having the virus is just a coincidence is insane. You die from the virus; not with it.

The numbers have to match the real-life narratives, but by avoiding any discussion of the experiences of doctors, nurses, patients, and families that have been affected by the virus, the misinformation promoters hope to bypass your compassion and even your sense of rational self-preservation and deeply ingrain the idea that the virus isn’t dangerous with fake numbers and false dichotomies between acute infection and chronic disease. If they are successful, then you will be automatically suspicious of any images, narratives, or personal accounts you hear that paint a picture of a deadly virus causing real human suffering. The word ‘trauma actors’ is not far off. Don’t let them rob you of your empathy for their own personal gain.


Doctors are being incentivized to list COVID-19 (14:44)

Check-out this article from PolitiFact that covers this question in some detail. Yes, part of the CARES act was to provide a 20% stipend for treatment of COVID-19 cases. This is being done because hospitals that are hardest hit by the pandemic are also the ones that are going to have trouble staying afloat; they will be cancelling elective cases and other more profitable treatments for longer and focusing entirely on COVID-19, often in the midst of needing to pay nurses and doctors overtime, hire outside help, and wildly exceed their budgets for PPE and supplies. Now, we can talk about whether or not I think hospitals being for-profit is a good model in the first place (hint: I don’t), but the idea that a bipartisan government stimulus for hospitals in the hardest hit epicenters of the pandemic automatically equals corruption and conspiracy is awfully flimsy.

But more importantly, I want you to watch the way the video, with it’s excellent background music and high production standards, weaves this part of the narrative. Go back and watch the 15 seconds from 15:00 to 15:15 and notice the way that the words “you’ll get paid $13,000” and “if that COVID-19 patient goes on a ventilator you’ll get $39,000” are overlaid against medical professionals, in PPE, treating patients in the ICU. Look at all of these doctors just waiting to cash their $39,000 checks from medicare, the video is telling you. The reality is that decisions about diagnosis and decisions about treatment are made by Physicians, who are not paid $13,000 for a certain diagnosis or $39,000 for initiating life-saving treatment. Depending on the way their compensation agreement is structured, they may or may not see any of that additional money (I certainly won’t should we get hit hard here in Waco and I have to admit COVID-19 patients or intubate the critically ill).

Also listen to Mikki Willis’s statement right at the beginning of the segment; “I’ve spoken with doctors who have admitted that they are being incentivized…” This is the verbal equivalent of the above cinematography trick, and is the type of sentence you can utter with impunity because there are so many doctors it would be impossible to prove he hadn’t talked with doctors who said this. But notice how doctors are only a reliable source of truth telling if they are blowing the whistle on some big conspiracy, and not when they are saying, en masse, ‘this virus is dangerous. we are doing the best we can to take care of patients but please stay home. there’s no conspiracy here, just a really, really bad bug.”


The ventilators are what’s killing patients! (15:15)

I’d like you to understand that Dr. Mikovits, who is a PhD virologist and not a medical doctor, is here repeating what she has heard or read and is not speaking as an expert by any means. I’ve had a friend write to me extensively about how dangerous ventilators are. I’ve seen videos and articles and facebook posts saying “88% of people who go on ventilators die”, as though that were proof that ventilators were dangerous, instead of that the virus is dangerous. (here is an article working through those ventilator numbers, by the way). You see, we only intubate the sickest patients, so they already have the highest chance of dying. There’s a confounding variable, and it’s called severe respiratory distress.

Now, I do think there is a discussion to be had here in terms of the best use of our ventilators. The myth here seems to be, as best as I can understand it, that “ventilators” are a discrete treatment the way “ibuprofen” or “knee injections” are discrete treatments; either you do a knee injection or you don’t (ok that’s also not accurate), either you give ibuprofen or you don’t. But ventilators are incredibly complex tools and their use is not monolithic. Here is a very basic but extremely helpful (at least to someone like me who doesn’t use a ventilator on a daily basis) guide to vent strategies from some people I admire over at EmCrit. Did you read it? You got all of that? This is the tip of the iceberg. Even the clip that PlanDemic shows at 15:18 is an ER doctor from New York early in the course of the pandemic arguing for a different ventilator strategy, not against the use of ventilators. His name is Dr. Cameron Kyle-Sidell, and he goes on to say:

Now, I don’t know the final answer to this disease. I do sense that we will have to use ventilators. We’ll have to use a great number of ventilators, and we need a great number of ventilators,  but I sense that we can use them in a much safer way, in a much safer method.

So they’ve shown this clip to make you think, doctors are using ventilators because they get paid more money, even though it kills people, but a few doctors like this one are speaking out against this corruption. The real narrative behind this clip is a lot more reasonable and a lot more hopeful, and it’s this: doctors are trying to fight this new virus with the best tools they have, and impassioned discussions and debates about how to use those tools well are already happening. I am a part of a number of Physician COVID-19 groups on facebook, and both there and in private conversations and discussions within my own clinic system, every aspect of when and how to use ventilators to support COVID-19 patients is being dissected and discussed. It’s a good thing that we know more than we did a month ago, and the more we can delay the spread of this virus, the more we will know when it finally hits your area.

But let me make one thing abundantly clear; this is not a choice between using a ventilator and making more money, and not using one so the patient can get better; that is a false narrative and, frankly, on the grossly cynical side even for the conspiracy theory people. When you intubate a severely hypoxic patient, having tried everything else you know of to keep them off the ventilator, your decision is to use a ventilator or watch them slowly die gasping for air. Unless you’ve been in that situation, your theories on doctors putting patients on ventilators because they were told to or are thinking about their next paycheck don’t carry much weight with me.

And let me just state, for the record, that if you suspect a doctor at your hospital is putting people on ventilators or doing any procedure in order to make more money, you should report that person right away. That’s what I did the one time in my education or career I thought I had seen it happen. And if you believe it’s happening on a large scale, that doctors all over the country are doing it, please start thinking now about what you will do when your child or loved one becomes terribly ill at some point in your life, because if you have that little faith in the good intentions and integrity and medical knowledge of doctors and nurses, I cannot imagine why you would ever come to a hospital (though I honestly hope you do, because I believe we’d have the best chance of helping them, even if you don’t right now).


What about Italy? (15:35)

I just want to say that as little as I’ve found in this video to agree with, I really respect even the willingness to address the parts of the Pandemic that simply can’t fit it into their narratives (ok, I’ve actually found nothing to agree with; but there is at least plenty I can’t comment on. For instance, I can’t say whether or not someone planted evidence in her house before she was arrested).

When the Bakersfield Doctors, misled by their shoddy statistics, concluded that the virus wasn’t at all dangerous, they simply hand-waved New York and Italy as ‘hotbeds’ and moved along; it didn’t fit their narrative and so they didn’t even make a show of trying to explain how a non-dangerous virus could cause such catastrophic damage. The narrative here is infinitely more interesting.

Reason #1 is good; Dr. Mikovits says that Italy “has an older population, and they are very sick with inflammatory disorders.” Now, I don’t have any data on whether Italy has a higher rate of autoimmune disease, which I believe is what she means by inflammatory disorders; but I think we can accept the idea that older populations with more chronic illnesses are going to be at higher risk for complications, including death, from COVID-19. That is very consistent with the data we have seen throughout the pandemic. I would also point out that Italy is not alone in having an older population; many US States have similar demographics. 22.8% of Italy’s population is older than 65; but so is 20.6% of Maine, 20.5% of Florida, and 19.9% of West Virginia. If Italy can experience a surge of cases bad enough to overwhelm their healthcare infrastructure, there is nothing to prevent it from happening here. And of course, age isn’t the only factor; it has happened in New York, and only 16.4% of their population is greater than 65 years old. But the point is, saying ‘Italy is old’ doesn’t explain how a non-dangerous virus can kill so many.

But at 15:47 she loses me. Her claim is that in 2019 Italy had a new, “untested” form of Flu vaccine, and that this explains Italy’s high COVID-19 burden. She says the vaccine was grown in a dog cell line, and that ‘dogs have lots of coronaviruses.’

So, does that even make sense? Well, someone will have to tell me whether the flu vaccine used in Italy last year was new in the sense of being designed or developed differently from flu vaccines used in prior years or in other countries (in another sense, the flu vaccine is new every year because epidemiologists have to decide which flu strains to include based on which are most likely to become endemic). By the way, Italy had a particularly light flu season; so if it was new it may be a really good vaccine. However, the mechanism she is describing isn’t logical. First of all, the flu vaccine they use in Italy includes only killed viruses; your body is exposed to the antigens and can mount an immune response, but the virus cannot ‘come to life’ and cause the flu (or any other ‘inflammatory reaction’ she is hinting at here). The antigens of the dead virus are picked up by circulating white blood cells and presented to the immune system, so that the next time the body sees the virus it has the ability to rapidly produce a robust antibody response, usually before a person is even symptomatic (it does not work by creating a magic forcefield around your body that flu germs bounce off of).

Glad I got that flu shot

But the trick is preserving the dead flu proteins without eradicating them completely. The idea that Coronaviruses have somehow come from a cell line used to develop the vaccine, have survived the process of creating the vaccine (all of the ‘harsh chemicals and toxins’ we are always hearing about), and have tagged along and actually entered the person’s body through the flu shot is nonsensical. Even if that were true (it’s not), she gives no clear mechanism by which that would have literally anything to do with COVID-19. Remember, Coronaviruses are a big, big family of viruses, and exposure to one would at worst have nothing to do with infection by another, and at best give some degree of cross-reactive humoral immunity, which sadly does not seem to be the case for COVID-19. Really, ‘dogs have lots of coronaviruses’ is little more than word association.

But the title of this article is “The Paradoxes of PlanDemic”, and here is another one. Just 5 minutes ago Dr. Mikovits told us that the COVID-19 virus, SARS-CoV-2, was created in a lab in Wuhan China, and was accelerated and manipulated in bats. So what would a flu vaccine in Italy, created in a dog cell line, have to do with COVID-19? There isn’t even a theoretical mechanism here; just the hope that by saying flu vaccine and Coronavirus close enough together in the video, their viewers will believe that the 30,000 deaths in Italy are actually another crime of the scientific community, instead of a stark warning of how bad this pandemic can become.


At this time the video has been removed from YouTube, Facebook, and Vimeo, the three sources I had used to view it while writing this post. I have mixed feelings about this. I don’t believe in censorship in general, but I also worry about allowing verifiably false propaganda to deceive millions in the name of freedom of speech, and the real human suffering that could occur if these videos were spread unchecked. I am a Physician, and it’s probably more a question for a philosopher or at least a constitutional scholar.

That said, if you do have a source for the video, feel free to send it my way via the “contact” page. Otherwise, the rest of my comments will be given without any time-stamp or specific quotes, though I have viewed the video in it’s entirety prior to now.


Hydroxychloroquine is a miracle drug, which is why they won’t let us use it.

I remember back in March (oh those carefree days, where have they gone?) when an OB/GYN I know, a friend from undergrad, first shared the French study showing promising results in COVID-19 patients treated with hydroxychloroquine, an immunomodulator we use mainly for Lupus, and azithromycin, an antibiotic (but you already knew that because they give it to you every single time you go to an urgent care…). At the time the responses of the clinicians I know ranged from cautiously hopeful to very skeptical. Hydroxychloroquine and azithromycin are not anti-viral drugs, some argued, and the study was so small that the results shouldn’t change our practice. Others argued that both medicines have some theoretical anti-viral properties, so even though they are not anti-virals per se there is at least a reasonable mechanism of action in play. For azithromycin, this involves anti-viral effects on the epithelial cells of the lungs; for hydroxychloroquine, prevention of viral entry into the cytoplasm of host cells.

Since this wasn’t a large randomized double-blind placebo controlled trial, this small article coming from France hardly constituted a gold standard of treatment; but since the medications were fairly safe and somewhat promising, and since it is the middle of a global pandemic, many doctors and hospitals began to use one or both. There were even some promising, but ultimately anecdotal results. Locally we used hydroxychloroquine but not azithromycin, generally, because of the concern that the combination of both could cause prolonged QT syndrome (which can, you know, kill you). Here is the very measured guidance from a field guide a friend sent me:

As far as I know, each hospital and Physician had to weigh this evidence for themselves. The FDA did release an emergency approval for hydroxychloroquine for COVID-19, and at no point were doctors told we weren’t allowed to use it, unless this came from their own clinics, hospitals, or medical societies; certainly I’ve never heard of any of the ‘doctors being threatened if they use hydroxychloroquine’ that they mention in the video. Unfortunately, subsequent larger and more intentionally designed trials have not shown a benefit; not to fault the French trial, they were trying to save lives and were publishing the modest but promising results they had so far, not trying to empirically prove the efficacy of the medicine. Here is an article from the New England Journal of Medicine that explains this all in greater detail, and the rationale by which the authors chose to stop using the medicine to fight COVID-19.

So that’s the story of hydroxychloroquine, and it’s hard to imagine how anyone could think there was any conspiracy behind that pretty straightforward sequence of events. Really, that’s how these things are supposed to work; if the treatment is safe and cheap and seems to help, it’s reasonable to use it while you are waiting for more reliable data. If that data then shows that the benefit just really isn’t there, you stop using it. When the president touted the drug as being promising, it was with his usual bravado but to some degree reflected the hope many of us felt about it at the time; when Dr. Fauci advised caution and stated the evidence was anecdotal, he was right, and was saying exactly what your local Physician might say at that point if she had been reading up on it. I don’t know anything about the doc yelling in the clip they showed, but unless he was actually treating COVID-19 patients and had some really excellent anecdotal results, I really can’t understand the vehemence he felt about the medicine; it hasn’t been warranted at any point by the evidence.

But before we move on, there’s one more thing I wanted to mention (and here is where I feel most keenly the loss of the video itself), and it’s that the idea of anyone in the healthcare industry actually trying to block doctors from using a medication because it is working is obscene in the highest degree. I’ve seen enough corporate espionage movies and read enough Spider-Man 2099 comics to have a healthy suspicion of the big pharmaceutical companies, but I really believe this is beyond even them. But if you wouldn’t put it past them, at least consider this; if the government or big pharma or whoever were really telling doctors they couldn’t use a medicine that the doctors knew was saving lives, how would the doctors react? Would they go along willingly, because their one and only interest is obeying their corporate masters? Would they shrug their shoulders and watch people die who they could have saved?

Would you see just that one angry doctor ranting on YouTube, or hundreds of thousands?

Another Doctor Webb

Wearing masks increases your risk of infection, reactivates your own COVID-19.

To me, this is the strangest claim in the entire video, and it’s hard to understand for a number of reasons. First, how in the world is asking people to wear masks a conspiracy? Many of the masks we give to patients even in our own clinic are homemade, so it can’t possibly be Big Mask trying to turn a profit. I know many people chafe under any sense of the government trying to control them; but does this actually count, asking us to wear masks in public, that we’ve either made ourselves or gotten for free at our doctor’s office, to keep ourselves and especially others from getting sick? I don’t like wearing masks much either (unless it’s for Comic-Con), but it always strikes me as a particularly troublesome part of our highly individualistic culture that we oppose on principle so much that we ought to do voluntarily the moment there is even a hint of it being mandatory, particularly acts of charity (financial and otherwise) toward our neighbors. Remember, you don’t wear a mask for yourself; you are wearing it to prevent transmission if you have SARS-CoV-2 and are asymptomatic, to keep from spreading it to others.

Will protect against certain Psionic attacks; but not against COVID-19

Of course, this demands the question of whether or not wearing these homemade masks actually is an act of charity; that is, if it really does protect our neighbors from the virus. And as easy as it would be to simply say, ‘yes, masks obviously decrease transmission of respiratory viruses by blocking droplets’, the reality is that in science, what feels right or makes sense intuitively isn’t always a reliable guide to what’s true (hence this blog). So the real answer is; yes, they probably help. LiveScience has a good summary of the most current info and recent studies. With promising but limited evidence we have to weigh the risks and benefits. Remember what we said about using hydroxychloroquine earlier; if a treatment is promising, cheap, and safe, it’s reasonable to use while waiting for more data, and the same is true about prevention strategies. In this case, while we may well get more data we will likely never have a definitive answer about the degree of benefit. What would it look like, exactly, to do a large double-blind placebo controlled trial of wearing masks?

But Dr. Webb, you said the masks are only a good idea if they are safe, and the video says they aren’t. There is a very strange claim in the video, The idea that wearing a mask is somehow dangerous. I’d be remiss if I didn’t mention that they are once again contradicting themselves, but this time in rapid fire sequence. They want at once for the masks to be bad because they keep viruses and bacteria out (they show the clip of Dr. Erickson talking about how touching your face and eyes is vital for your immune system, failing utterly to distinguish between a deadly pathogen and mere microbes), and for them to be bad because they expose you to your own microbes. This is not only poor science, it’s also poor debating. To borrow from Scott Adams (Dilbert), it’s like saying Sorry, I never got the message to call you. And when I did return the call, you didn’t answer. One excuse is better than two.

But I think what’s really going on with this claim is two things; an appeal to the deep desire we all have for a sense of normalcy, and an exploitation of the sensationalization of wearing masks. The truth is that wearing masks isn’t new, and we do it all the time anyway. I wear a mask frequently at work because it both protects my patients when I have a cough that might be infectious, and protects me from respiratory organisms. But you wear a mask too. You wear one when you have the flu and don’t want your kids to get sick; people ask me for them all the time when they are at the office. You wear them when you go snow skiing, or when you are around dust, or when you are painting or staining wood or doing projects with strong fumes, or at Halloween. I’ve never heard of anyone, health conspiracy theorist or otherwise, crying out that they were dangerous, that they reactivated your own viruses or starved your brain of oxygen. But now that it’s a matter of admitting how deadly and dangerous this virus can be for the people you are interacting with and following a reasonable recommendation from the government, all of the sudden they are part of a conspiracy, a symbol of oppression?

All of that said, there is one situation where wearing masks really is dangerous, and it’s when people treat them as though they alleviate the need for any other safety measures; as though it made them invincible from the virus. With only limited efficacy at protecting against respiratory viruses, masks are not the ultimate answer to COVID-19, and physical distancing, hand washing, and careful mitigation strategies are still vitally important. But most of us can remember to do those things while still wearing a mask.

Even if it makes you look silly

Healing microbes in the Ocean.

I’m sorry, I’m just totally lost here guys. Maybe she means these?


COVID-19 Deaths from the day PlanDemic was released:

Lies, Damned Lies, and a Few More Statistics – Dr. Erickson and COVID-19, Part 2

Link to Part 1: Dr. Erickson and the 3rd kind of lie (Statistics)

So the video has resurfaced (thank you to all who provided the links), and rather than any “DOCTORS CRUSH COVID-19 CONSPIRACY!” headline, it has been posted with the much more subdued (though still fairly inaccurate) “Doctors report from Front Lines.” The whole point of their video is that they really haven’t been at the front lines because the surge isn’t there yet; but since that is exactly where I find myself as well (albeit gratefully), maybe I shouldn’t put too fine a point on it.

A note on timing: Since the original video on YouTube was removed, I’ll be working off of the video on Facebook here, which is about 12 seconds ahead of the video used in part 1.


In the last post we went through the first 15 minutes or so of Dr. Erickson’s video, addressing the gross errors in his statistics methodology that leads him to the clearly erroneous conclusion that COVID-19 is not very dangerous. For state after state and country after country, he multiplies the total population by the results of non-random testing that is not representative of that population, to arrive at outrageous figures for prevalence (number of cases) of COVID-19. This mathematical trick shrinks the death rate, certainly, but it isn’t founded in reality; these are figures that can only exist in Dr. Erickson’s mind and on his calculator. He does this while ignoring the best data we have available that shows very high case fatality rates for known COVID-19 patients, framing that data as a good thing. “New York has a 92% Recovery Rate! If you get COVID, 92% of you will recover!” This is exactly the same as saying that COVID has an astronomically high 8% case fatality rate, but he has chosen to frame this as a good thing by flipping the statistic.

Now that the video is available again (for better or for worse), we will move on to the other arguments in the video.


9:16 “Is this significantly different than Influenza A and B?”

This is a question I have already addressed here, but frankly it’s absurd to still be comparing COVID-19 to influenza this late in the game. We are less than 2 months in from the first reports of deaths from COVID-19, and already it has killed as many people as the worst flu seasons we have experienced; and most places have not yet experienced a surge in cases. Our comparisons for COVID-19 are the bubonic plague and the Spanish Flu, not seasonal influenza; even in a very bad year like 2017-2018.

Comparisons to the flu do not match the reality of the people facing this virus as patients or healthcare workers, and can only be clung to by those who have not yet been affected by the pandemic. This is an argument from privilege, pure and simple. And yet, all of us in healthcare sincerely hope that as many people as possible will still go on unaffected; I sincerely hope Dr. Erickson never has to recant this silly argument because the deaths in his own community have made him do so.

But a few more lines on statistics won’t hurt the discussion.


9:24 COVID-19 Vs. Flu in the USA.
  • USA – COVID-19
    • Tests: 4,000,000
    • Cases: 802,590

“Which gives us a 19.6 positive rate out of those who were tested (emphasis mine). If this is a typical extrapolation (his term for ignoring all sound statistics and epidemiology principles for arriving at accurate prevalence data)”… ‘That’s 64 million people with COVID-19.’

So to summarize his math for the USA:

  • Known COVID-19 cases in the USA: 802,590
  • Dr. Erickson’s number of COVID-19 Cases: 64,000,000
    • 63,197,050 without a confirmed diagnosis.
  • Actual number of cases: Unknown, because we do not yet have large scale, random antibody testing; in other words, we cannot yet actually do the type of math that Dr. Erickson is only playing at, because we do not have the data.

By the way, this also means that of the imaginary 64 million people who have had COVID-19, 79 times more people had the virus and didn’t have symptoms, or didn’t meet testing criteria, than those who actually had a confirmed case. This is a big, big logical leap from the rallying cry of ‘we need more testing’ that we have all been saying for a month, and it should be another check for Dr. Erickson when deciding whether or not to trust his data. He has talked briefly about quarantining the sick only, but the implication that his data leads to is that only a very small number of cases will even have symptoms. It’s hard to say if this is simply another oversight on his part, or if he is deliberately playing into the ‘we all had this back in December’ myth that has already been popular.

10:06 Why not the data for 2018-2019 you ask? Or average over multiple years? Because 2017-2018 was the worst flu season we’ve had in decades, and did nearly overwhelm the healthcare system in many places. He is cherry-picking his data; deadliest flu season vs. artificially minimized COVID-19 deaths.

10:00 “50-60 million with the flu (compared to his 64 million for COVID-19). 43,545 deaths. Similar death rate.”

Estimates vary, but most commonly reported is closer to 60,000 deaths from flu that year (not sure where he got the 43k figure from). But how is this data derived? Well, what they didn’t do was multiply the ratio of tests that were positive by the total US population (his methodology); this method would give us over 180 million cases. No, they used actual statistical modeling (https://www.ncbi.nlm.nih.gov/pubmed/25738736). They also didn’t then divide the number of deaths by some crazy high number to get a low case fatality rate; instead they did much more complicated math to determine the excess attributable mortality. So already we are comparing apples to oranges, except that since his data is the product of his imagination, we are really comparing apples to… well, to some made up fruit.

Oh, and they didn’t do any of those calculations early in December before most places had even experienced their peak flu season, which is what attempts to ‘close the book’ on COVID-19 data right now amount to.

10:25 Again, he is talking about a flu season that lasts for 4-5 months, for which there is a vaccine (he will say this in a moment), and which has a much, much lower mortality rate. And we probably should be considering some of those things, to some extent, each flu season anyway.

10:55 Resisting the urge to dig on Urgent Care’s here. Testing everyone for flu is not sound clinical medicine. But that’s a different rant entirely.


13:47 Here he compares California to Sweden briefly. Again, do not trust anyone to do statistics work for you if they are comparing regions without looking at population size. He is comparing the number of deaths in California (“with isolation; 1,220”) to the number of deaths in Sweden (“without isolation; 1,765”) and saying they are similar, with just a quick nod to their populations; “we have more people, but…”

Here’s how he should have phrased these numbers, if he really wanted to compare the impact to date of COVID-19 in these two regions:

  • California Population: 39.51 million
  • Number of Deaths: 1,220
    • Deaths per 100,000 People: 3 “with isolation”
  • Sweden Population: 10.23 million
  • Number of Deaths: 1,765
    • Deaths per 100,000 People: 17 “without isolation”

It isn’t fair to compare these two places in the first place, since a true surge hasn’t hit California yet (at least partially because of social distancing/mitigation measures), and because California and Sweden have very different healthcare structures and very different population vulnerabilities and demographics. But if we did a Dr. Erickson style extrapolation from Sweden to California, we would estimate 6,817 deaths so far in a California “without isolation”, 5.7 times higher than “with isolation.”

But again, these aren’t meaningful comparisons because statistics is a real field of mathematics and it doesn’t work that way. You can’t just take number of deaths from one place and multiply it by the population of another place and say ‘well this is the best data we have so we might as well trust it’, just like you can’t take data from very limited symptomatic testing and ‘extrapolate’ it to the entire population. The assumptions underlying the calculations are every bit as important as the calculations themselves, and so these particular ‘statistics’ I’ve just made up are probably only marginally more helpful than the ones Dr. Erickson made up.


14:00 Brief discussion of Sweden (1,765 deaths) and Norway (182 deaths) in Part 1 as well; the difference in how these nations have been affected by COVID-19 is only “statistically insignificant” (and not even then) when you invent tens of millions of phantom COVID cases to minimize the deaths, injury, and suffering of real life people.


14:58 Weird one to include, but ok.


15:14-16:47 Secondary effects of COVID-19

It’s pretty ridiculous that I’ve been trying to finish this overlong video analysis for 4 days now, writing between patients and during lunch, at the end of long days of clinic and pausing to read the Hobbit to my children, and have only made it to the 15 minute mark. But this is where I’ve been trying to get to, wading through all of the bad statistics and the misleading numerical comparisons, because it is this segment that I’ve been wanting to get to.

Because here, at least, I 100% agree with Dr. Erickson.

Doctors hate disease. We hate suffering. We hate abuse and neglect. We hate that people find themselves in dark places where there seems no way out. We probably hate it more than anyone except those experiencing them and the people who love them. The less wise among us take on far, far too much of that anguish in hopes of offloading a little of it from our patients; sometimes with tragic results. We took an oath to First Do No Harm and we take it pretty seriously. There’s a cultural myth that doctors like illness because without it we wouldn’t have jobs; which is a bit like saying that teachers like ignorance or soldiers love the enemy… although in the latter case, they really ought to, even if they still must fight them. Every doctor I’ve ever met would joyfully find a new line of work tomorrow (most of them are very talented) if they woke up to suddenly find disease, mental illness, physical pain, and all human suffering had suddenly ended forever (and some of us firmly believe that this is exactly what will happen).

In spite of everything, I believe this is probably true even of Dr. Erickson, and that when he is speaking of the suffering that will result from the necessary measures to fight COVID-19, he is speaking for the first time in this video as a Physician and not as an Entrepreneur. I think that’s why he’s had to dive so deeply into his false numbers in order to justify essentially ignoring COVID-19; because if he didn’t really convince himself that it wasn’t the threat that it so clearly is, he probably couldn’t bring himself to risk lives by making this video. At least, that is my sincere hope.

We are all concerned about the secondary effects he is talking about here. I wrote over a month ago, “All of us are afraid of a second spike in COVID-19 deaths if social distancing measures are discontinued too soon, but we are also concerned about a third spike; a spike of all-cause mortality and morbidity from the disruption this pandemic is causing to our normal modes of treating patients. That’s why we are working around the clock to figure out the best way to take care of the patients under our charge while at the same time preparing for and fighting the battle with COVID-19.”

I’ve written about it elsewhere, so I won’t go into details about all the things my clinic has done to work hard to address these very real threats. I work with some amazing people and they have been working their butts off. Since day one we have talked about what this would do to mental health in our community, about children trapped at home with abusive parents, about those with already tenuous chronic medical conditions or severe anxiety and depression, those with addiction, those with food insecurity, those with so-far silent conditions that need to be caught early.

Honestly, these are the things we worry about anyway. I worry about my mental health patients every time I take a vacation. I worry about patients with severe chronic illnesses not being able to get seen every time I make the difficult choice to cut back in clinic, in any way, because I’ve been drowning at my job since 3rd year of medical school. When I don’t have the mental bandwidth or the time to ask a more in depth question or allow a few more seconds of silence that gives the patient time to respond in a less guarded way, I worry what might have been missed. These are the realities of being a Physician in modern healthcare.

Which means that at whatever point doctors can in good conscience advocate for lifting the burden of social (physical) distancing and quarantine and sheltering-in-place off of our patients, friends, families, and selves, we will be the loudest and most persistent voices. If Dr. Erickson’s numbers were at all reputable, we would be thrilled; we would shout it from the rooftops. But they aren’t. And as someone who takes care of many of the patients in my city that our data tells us have the highest risk of complications and death from COVID-19, the only choice I can make is to work hard on my patients’ and community’s behalf to mitigate not only the very real risk of this one deadly virus, but also all of these secondary threats he is naming.


16:55 See discussion of the flu above (didn’t realize he was going to jump around so much). All I’ll add here is a reminder that the CDC is calculating the death rate as a comparison of deaths to estimated cases based on the best methodology available. If we used the Dr. Erickson method, the death rate for flu in 2017-2018, the worst flu season in decades, would be 0.03% instead of 0.13%. But again, it’s not a method any statistician would be tempted to use, not on a dare.

17:26 “The lethality of COVID-19 is much less.” There it is; don’t let anyone tell you that this doctor is just saying that COVID-19 is like the flu in some vague way. He is definitively telling you one is more dangerous than the other, and he’s got it exactly backwards.

17:28 Could someone explain to me how a ‘hotbed’ of a not-at-all-dangerous virus can overwhelm an entire city and kill thousands?


17:44 “I’m sick of following the science. I’m just going to ask it where it’s goin’, and hook up with it later.” -Mitch Hedberg if he were a doctor, probably.


18:00 I would like to know where Dr. Massihi taught immunology. Maybe they will fill in the gaps later, but at this point this could mean absolutely anything. I taught Kaplan MCAT and LSAT test prep courses after college and I was fairly bad at it I’m afraid; do I also get to claim to have taught immunology? What about logic and analytical reasoning?

We all have courses in microbiology, biochemistry, immunology, pathophysiology, virology, etc. It’s part of our curriculum from pre-med onward; what he is describing is the same education that all Physicians have. But the thing is, just because we’ve all had that training doesn’t make us experts; relative experts compared to the general public, sure, but there are people who have studied these systems a lot more. It certainly doesn’t mean we are each entitled to our own opinion about how the human body works, because medicine is a hard science. If he is going to make claims about the immune system, his authority as a doctor isn’t going to get him very far; the immune system is the authority on the way that it works, so we need to check his facts against it.


18:35


18:18 – 19:38 This is something that seems to crop up in almost every single medical misinformation video. I’ve written about it here, and here, and did an entirely overwrought Star Wars analogy about it here; and other people have written about it much better and in more detail than I have. It’s a common theme among alternative health “experts” who are spreading misinformation right now; don’t hide from the virus they say, your body needs it to build up the immune system! It plays into a lot of the cultural myths that Physicians are only interested in giving chemicals and harsh drugs, think all bacteria are bad, and don’t know anything about the body’s own immunity; ideas that are popular in alternative health spheres. So it’s pretty shocking to hear it from a doctor.

Uh oh. Now you’ve got to pick a side; Dr. Erickson or Dr. Ayyadurai

The major failure here is to distinguish between microbes and pathogens. Pathogens are microbes that can cause disease in humans, and some pathogens are so dangerous that either vaccination or avoidance are the best strategies to prevent the terrible, possibly life-long suffering and death that can result. Yet these misinformation purveyors want to pretend that when public health experts and epidemiologists recommend practical methods to decrease transmission of just such a deadly virus, they are actually saying that you can’t go outside, you should live in a sterile room, and your kids can’t play in the mud. Dr. Erickson wouldn’t tell you to touch your face and not wash your hands if you had been around Ebola. He wouldn’t tell you not to wash the surface of your kitchen counter if you had been cutting up raw chicken. He wouldn’t tell you that exposure to viruses is important to building a healthy immune system if you were about to pet a rabid dog.

But because his fake statistics have convinced us and especially himself that COVID-19 is about as dangerous as the common cold, he is willing to spend several minutes expounding the value of touching your face and eyes and not washing your hands so you can get that good IgG and IgM and have a healthy immune response… in the middle of the worst pandemic in a 100 years.

19:26 Just to be clear, you do NOT need SARS-CoV-2 to survive.


With that I am going to pause for the night. Thank you to all who have read these two very lengthy posts, despite my failed endeavor at choosing a format specifically intended to force me into some sort of brevity.

If this video continues to be widely circulated among friends and family in the coming days, I will return to finish the other half. I haven’t even met Dr. Massihi yet; maybe he’s a super reasonable guy who is going to give a balanced counterpoint to Dr. Erickson’s perspective? (Update: Nope.)

But my guess is that we are only hours away from the Next Big Thing in COVID-19 misinformation, and I’ll be forced to abandon this particular analysis at 19:26, just under halfway. If there is anything that particularly needs to be expounded on later in the video, I’ll quietly post it above; but feel free to leave a comment if there is a statement or section you would like me to address. Otherwise, I hope my perspective as a Physician has helped you to make sense of the dangerous errors my peers have fallen into in this video.

“Without education, we are in a horrible and deadly danger of taking educated people seriously.”

― G.K. Chesterton

Dr. Erickson and the 3rd Kind of Lie (Statistics)

There are three kinds of lies: lies, damned lies, and statistics.

Now that the video is back up, Part 2 is in progress.

Yesterday a friend sent me the following video and asked two things; would I write about it, and would I try to make it short! The second skill is not really in my wheelhouse, and it is a very, very long video, clocking in at 52 minutes; I am currently writing a 2 part essay on a video that is less than 5 minutes long. 

I’ve chosen the “live tweet” format (I don’t know what else to call it) in order to keep my comments brief and in-line, chronologically, with the video itself; I am sure I will have some additional closing remarks, however.   

While most of what I try to address on this blog falls into the first two categories of ‘lies’ and ‘damned lies’, Dr. Erickson’s analysis belongs primarily to the final category. Dishonest statistics are extremely difficult to dispel because those who don’t have a background or training in interpreting them are apt to chalk up disagreements to a mere difference of opinion about what the numbers mean. They are often right. However, in this case Dr. Erickson is actually creating false statistics out of thin air, and then framing his arguments with these imaginary numbers.

Edit 4/28/2020: The video is available again here: https://www.facebook.com/watch/?v=537566680274166


(Note on time: with the original video removed from youtube, these time stamps are going to be a bit off. The facebook video above is about 12 seconds ahead of the original video; so 0:22 becomes 0:10, 0:27 becomes 0:15, etc. Sorry for the inconvenience.)

0:22 Kern County California.


0:27 This is my first yellow flag; “ER Physician/Entrepreneur perspective.” Most doctors wouldn’t describe themselves in that terminology even if they run their own practice, so I’m listening very carefully for what the “entrepreneur” angle is. 

Over and over again with these misinformation videos, we have seen that the creating of false information has some direct link to attainment of money, power, or fame for the person in the video.


0:45 “If that still makes sense.” This is the question on every person’s mind, and rightfully so. For medical people, clinicians and nurses, it’s a definitive and resounding “yes,” so I’m interested to hear his perspective. 


1:00 Already this video is different from most of what’s going around, because these guys are actual doctors.


1:34 Here we reach the “entrepreneur” piece; my understanding is that Dr. Erickson is an owner or partner of Accelerated Urgent Care, a group of 5 Urgent Care centers around Bakersfield CA. 

Two things about this: First, we do need to recognize that while Urgent Care centers can and do provide services that help take the pressure off of over-utilized hospital emergency departments, they are NOT emergency rooms, and so unless Dr. Erickson is also working in a hospital context it is not quite accurate to treat him as a practicing ER Physician; he is likely ER trained, but not currently working in that context. 

Second, Urgent Care centers are indeed entrepreneurial ventures; they are for profit, like so many fixtures of our broken healthcare system. During this entire video we are going to have to ask ourselves how the pandemic is affecting his business, and how that is implicitly affecting his understanding of the situation and statistics. 


1:44 See above. 


1:58 I don’t know what “furloughing patients” means, but otherwise this is the exact situation in Waco; we’ll get into this in more detail later because I think it’s an important topic.

One note for now; do not fall into the trap of thinking that “empty ICU’s” means that the pandemic is not real. Cancelled elective cases and alternative delivery of care is part of containment measures in areas where COVID-19 has not yet surged, like Waco or Kern County California.  The worst is yet to come. 


2:03 Make note of this. Everything else that is said in this video needs to be understood in the context that even Dr. Erickson recognizes that this virus can overwhelm healthcare infrastructures; it’s doing it in New York right now.


2:30-3:02 He’s absolutely right, in a way. As I’ve written before, every single clinic I know of is working hard to make sure that their patients with chronic medical and mental health needs are still receiving the best care possible under the circumstances.

But there is another side to ‘secondary effects’ of COVID-19 as it relates to chronic conditions, and it’s this; as deadly as this virus is for people with the very conditions he is listing (in other words, their fear or caution is not unfounded), an overwhelmed healthcare system is also dangerous even apart from the virus. When patients who have heart failure or diabetes, or depression, or any other medical or mental health condition cannot get care because the healthcare system is overwhelmed with a pandemic, that is no less dangerous than not getting seen for other reasons; and probably much more dangerous in many cases because at least with the ‘minimum capacity’ healthcare usage he is discussing they could still get timely treatment in a true emergency, which is not a guarantee when the local ER’s are overwhelmed. These are difficult decisions that every clinic, hospital, and system is weighing carefully; and the quality of that decision making depends on reliable COVID-19 data, as we will see shortly.

One more note; this absolutely is being talked about, and extensively. Don’t fall for the “why are the higher ups keeping quiet” argument about very complex medical systems and situations; these conversations are being had on every level and have been for months (I have yet another Zoom meeting this afternoon about this very issue). 


3:17 I think this is a really misleading way to frame the amount of data we had 1-2 months ago, and at the beginning of our social/physical distancing measures. Cases began to rise outside of China in early to mid February, and We already had 100,000 confirmed cases worldwide by March 7th. It was officially declared a pandemic on March 11th. So those (not) early (enough) decisions to begin social (physical) distancing measures were made based on data, not in the absence of it.


3:33-3:50 This is a false equivalence, and actually rather silly. What would it look like to quarantine the healthy because of ‘normal’ infectious diseases? “Sorry Billy, no school today; somebody at your school has pink eye so everyone is staying home.” “We can’t go to Church today kids; the pastor’s daughter had Hand, Foot, and Mouth Disease.” Pretty ridiculous, right?

But our template for COVID-19 is not pink eye, or strep throat, or even the seasonal flu; it is the 1918 Spanish Flu pandemic, smallpox, and the freaking Black Death. He is acting as though he didn’t study these diseases and periods of history in pre-med and Medical School.

In a Pandemic, social (physical) distancing, what he is calling ‘quarantining the healthy’, absolutely saves lives. If you don’t believe me, read this article. Or go play the Plague, Inc flash game and try not to throw your phone across the room when Madagascar shuts down it’s seaports.

https://www.contagionlive.com/news/analysis-spanish-flu-pandemic-proves-social-distancing-works


4:21 I didn’t realize what he was trying to say here right at first, but it’s worth pointing it out here instead of 10 minutes later when it finally hit me, since this is actually his main thesis throughout this video.

  • Kern County:
  • People tested: 5,213, Positive Cases: 340
  • Dr. Erickson: “That’s 6.5 percent of the population.”
  • Wait, no, it isn’t!
  • “Which would indicate that there’s a widespread viral infection.”
  • No, it doesn’t.

You see, this is where the statistical bungling really begins; he’s saying that since 6.5% of the people tested were positive for COVID-19, we can conclude that 6.5% of the entire population has it. But that’s an absolutely erroneous conclusion, because the testing wasn’t random. This testing was done, especially early on, primarily on patients who had symptoms of upper respiratory illness and fever, had known medical conditions that made them high risk of complications from COVID-19, and who had some degree of known exposure to the virus.

Do you remember how just a couple of weeks ago so many people were upset that they couldn’t be tested because the criteria for testing was so strict? The fact that only 6.5% of even these patients had positive tests shows that the virus is not yet widespread in Kern County California, just like it isn’t here in Waco, or in any city that hasn’t yet hit a surge in COVID-19 cases yet.

This data cannot be “extrapolated” to the general population to determine the prevalence of the virus because the testing, so far, has not been random or representative. His methodology sounds reasonable enough on the surface, but it is actually leading him to wildly inaccurate numbers and conclusions that are the exact opposite of the case.


“We think it’s kind of ubiquitous throughout California. We are going to go over the numbers a little bit to help you see how widespread COVID is.”

This should properly be understood as Dr. Erickson’s thesis for this video.

  • 4:40 California:
    1. 280,900 Tested.
    2. 33,865 Positive for COVID-19.
    3. *dubious math*
    4. “That means that 12% of Californias were positive for COVID”
  • Except it doesn’t, because you can’t get data on the number of cases in the state from non-random testing of symptomatic individuals with known exposures.
  • It actually shows the opposite; even in patients who met the until recently very strict testing criteria, only 12% of those patients tested positive; California has NOT hit it’s peak yet. https://www.latimes.com/projects/california-coronavirus-cases-tracking-outbreak

5:08 These projections were based on what would happen without social/physical distancing, shelter in place orders, and other mitigation strategies. The fact that it “hasn’t materialized” is evidence that mitigation is working. We have been saying since day 1 that as soon as these strategies started to show success, people would say they weren’t necessary.

But don’t worry; if we work hard to return everything back to normal and forego all mitigation efforts, we can still make these numbers materialize.

5:20 You cannot extrapolate prevalence data from testing of symptomatic individuals. We will explore how you could get this data later on, but for now, each time he ‘extrapolates the data’ you need to realize that the number that results doesn’t actually mean anything.

5:32 “That equates to 4.7 million cases in the state of California.” (No epidemiologist believes this; this is a nonsense number.)

“We’ve had 1,327 (now 1,651) deaths in the State of California with a possible prevalence of 4.7 million.”

“That means you have a 0.03 chance of dying from COVID-19 in the State of California.”

Dr. Erickson

Do you see what he’s done here? He’s multiplied the percentage of tested cases that were positive by the population of the entire state and called that number, 4.7 million, “prevalence.” He’s then divided the number of deaths by that gigantic made up number in order to make the death rate seem incredibly small.

You are supposed to think, “wait, I heard something like a 3-4% death rate, but he’s saying it’s 0.03%. They’ve blown this whole thing out of proportion!” But the number he is deriving is incredibly small because the fake denominator he has come up with is gigantic; and that is going to be the case for any location regardless of whether they have yet been hit hard by COVID-19, because while he is multiplying the percent of positive tests by the entire population, the number of deaths stays the same. He is comparing known COVID-19 deaths not to known cases, but to a wildly inflated ‘guess’ at the number of cases that is not based on sound epidemiology statistics principles.

In fact, while he isn’t really calculating anything, what he’s closest to deriving by comparing number of deaths to population is what’s called the mortality rate, and since most people don’t die in any given year, this number is always going to be small compared with the general population; any number of deaths looks small compared with 328 million people. This is the reason we talk about mortality and attributable mortality rates in terms of ‘per 100,000 people’, because most of us (myself included) can’t conceptualize the significance of very, very small numbers. If I told you that the mortality rate of heart disease is 0.122% and the mortality rate of cancer is 0.049%, that’s going to be much less helpful than the more typically reported figures of 165 deaths per 100,000 vs. 37 deaths per 100,000, respectively.

So, what he’s giving us is an erroneously calculated ‘death rate’ that is so impressively tiny it cannot be conceptualized and compared well, in place of the commonly discussed and oft debated case fatality rate, which is the chance of dying if you do get the virus.


6:10 “I also wanted to mention that 96% of people in California who get COVID recover.”

Here he has tipped his hat; this is the case fatality rate. You see, the opposite of ‘recovering’ is ‘not recovering’, i.e. dying. He’s sharing the actual case fatality rate, what laypeople call the death rate, but in a form that is unrecognizable.

This is a classic spin technique; flip the statistic so it suddenly sounds like a good thing. “96% is really high! Recovery is good! See, the good thing has a high number, so we are fine!” But if 96% recover it means that 4% die, and that number is astronomical for a case fatality rate, far closer to the Spanish Flu epidemic (2.5%) than to the seasonal flu; and this is just in an area where the healthcare system is otherwise slow due to COVID-19 concerns; in places where hospitals are overwhelmed, the death rate (case fatality rate) is much higher.


6:12 “With almost no significant continuing medical problems (sequelae)”

It is way, way too early to know what the long term sequelae from surviving this virus are going to be.


6:28 “This is our own data, this isn’t data filtered through someone.”

Like, for instance, an epidemiologist who could help make sense of it for you? Sorry, I’m getting snarky again.


6:42 This is exactly backwards; the more the prevalence data goes up, the more positive tests you will get; but because it’s the real prevalence and not the erroneous prevalence he has calculated, that increasing prevalence will be accompanied by increased hospitalizations and increased deaths.


6:47 He’s just admitted to the calculation error I was talking about earlier. Incredible.


6:53 “Millions of cases, small amount of death”.

He says this over and over again; it may as well be the title of the video. Except it isn’t true; there isn’t any evidence that there are millions and millions of cases in California (41,000 confirmed at this point), and the number of deaths is anything but small. By the end of this week we will likely have passed the deaths from the worst flu season I’ve ever experienced, 2017-2018 (62,000 deaths), and epidemiologists believe we are underestimating the number of deaths from COVID-19. Moreover, this hasn’t peaked yet in most areas of the country; if we stop mitigation efforts, this could blow anything in our lifetimes right out of the water.


7:058:56 “So I want to look at New York State.”
  • 25,272 Positive Cases
  • 649,325 Tests
  • 19,410 Deaths (not sure where he got this number from)

“That’s 39% of New Yorkers tested positive for COVID-19”

At this point one of the reporters clarifies that it is not 39% of New Yorkers, but only 39% of people who were tested in New York State, and how if it were 39% of New York’s population that would be nearly 10 million cases of COVID-19 in that state alone. This is an incredibly important distinction. Dr. Erickson acknowledge this but fails to understand the implication; he is still insisting that you can “extrapolate” data from the testing that has been done.

An explanation of why we can’t extrapolate the information he thinks we can, and how we could get that data.

This data can’t be used for the purposes he is trying to use them for, for at least three very compelling reasons. First, it’s the wrong testing strategy. He keeps saying you can extrapolate the test data we have to the general population, but the people who were tested do not represent the general population. They have self selected due to exposure or illness and, especially early on, had to meet very strict criteria (or be an NBA player or celebrity) to even get tested in the first place because of the shortage of tests; these tests were done on the people who were already the most likely people to have COVID-19, and so their percentage of positive tests (39% in New York, 12% in California per Dr. Erickson) is going to be far higher than any other group. Even accounting for asymptomatic carriers, there is no reason to believe that asymptomatic people would have the virus at anywhere near the rate of people who have symptoms of the virus. This is… pretty common sense stuff, actually. For testing to be used to extrapolate to large numbers that give us population level data, it has to be random, and this is the opposite of random. So it’s the wrong strategy for the conclusions he is drawing.

But even if it were random, it simply isn’t the right sort of test for that. The current tests detect COVID-19 (SARS-CoV-2) antigen; circulating proteins specific to the virus; it is detecting the virus itself. It can do this before the patient is symptomatic if the virus is replicating inside them, but not once the virus has been eradicated from the body. Because of this, it’s actually the wrong test for the job; a person can test negative once they have recovered, so they would be miscategorized as a ‘negative’ test even though they had already had the virus. At best, a sufficiently large number of (random) tests done on the same day could give you a snapshot of how many people have the virus at any given time; this is called point prevalence. If this were at all possible, it would indeed be helpful for knowing the current risk of being exposed to the virus (though it would change quickly and require serial rounds of testing). But you can’t use it to determine a death rate; for that we need period prevalence, the total number of cases throughout the time period of the pandemic, and for that we need to know who has had the virus, not just who has it now. So, it’s the wrong test.

But it’s also the wrong time. If we want to know the final, true case fatality rate for COVID-19, which we all expect to end up being very high but much, much lower than the astronomical numbers we are seeing now, we are going to need that period prevalence for the entire period of time of the Pandemic. Even if Dr. Erickson’s calculations were correct up till now (and they are so, so not), it would still be the wrong time to rely on them because many of the regions he is discussing, including his home state of California, have not yet hit their surge. We don’t know what the death rate in California will be because the virus hasn’t come and gone yet; their healthcare system, doctors, and nurses are yet to be tried. It is the same in Waco; we are still in the long calm before the storm, hoping that something will give (a vaccine, a brilliant epidemiological strategy, a radical new treatment being discovered, seasonal decrease in transmission, etc) and we won’t have a surge at all.

So, what would an ideal testing strategy look like if we really wanted good quality case fatality data? It would use antibody testing (which tells us if the person has ever been exposed and had an immune response to the virus, not just if they have it right now), would be random, and would be done after or at least at the tale end of the pandemic. This would take into account asymptomatic and minimally symptomatic cases, and people who had symptoms but never got tested at the time. With a sufficient number of tests it could be used to extrapolate data for the entire population with a good degree of reliability. He’s probably right that we won’t ever do testing quite like that; but since there are potentially lots of other uses for antibody testing, and some of it involves testing people who aren’t actively ill, it is likely that we will get data that can at least be legitimately used to derive some idea of prevalence and true case fatality rate.


While we are discussing New York and possible testing strategies, it is important to note that there is some preliminary data about the actual prevalence coming out based on the antibody testing we discussed earlier, and the news is indeed hopeful; but even the most optimistic numbers so far only get the case fatality rate down to about 0.5% in New York, when you include asymptomatic carriers, assuming the sample is representative; 5 times higher than the number Dr. Erickson has landed on, and still incredibly dangerous. This is a number most of my colleagues would believe sooner than something apocalyptic like the 8-12% in overwhelmed healthcare systems across the globe, and Physicians and Epidemiologists have anticipated and said from the beginning that these numbers would drop significantly once broad-based testing and antibody testing were available. But unlike Dr. Erickson, most doctors I know are not comfortable making that kind of stuff up and would prefer to wait for data that actually has a logical connection to the questions we are asking.

https://www.livescience.com/covid-antibody-test-results-new-york-test.html

But even as more random antibody testing is done and death rates for COVID-19 hopefully trend down away from the utterly incomprehensible numbers they are at now, please remember; it isn’t just the case fatality rate that makes a disease dangerous, it’s also the degree of infectivity. Even if COVID-19 settles out to be less deadly per case than the bubonic plague or ebola or the Spanish Flu Pandemic of 1918, it can still kill incredible numbers of people if it makes up the difference by being highly contagious… Unless our mitigation strategies can prevent it from spreading.


8:12 Reporter: “Those models were based off if we did no social distancing.”

Dr. Erickson hand waves this off, but it’s an important point for understanding the timeline of this pandemic and understanding that those models are still a real possibility if we stop mitigation efforts.

It’s also an important opportunity for demonstrating some intellectual integrity, since the reporter is correct that those models were for scenarios where social distancing wasn’t followed, and Dr. Erickson has been dismissing them as ‘wildly inaccurate’. Sadly he fails to rise to the occasion and acknowledge this.


8:54 “We extrapolate out and use the data we have, because it’s the most accurate we have, versus the predictive models that have been nowhere in the ballpark.”

This is a blatant false dichotomy. The predictive models were done to show the range of possibilities of the impending danger if no action was taken; the antigen testing strategy to identify and isolate cases. Neither can be used to establish actual prevalence, but he wants us to think we have to accept his calculations, based on erroneous assumptions, because it’s the only option.


8:59 “So how many deaths do they have? 19,410, out of 19 million people. Which is a 0.1% chance of dying from COVID in the state of New York. And they have a 92% recovery rate! (Edit: That’s an incredibly high known case fatality rate of 8%!) Millions of cases, small amount of death. Millions of cases, small amount of death.

I want to be as generous as possible here. I really believe that this could be me, were the circumstances different, going on youtube and sharing these false statistics. Yes, Dr. Erickson has financial interests at stake here, but so far I’ve been inclined to think that he really believes his numbers. When you are pouring over data like this for hours or days and you think you’ve hit on some vital statistic that nobody else is picking up on, and it confirms what you already really, really want to believe, it can be so easy to get tunnel vision and not check your math against the backdrop of reality.

But New York should have been the “Aha!” moment for him; the point where he sees the house of cards he’s built collapse so he can start over from scratch with all of his equations. 19,000 deaths; 19,000 deaths in one state, in one month. Overwhelmed hospitals, too few ventilators, nurses and doctors collapsing at work. These stories from the front lines should be enough to make him question the conclusions he is drawing.

If you are calculating a pediatric dose of antibiotics and arrive at instructions that tell the parents to give 28 teaspoons three times per day, you’ve made a mistake somewhere; it doesn’t matter if your math was perfect, something must have gone wrong because those numbers don’t mesh with reality. If you are trying to figure out how long it will take you to drive from San Antonio to Waco and google maps tells you it’s 22 hours, something went wrong; it doesn’t matter how good their calculations and traffic algorithms are if the app thought you meant Waco, Montana instead of Waco, Texas. And if you are trying to derive real-life mortality data from numbers available on google and discover that a virus that is killing tens of thousands in a short amount of time, overwhelming hospital systems, and leaving your colleagues in New York with post traumatic stress disorder is actually not that dangerous, you’ve probably made some flawed assumptions before you even fired up your calculator. Your mathematical conclusions have to line up with reality, and his don’t.

He has concluded that COVID-19 is no worse than the flu, which in any given year will kill between 10,000 and 60,000 people nation-wide over 3-5 months. But the deaths of 19,000 human beings, with friends and families, who wouldn’t have ‘died anyway’ at this time, many while their doctors and nurses looked on helplessly because they had not the time or lifesaving equipment to intervene, in one state in one month, should be a wake-up call even for him.


9:48 “We’ve tested 4 million people. Germany is at 2.” The population of the US is 330 million and the population of Germany is 83 million; their tests per capita is double ours. He hand waves this with ‘sure I realize their populations are lower, but…’ Don’t trust anyone with your statistical analysis who waves away the single most important statistical number for comparing countries, their respective populations.


And at this point, mercifully, the video has been removed from Youtube for spreading verifiably false information. This is a double-edged sword, because it inevitably means that copies of it will be spread elsewhere with the heading “BANNED FROM YOUTUBE!”, and even more people will click, watch, and be deceived (or more likely, further entrench the false narratives they have already chosen to believe before watching). If someone does have links to the video when it’s up again, please send it my way so I can finish the other (checks notes) 45 minutes of the video.

But some sanctions cannot be waived away by your being popular with conspiracy theorists. The American College of Emergency Physicians and the American Academy of Emergency Medicine today released a joint statement condemning the irresponsible and flawed information in the video. And while the parts that we have covered so far have been mainly bad statistical analysis disconnected from reality, there are statements made by these doctors later (which I cannot now quote verbatim) that much more flagrantly disregard the oath they took in medical school. I honestly hope these are played back for them the next time they are set to renew their board certifications, and indeed their medical licenses.


With the video down, I’ll have to conclude here for now, and considering the number of charts I need to close for clinic, I can’t thank YouTube enough for taking down the video when they did.

Over the next 10 minutes or so, Dr. Erickson applies his same flawed methodology to other countries, multiplying their positive test rate by their total population to come up with his fake prevalence numbers, and then dividing the number of deaths by that to show how not dangerous the virus actually is. “Millions of cases, very small deaths.” If the video ever comes back, you can watch him do it time and time again, as a tutorial of sorts, so that you too can enjoy creating your own fake statistics at home.

And this leads him to conclusions which, while obvious from his erroneous numbers, defy both our reason and the experience of our fellow human beings. He concludes, remarkably, that the COVID-19 virus has not been that bad even in Italy and Spain, where it decimated the healthcare infrastructure and killed tens of thousands. He concludes that the difference between Norway’s 200 deaths and Swedens’ 2000 deaths is statistically negligible, and therefore social (physical) distancing measures don’t actually matter. He does this because, again, he’s invented a sufficiently high denominator for his “prevalence” that literally any number of deaths is going to seem “insignificant,” at least statistically.

  • Sweden’s Population: 10.2 million.
    • Deaths in Sweden (without mitigation strategies): 1,765
  • Norway’s Population: 5.4 million.
    • Deaths in Norway (with mitigation strategies): 182

14:30 Dr. Erickson: “1,700 (deaths), 100 (deaths); these are statistically insignificant.”

I want you to stop and say that out loud a few times. Go ahead.

These lost lives are not insignificant; statistically or otherwise.


One more thing I remember specifically, because it was so shocking to me at the time. He goes on to talk about the way that the mortality data is being ‘manipulated’, even saying that a deceased patient with COPD (Chronic Obstructive Pulmonary Disease) who contracted COVID-19 has not actually died of COVID-19, but from 25 years of smoking… As though the medical vulnerabilities that predispose a patient to becoming a victim of this horrible virus and the pathology caused by the virus itself are mutually exclusive. As though tens of thousands of COPD patients who have been smoking for decades were suddenly going to go into respiratory distress in April 2020, apart form any exacerbating factors, and their happening to have the virus that is also killing people with heart disease, diabetes, compromised immune systems, and even the young and healthy is just some weird coincidence.

Bad at statistics is one thing. This is bad at being a Doctor.


Now that the video is back up, Part 2 is in progress.

Data Analyst Declines to Analyze Data, Part 1: Home Isolation, Medicare Fraud, and The Flu.

I want to begin by acknowledging that the headline to this article is quite snarky. While I try to write about these issues of medical misinformation with some degree of charity towards those I disagree with (and often fail at that), writing titles to posts doesn’t allow for quite so much nuance; I honestly find it to be the most challenging thing about blogging.

Here is a video that was recently shared on my friend’s Facebook timeline. It is mercifully short (less than 5 minutes) and I have included the link for those who would like to watch it in it’s entirety. My friend is an Emergency Physician in New York state, and she was probably on shift when this was shared to her wall. Later on she did leave her own comments, and I have chosen to include some of them, and snippets of our conversation afterward, in this blog post. Let me tell you why.

This was about the guy in the video, not about me.
I’m pretty sure.

I tend to believe that while the people generating these conspiracy theory videos are motivated by desire for some combination of fame, power, or fortune (and this video may well be an exception to that) the people who are sharing them widely on social media and forming opinions based on them are more victims than accomplices. They are being given false information exactly calculated to appeal to their fears, their political leanings, and their preconceptions, and they are deciding to place their trust in these so-called experts because they themselves do not have the background or knowledge base to parse the information on their own. Without a background in statistics, medicine, epidemiology, etc. they feel they have no choice but to trust one “expert” or the other, and all too naturally quiet their own discernment and choose the one that reinforces their own views. The problem is that while one group of experts have devoted their lives to rigorously studying disease and the human body so that they can help those who are suffering, the other group of “experts” are actually only experts in engendering this sort of trust, and not in the areas of knowledge they claim to understand; they are essentially false information experts.

Because of this, I do try to approach these topics with gentleness, recognizing that it is easy to be deceived and hard to sort truth from fiction. I have that privilege because right now the COVID-19 pandemic has really impacted my life quite minimally, compared to the rest of the world. Katie is still homeschooling and I am still going into work. We haven’t hit a surge yet and so while I have seen COVID-19 patients, and we have had some deaths due to the virus in Waco, I am not being called upon, at this time, to work extended hospitalist or emergency room shifts trying to care for patients in an overwhelmed hospital with physically and emotionally exhausted staff and colleagues.

But my friend is working under exactly those circumstances, and if she’s a bit more adamant than I am about how hurtful, how dangerous, and how dehumanizing these types of nonsense and lies are to not only the victims of this terrible virus, but also to the healthcare workers fighting it… well, I think she’s perfectly entitled. Please trust me, if she found these falsehoods shared on her Facebook wall by friends or family members when she came home from a shift where multiple patients died or were admitted to the ICU due to COVID-19, she could be considerably more vociferous if she chose.


I’d like to devote a separate essay to the the main point of his video, which to him constitutes “100% proof” of fraud and a major international conspiracy lead by WHO and the CDC, and apparently involving doctors and healthcare workers across the globe. This revolves mainly around CPT codes, and the “two CPT codes” being used for COVID-19 in order to cook the books “right in front of your eyes.” We are going to go into this in more detail, hopefully sometime in the next 2 days, but first I want to discuss the other issues he raises in the video.

Home Isolation

At the 1:46 mark of the video, Mr. McCarthy says, “Here’s a document from the CDC dated July 2020 (Note: this means that the article is due to be published in July, not that this article is from the future, as helpful as those would be if we could get our hands on them) that clearly states…”

“In addition, our findings suggest that home isolation of persons with suspected COVID-19 might not be a good control strategy (McCarthy: Oh there’s a shocker!). Family members usually do not have personal protective equipment and lack professional training, which easily leads to familial cluster infections.”

He concludes, “meaning it’s making it worse, not better folks!”

This is a direct quote from the study below (image links to full article on CDC website).

His point here seems to be that having people who are actually suspected of having the virus stay medically isolated at home is actually worsening the pandemic. Which is… pretty nuts. We are not even discussing broad based social/physical distancing measures and shelter in place orders here, but actual management of suspected cases. It’s hard to imagine in what way, or compared to what strategy, having these patients isolate at home would make things worse. Would he prefer for patients with suspected COVID-19 just go back to work, despite their cough and fever, and wait for their test results? Does he think that patients wouldn’t be in their homes exposing their families at all if not for doctor’s orders? He doesn’t say, but the implication, in the context of the rest of the video, is that having patients who are actually ill keep themselves at home and away from the general public is yet another tool of the COVID-19 conspiracy… As opposed to being a common-sense step we already take for pretty much every other contagious illness.

It’s hard to know whether Mr. McCarthy is simply confused in thinking that the article’s point is that home isolation is too draconian, or if he is intentionally drawing the wrong conclusion in order to deceive his listeners. Sadly, I think it must be the latter, because the very next sentence of the article reads as follows:

During the outbreak, the government of China strove to the fullest extent possible to isolate all patients with suspected COVID-19 by actions such as constructing mobile cabin hospitals in Wuhan, which ensured that all patients with suspected disease were cared for by professional medical staff and that virus transmission was effectively cut off.

So the opinion of this articles authors is that having suspected COVID-19 patients isolate at home is not nearly extreme enough to prevent spread of this virus, and that patients should be kept in mobile hospitals instead. Considering that his very next point is that hospitals are manipulating the COVID-19 data to make money, we must concluded that his omission of the very next sentence and his substituting his own conclusion, which is the exact opposite of that drawn by the study’s authors, is actually intentional.

Hospitals are miscategorizing people as COVID-19 patients because of the CARES Act.

This claim, which is implicit throughout the video, is explicitly stated at the 2:56 mark:

“All they have to do is use the right code! Why aren’t they using it? Because the average COVID-19 case for medicare or medicaid is between $13,000 and $100,000 right now folks. So by flipping this number to this number (pointing back to the CPT codes), the hospitals are making a tremendous amount of money off of medicare and medicaid… It’s absolutely fraud.”

Now, there’s a lot wrong and just plain silly with his take here. There’s the fact that our healthcare costs in this country are so inflated (largely because of the hospital-insurance company arms race) that those numbers, which he means to be a ‘they are charging how much!?’ moment… really aren’t all that shocking (also, that’s a pretty big range there). There’s the fact that using one COVID-19 code vs. another based on whether a test was positive isn’t going to affect billing or epidemiology data (we are going to go into this in more detail in the next blog post). And there’s the fact that this really does seem like the type of information that, like the last example, actually proves the opposite of his point if it proves anything at all. Many patients with COVID-19 are incredibly, unbelievably sick and require high levels of support and prolonged hospital stays (we have been closely following the story of a man here in town, a friend’s brother, who has only just returned home after over a month in the hospital, including an extended ICU stay), and quoting numbers about the exorbitant expenses associated the disease really shows two things; we need to move away from a for-profit model of healthcare in this country, and this is a very, very bad bug.

But unlike nonsensical theories of 5G towers reprogramming our DNA or defeating COVID-19 by doing a cellular health detox cleanse, most Physicians are not so quick to dismiss the idea that some in hospital administration and corporate medicine might see government provision for COVID-19 treatment, such as that provided in the CARES Act, as an opportunity to profit; or at least to make up for lost revenue from cancelling elective surgeries and decreased admissions leading up to any COVID-19 surge. I have known hospital and clinic administrators I trust implicitly, and I have known hospital administrators who have lied directly to my face; but most probably fall into a very broad category of people who just have different values and convictions around what medicine is supposed to be than I and most other Physicians hold to. At the end of the day, I tend to think it’s a bad idea in general to have the practice of medicine driven by, in so much as it is driven by, people who have studied and been hired to increase profits and market shares rather than people who have taken an oath to do no harm and to aid the suffering. It would be somewhat naive to expect that dynamic to disappear entirely in a pandemic.

But let me be clear; if a handful, or even a large number, of unethical hospital administrators are actually trying to commit fraud to gain access to additional payments related to COVID-19, either by attempting to influence clinician decision making or by actually modifying medical records, those people should be convicted. But even if this were the case, I do not believe for a moment that such activity has any way of significantly changing the hard data we are seeing, for a few reasons.

First and most importantly, the numbers we are seeing do match the experiences of doctors and nurses on the ground. Doctors have a good gauge for what a bad flu season looks like or when a viral GI bug is going around, and generally have a bead what is happening with the health of their communities. It is absurd to believe that doctors and nurses who are suddenly fighting for their own and their patients’ lives against this horrible virus have all been wrapped into some big conspiracy to profit hospital administrators and stock holders. That’s why the ‘hospital administrator cooking the books’ (note to self: new idea for a Les Mis parody song) idea tends to be a final redoubt for conspiracy theorists once they have been confronted by actual doctors and nurses, who in the cultural atmosphere since COVID-19 they no longer feel they can get away with calling liars and conspirators directly to their faces.

But it also doesn’t make any sense to equate medicare or medicaid fraud related to COVID-19 to an inflation of the epidemiology data, because even if EVERY hospital administrator were in on it, they would still have very limited influence on that data. They would not, for instance, be driving to community based and free standing labs to convince lab techs to report positive tests, so they would have a better COVID-19 paper trail if those patients showed up in their ER’s later. They are not going to unaffiliated, clinics and underserved healthcare centers and convincing Physicians, NP’s and PA’s to fudge their evaluations to make COVID-19 look more prevalent. They are not telling ICU and Emergency Room doctors when a patient’s respiratory status is sufficiently dire to require a ventilator (I have actually heard of such cases in the past, and those administrators were promptly reported for practicing medicine without a license), and at any rate if they were they would be ignored. They are certainly not killing people; it is the virus that is doing that.

Just like with pharmaceutical companies, insurers, drug reps, home medical equipment companies, and so, so many other players in the healthcare arena, Physicians have complicated and often antagonistic relationships with hospital administrators. But even if you believed that every single hospital administrator were corrupt and currently working overtime to try to game the COVID-19 situation, there are just so many other people involved in tracking this data. There are epidemiologists and infectious disease doctors, the local public health department, the coroner’s office, local and state government officials of all political influences, and many, many people evaluating this data from every possible angle to see what we might be missing, or what patterns might help us be prepared for what comes next. And finally there are the people living through this pandemic; the doctors and nurses and respiratory therapists, yes, but also the patients, those living and those deceased, and their friends and family and loved ones. These are the people who are robbed of their dignity and their opportunity to grieve and process in peace when people like Daniel McCarthy erroneously claim that COVID-19 is being blown out of proportion to make money for a fairly small group of businessmen.

The flu kills more people anyway.

It’s hard to know exactly what point he’s trying to make by touching on influenza death and hospitalization data toward the end of the video. My hope is that he’s merely pointing out the importance of having reliable data. If so, I would agree with him, although from the rest of the video I don’t think I would trust him to recognize it once we had it. Unfortunately, however, I think he is simply reviving the ‘it’s just another flu’ rallying cry that we’ve heard consistently for months from those ignoring the realities of the COVID-19 situation; if that wasn’t his intent, my apologies to Mr. McCarthy; it’s a good thing for us to talk about here at some point anyway.

I’m honestly so sick to death of this one. It is the end of April and I am sure that this has been explained to Mr. McCarthy several times by now, so I can only assume he has chosen to perpetuate the lie that COVID-19 is ‘basically just like the flu’ because it fits with his narrative, and not out of actual ignorance. I hope I am wrong about that. I won’t go into extensive detail (I have included a link to an article below), but essentially the flu is a partially vaccine-preventable virus that demonstrates seasonal prevalence and has a high rate of mutation. Because of this, epidemiologists have to try to predict which strains of seasonal flu are likely to be prevalent in the coming flu season so that vaccines can be prepared. Some years these are more effective (and more widely accepted) than in other years, and some years the seasonal flu strains are more dangerous or more widespread than other years. This means that seasonal influenza has the potential to be very, very bad in any given year; but also that there is a high degree of variability. 

In addition to flu vaccines, there are several mitigating factors that help keep the flu from overwhelming our hospitals and healthcare infrastructures every Winter. First, flu season is fairly long; usually above 3 months, with a high degree of chronologic and geographic distribution. This means while hospitals are sometimes extremely taxed by the flu, it is rare for them to actually be overwhelmed; though there are certain years and certain locations that come very close. If you consolidated the impact of even a light flu season into a 1 month period, affecting every community in the country at roughly the same time, it would absolutely overwhelm our healthcare systems and people would begin to die not just from the flu but also from our inability to provide care for other conditions while battling it; and this is exactly what COVID-19 does threaten to do (and has done) because of it’s much higher degree of infectivity and, likely, higher degree of asymptomatic or minimally symptomatic spread compared with influenza. 

Second, we know the flu is coming. Each year Physician, Nurses, and other healthcare workers make strategic decisions leading up to flu season. When I have taken leave to work internationally, we have always scheduled that time during the late Spring or Summer, when I knew I would be less needed because we wouldn’t be in the midst of fighting the flu. Staffing decisions and other resource organization is made based on the expectation of a surge, even if the exact timing and parameters of that surge are unknown. With COVID-19, there was no preparation time in those regions that were hit earliest, and the rest of us have been scrambling ever since to ensure that our systems are ready for a surge that is unpredictable because there are no decades of past data to help us now what to expect at our hospital or in our region.

Third, we already how to deal with the flu. While influenza seasons and symptom clusters do vary, the syndrome is very recognizable and we generally have a good idea of what to expect with flu cases, and how they interact with other acute and chronic illnesses. As several quotes I’ve read recently have said, “The flu is an old enemy.” Yes, it is a very, very dangerous enemy, but it is definitely ‘the devil we know’ compared to COVID-19. We have years of research and clinical experience to help us. We know which medications have modest therapeutic benefits and which have none, and what strategies to use when patients present for dangerous complications of the flu, such as post-influenza bacterial pneumonia, or when it causes complications in preexisting lung disease. With COVID-19, new data is still emerging continuously about both the strange spectrum of harm that this virus causes, and the possible treatment approaches; those fighting the virus later in the course of this pandemic really do stand a better chance of both diagnosing it accurately and treating it effectively. 

Finally, the flu itself is already bad enough, and dismissing COVID-19 as ‘basically another flu’ just shows how the people spreading these ideas are already in the habit of dismissing incredibly dangerous infectious illnesses. Already COVID-19 has killed more people in the US than almost any flu season, and yet people are still waving it off as ‘another flu’ the way they were weeks ago when it had ‘only’ killed a few thousand. In the coming days the total number of deaths in the US will surpass the 62,000 mark set by the 2017-2018 flu season, the worst we’ve had since I’ve been a Physician. Once this benchmark is passed, will these conspiracy theorists finally abandon the ‘it’s just like another flu’ argument, or would they like to hold on to it until COVID-19 has actually surpassed the numbers set by the Spanish Flu pandemic in 1918?

https://www.sciencealert.com/the-new-coronavirus-isn-t-like-the-flu-but-they-have-one-big-thing-in-common

Treat Your Immune System Like The Death Star (A Slideshow)

The amount of medical misinformation out there right now is staggering. Would-be alternative health celebrities see the COVID-19 pandemic as their opportunity to make a name for themselves and increase their fame and fortune, and their videos seem to range from 5 minutes of mostly benign half truths, to one I saw today that was 48 minutes of crazed rantings. As a Physician, I despair of being able to address even a fraction of the misinformation my friends and family are being exposed to right now.

But you have to start somewhere. One of the biggest areas around which falsehood and distortion crops up consistently is the role of your immune system in fighting disease in general, and in protecting you against COVID-19 in particular. And in this area there are two dangerous distortions that seem to crop up again and again. But to address those, I think it’s important that we think of the immune system as a Death Star.

 

The Church and Medical Misinformation During COVID-19

Preamble 1: This is written to Christians, and intended as a call to my fellow believers in Christ to hold to very high standards of truth telling, particularly as it relates to the COVID-19 pandemic we are currently facing. I do think that the general principles I am espousing here apply to others as well, and all our welcome to read and comment.

Preamble 2: In this post I do talk quite a bit about holistic healing/alternative medicine. This is an area of complexity and nuance, but here I am primarily talking about self-proclaimed alternative health “experts”: modern day snake-oil salesmen who are seeking to use the COVID-19 crisis to create a name for themselves and garner greater fame and fortune. I know many of my friends lean towards ‘holistic’ alternatives or adjuncts to modern evidence-based medicine (modern medicine IS holistic but that’s another soap box entirely). I have FB and real life friends who are into essential oils, I have family that swear by their chiropractor, and I myself have received acupuncture in the past (it was kind of fun, to be honest). Most of them, thankfully, also choose to bring their children to the doctor when they are ill and to vaccinate them to prevent communicable diseases. Most of them have been very, very supportive of healthcare professionals in general and of me personally during this pandemic, and I have seen them both seek out and share good, reliable medical information. In short, I have been quite proud of these crunchy, oily friends of mine. If you are reading this as someone who identifies strongly with holistic or alternative medicine, I would ask you to please consider carefully whether the conspiracy theorists and COVID-19 deniers who are so prolific on the internet right now really represent your movement well and are espousing the same values that you find important in your area of wellness. My hope is that you wouldn’t be deceived by them easily just because they are comfortable using the same terminology that you hold close to your heart; an error we in the Church have all too often made with false teachers of all stripes.


“Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.”

“Keep your tongue from evil, and your lips from telling lies.”

When the initial wave of concern over COVID-19 began for our clinic system a few short weeks ago, there seemed no end to the things that needed to be done. We had to rapidly prepare to protect our staff and patients by minimizing transmission risk and eliminating fomites, go through all of our processes with a fine toothed comb and revise or rewrite a fair number, and innovate and implement novel ways to deliver high quality primary care under circumstances where it was no longer safe for our patients to sit in a crowded waiting room as they wait to see their primary care Physician, or even pass each other in the hallways on the way to the lab or radiology. This all in addition to learning how to work-up and treat the virus itself. During those first few weeks many of us worked until the wee hours of the morning each night and through the weekends, all the while continuing to see patients, return phone calls, and refill medications. But as these systems have been put into place and fine-tuned, and as the physical distancing and other epidemiology measures on a community level have effectively limited the spread of the virus in our area, life has thankfully slowed somewhat again.  Many of us that do hospital work are waiting to see whether more doctors will be needed to cover shifts, or if the shelter-in-place orders and distancing measures will be enough to avoid a true, overwhelming surge. In the meantime we read and stay up to date, we see our patients via telemedicine or in outdoor COVID-19 clinics and work hard to make sure they don’t fall through the cracks, and we prepare, personally and professionally, for worst-case scenarios. Throughout all of this we have each continued to ask ourselves what our next responsibility is as Physicians in the midst of this pandemic.

In answer to that last question, I have found myself more and more called on to provide an answer to misinformation around COVID-19, as friends and family have attempted to sort out the unprecedented amount of misunderstanding and abject falsehood that has been circulated over the past month. To be clear, even in the best of times there is already an overwhelming amount of misinformation around health and healthcare. The nuances of human health and disease and the means available to protect the former and fight the latter are unbelievably complex, and because of this it is easy for an individual who hasn’t spent a lifetime studying this area to feel overwhelmed and disempowered. The temptation of easy answers and quick fixes is very real. More to the point, Physicians have historically done a fairly poor job, in my opinion, of helping our patients to feel empowered and knowledgeable to the greatest degree that is possible without them actually entering the medical field themselves. In this context, it is no surprise that during this time of increased health anxiety and uncertainty, and with a myriad of political and economic motivations to obscure the realities around the virus, the amount of misinformation has increased dramatically. Between my day job, extra duties related to the virus, and this small matter of having a wife and four children, I consider it a real privilege when I have the margin to address a video or article that a friend has ‘tagged’ me in asking for my input.

But though there are plenty of unaddressed articles, videos, and memes spreading medical misinformation on my facebook feed this very day, I am writing this afternoon with a slightly different, though related, purpose. I am writing to call the Church to participate in this work with me.

We are called to be a people of the truth; we are not called to be a people of truth and falsehood mingled. When discussing his conversion to Christianity, G.K. Chesterton wrote, “My reason for accepting the religion and not merely the scattered and secular truths out of the religion… I do it because the thing has not merely told this truth or that truth, but has revealed itself as a truth-telling thing.” As followers of Christ, Christians ought also to have a reputation of truth-telling. Truth-telling in love, when the truths are difficult. Truth-telling in courage, when the the truths are spoken to those in places of power. Truth-telling in humility and repentance when those truths reflect poorly on ourselves or our conduct. We cannot afford the damage done to the witness of the Church by our gaining a reputation as unreliable sources of truth. Yes, physical health in general and the COVID-19 pandemic in particular, as devastating as it is, are still ultimately minor issues compared to the eternal importance of the Gospel; but how can the world around us look to us for the Truth of the latter when we have only provided them falsehood about the former? “Whoever can be trusted with very little can also be trusted with much, and whoever is dishonest with very little will also be dishonest with much.”

For this reason, I believe that our willingness as a people of Faith to perpetuate misinformation, particularly when it may truly injure our neighbors, is not a political issue or even an integrity issue, but a spiritual issue. There is no truth, whether philosophical, metaphysical, or scientific, that does not belong to our Creator; there is no Truth that we as Christians should fear, and there is no falsehood, no matter how convenient to our preferred narratives, that does not originate from our Enemy.


What follows is my take, as a Physician, on what a lay person can do when trying to weigh truth and falsehood and judge the reliability of medical information during the COVID-19 pandemic. I want you to know that I realize it is often very, very difficult. As a Physician I have the privilege of years of education and training in thinking about real and reliable truths about our bodies and the diseases that affect us; it is never my place to judge someone for sharing information they find convincing because they do not have those same experiences and have spent their time in other important work. It is my job, I think, to help my fellow believers supplement their God-given discernment with reliable data and professional insight; we are all one Body, but made up of many parts.

1. Understand your source.

Returning to Chesterton, I think it is reasonable to ask whether the author of the article or the self-purported expert we are listening to has a track record of providing reliable medical information; have they proven themselves to be a ‘truth-telling thing (er, person)’. Many of the people generating widely shared false information are political partisans who have no medical or other scientific background; are they sharing the perspective of actual experts, or are they merely creating false narratives and opinions out of thin air? If the source is not a politician but instead claims to be an expert, what is their education and background? So often we give our trust to people whose primary credentials are an attractive and disarming physical presence and a high verbal IQ but who do not have even the basic science background to understand the frameworks they are tearing down. I have seen youtube videos captioned ‘so and so DESTROYS the COVID-19 pandemic myth’ or ‘Dr. X crushes the CDC and WHO conspiracy’, etc., only to find that not a single intelligible sentence of valid scientific information was uttered during the entire 15 minute video. These are the ‘used car salesmen’ (no offense to actual used car salesmen; I am very pleased with my 2012 Honda Odyssey) of medical information, and their true area of expertise is in pretending to be experts.

Please understand what I am not saying; I am not saying that you must have a certain degree or a certain prerequisite combination of education or work experience in order to have a valid take on the pandemic. But often these videos are made by people putting themselves forward as experts without the credentials to support that claim; the first piece of misinformation is imbedded in their own self presentation. An example is a video a friend recently asked for input on, from a doctor putting himself forward as an expert on the immune system. It turns out that he was not an immunologist or a microbiologist, but a disgraced chiropractor turned “cellular detox diet” specialist. Again, this does not negate what he has to say; but it is a vital piece of context for weighing the claims he goes on to make.

This research is sometimes hard. These people are often incredible at building legitimate sounding resumes for themselves and at using terminology on their websites and bios that smacks of authenticity and scientific rigor. Moreover, there are also those who do have impressive credentials yet have strayed from any integrity in their work and have become deeply unreliable sources of healthcare information in their pursuit of fame or fortune (a fellow MD friend and I often joke, darkly, how easy it would be to make tons of money as a Physician, if it weren’t for these pesky morals). But even if you cannot establish someone’s reliability with a few minutes on google alone, conducting such research will help to answer a few basic questions that should set the tone for the information itself. Is there a direct link between the reach of this person’s social media influence and their opportunities for attainment of power and profit, such as a political office being at stake or a website that sells services or goods directly? Such a relationship would be fairly rare in medicine or academic science. Are the claims this person makes the types of things that would fall within their area of knowledge based on their education and work experience? Are they setting themselves up as experts in areas, such as clinical medicine, immunology, or epidemiology, where they seem to have had little to no experience? Finally, do they have a history of fraudulent claims, moral turpitude, or failed (or successful) scams in the past?

This step is sometimes a bit tedious, but I believe vitally important, especially when some of these videos are made by people who have spent a lifetime mastering the art of convincing others with their looks, manners, and likability. When it comes to medical misinformation, these are the wolves in sheep’s’ clothing of the moment.

2. Do your research.

This second point is so similar to the first that I won’t spent much time on it. Though understanding whether the source is reliable is important, I firmly believe that the content of the argument is more important still. When considering any degree of medical information shared on social media, or even mainstream media, pause to reflect on the main themes and content of the article or video. What was the driving point? What information contradicts that which is already widely available? What data seems shocking or seems to rely heavily on the existence of widespread conspiracies? For that matter, do those conspiracies depend on the sudden cooperation of diverse and often opposed sectors of society, such as the sudden cooperation of politically unaligned nations or the widespread collusion of large groups of healthcare professionals? What part of the information is benign and widely accepted already, and is it being presented as such? Or is there a claim that commonly accepted facts are denied by or unknown to ‘the powers that be’ (the CDC, the medical establishment, etc), and does that seem very likely? What would the major implications be if this video were true, and who would stand to profit by its widespread acceptance if it were false?

This list could go on, and in another time we would have only these important critical thinking questions to guide us to the informational content itself. But we live in a technological age and the odds are that if we are seeing a video, or at least a popular video, it has been critiqued or fact checked already. Read these critiques; seek them out. This alternative perspective, even if it comes from a source you normally don’t subscribe to personally (I know people who despise certain fact checking websites), may be enough to give you the ‘aha!’ moment you need to reach conclusions on the information for yourself. And if you believe the information and think it is worth sharing, then understanding the arguments against it will only strengthen your position.

3. Be honest with yourself about your political leanings.

I’ll keep this one brief because I don’t particularly want to be dragged into a specific political debate, at least at this time. As people of faith who are committed to the truth, we will find ourselves politically homeless a fair amount of the time, and holding onto important caveats and a sense of tension even in our areas of agreement with political movements. When the truth conflicts with the narratives of the political groups with which we most closely align, our choice is clear. Before sharing information from questionable sources, that our research tells us is not reliable, we have to check our politics; we have to be very honest with ourselves regarding whether our impulse to perpetuate the information stems from a real belief in its veracity or from a mere desire for it to be true. I have heard fellow Christians tell me “all politicians lie” (generally to excuse untruths from one group or individual), and then have seen them blindly re-post the lies that come from their own side. I may very well have been guilty of this myself. If we believe that politicians are not reliable sources of information in general (and we can debate later if some are worse than others to an almost unprecedented degree), it means that we will sometimes choose for reasons of discernment not to pass along information that, were it true, would be extremely convenient to our party or candidate. In contrast, if we find ourselves always repeating the party line and reinforcing the narratives of those in positions of power, I fear that we are in danger of rendering unto Caesar something that never belonged to him.

4. Beware of easy answers.

“Reality, in fact, is usually something you could not have guessed. That is one of the reasons I believe Christianity. It is a religion you could not have guessed. If it offered us just the kind of universe we had always expected, I should feel we were making it up. But, in fact, it is not the sort of thing anyone would have made up. It has just that queer twist about it that real things have. So let us leave behind all these boys’ philosophies–these over simple answers. The problem is not simple and the answer is not going to be simple either.”
C.S. Lewis wrote this when discussing the reality of Christianity and the complaint heard so often that ‘religion ought to be simple.’ But I think this quote is informative for us in this discussion of medical misinformation. Alternative health popularizers like the ones we are seeing in video after video right now have long mastered the art of combining oversimplified ‘common sense’ arguments with the right kind of complex medical vocabulary (some real, some fake), to appeal at once to both our desire that healthcare should be fully comprehensible and explicable to us and our desire to know we are hearing form an expert. They are experts in tickling the ears, in confirming our biases and ingratiating themselves to a public that is anxious over health and disease. For someone who has actually studied both the real concepts they are distorting and the real vocabulary they are misusing, these arguments are as transparent as they are ridiculous; but they are not trying to convince me, they are specifically trying to convince people who don’t have medical training.

That said, you don’t have to spend your life studying pathophysiology and be intimately familiar with medical terminology to spot these patterns for yourself and know when to be wary. These false arguments tend to fall along a few common themes, and once you learn to spot them you will be a big step closer to at least being able to ask the right questions.

  • The real solution is easy but they don’t want you to know that.

This one has come up a lot recently as people advocating against social/physical distancing measures (for political or financial purposes) are pushing the idea that other simple measures would actually prevent getting sick from COVID-19. Typically these are oriented around the immune system, and the idea that having a healthy immune system would actually prevent the disease entirely. Aside from being untrue, this is extremely problematic for two big reasons. First, I think we should recognize the degree of victim blaming involved in this line of reasoning; if these 41,000 people who have died from COVID-19 in the US had just taken enough Vitamin C or eaten a healthier diet they wouldn’t have died. Certainly the interaction between health and lifestyle, including limitations in choices and socio-economic vulnerabilities, is complex. But there is not a set of choices that can make someone immune to illness in general, and in the case of infectious diseases specifically there is not a combination of lifestyle and nutrition that can make a person invincible (even Chris Trager got the Flu on Parks and Rec). Second, just consider the sheer number of people who would have to be in on such a conspiracy. Millions of doctors, nurses, and public health experts, many of whom have themselves become ill or lost friends and loved ones. The idea that all of these people are interested in covering up that a certain number of milligrams of Vitamin C or a certain number of hours of sunlight exposure could have alleviated all of this suffering is not only incredibly naive, but also unbelievably calloused.

  • Germs are good for you.

This is an argument that crops up when discussing any infectious disease, but it is particularly popular now. Many alternative health and particularly detox and microbiome style wellness salesmen are all too quick to tell you that viruses, bacteria, and fungi are important for us; that without them we wouldn’t have functioning immune systems. And they are right. But like so many of their arguments, they have taken just one piece of the incredibly complex story of human health and disease and have extrapolated it to illogical and harmful proportions. I have written about this more extensively recently, but they are essentially failing to make two important points. First, the difference between a microbe (any bacteria, virus, or fungi, etc) and a pathogen, which is a microbe known to cause human disease; it is absolutely not true that because ‘germs are good for us’, therefore infectious diseases are good for us. This virus can definitely kill you. And second, the role of an acute infection in establishing a secondary immune response. Yes, exposure to a pathogen does generally cause some degree of enhanced natural immunity against that same pathogen later (this is the entire principal upon which vaccines are based); but it is not necessary to allow yourself to get ill or indeed become as sick as possible in order to build that robust secondary immune response, and sometimes the risk is much greater than the reward. “Whatever doesn’t kill you makes you stronger” still implies that dying is at least on the table.

I won’t rehash all the points I wrote about last week, but instead will share a quick story. When we lived in Denver we were visiting with a friend after church who showed us a fairly deep cut to his finger, near the joint, which he had received that morning. My wife, an RN, asked what he had used to clean the wound. He explained that he had NOT cleaned the wound because his body needed the germs to build an immune response, and that soap and water would prevent his body from fighting off the infection ‘naturally’. Katie attempted to persuade him otherwise and explain the roll of his immune system and ways he could help his body prevent an infection, but he wasn’t convinced. Two weeks later we saw him again, this time with a large bandage over his finger. We asked about this and he explained how his finger had become infected and he had to go to the emergency room, undergo and incision and drainage procedure to remove the pus, and then take antibiotics. He went into glorious detail about the procedure and the appearance of the infection and even showed us pictures. He did all of this without any sign of chagrin, and to this day neither of us is sure whether he had forgotten the first conversation entirely or if he is just the world’s most humble man.

And while what happened to my friend is funny in retrospect, because his finger fully recovered, it is certainly not funny when someone contracts a deadly illness because they are misled into thinking it’s actually better for their health.

  • The doctors don’t understand (or indeed know about) the immune system.

I’m always amazed when this one makes the rounds because it’s just such an incredibly goofy thing to say. We could spend paragraphs discussing the thousands of hours spent in medical school understanding every aspect of the human body and the huge swaths of microbiology, biochemistry, pathophysiology, infectious disease, anatomy, and pharmacology coursework that were devoted to understanding our fearfully and wonderfully made defenses against infection. I promise you we spent so much time studying the immune system that we dreamed of angry macrophages and inflammatory cytokines. So why such a silly and nonsensical lie? They are setting up a false dichotomy between your own immune system (which they would like to sell you products and services to augment) and the “big-pharma model of medicine”, a red herring of their own invention, which only believes in harsh chemicals. They have to reduce modern medicine and the scientific discoveries of the human body to just this one aspect in people’s minds so that they can claim for themselves the parts of it which seem to sell best. Whether the hucksters making such claims have actually studied the immune system in an intellectually honest and scientifically rigorous way themselves, however, is a question that perfectly justifies speculation.

I explore the rest further in the next section, but a few more, briefly:

  • The doctors want you to stay sick.

This is 100% a lie. Don’t be fooled by ‘common sense’ arguments that suddenly call for millions of well-meaning people to act nefariously.

  • The doctors are being controlled by big pharma.

Don’t be fooled by arguments that require passionate, notoriously difficult to control, and (let’s face it) often egoistic people to suddenly be submissive. Physicians are one of the primary reasons that pharmaceutical and insurance companies don’t yet control all of healthcare.

  • The doctors mean well but have been tricked.

Don’t be fooled by arguments that require very smart people to suddenly be easy to dupe.

5. Ask your brothers and sisters in Christ.

One of the many false narratives that Christians seem to believe at an alarming rate is that the medical field is somehow opposed to the Church. It is easy to point to controversial areas of medicine, or even the general principles of understanding illness and health as primarily physical phenomenon, to say that modern medicine is at it’s core agnostic or secular, and thus antagonistic to the Faith. This is an incredibly profitable narrative for televangelists and healing charlatans who would like you to believe that pursuing any means of healing aside from the overtly miraculous is a sign of lack of faith, and who exploit our fears and insecurities around health to sew mistrust in Physicians and other health professionals for their own profit. Perhaps a step down from the overt chicanery of these false prophets, we also see a strange marriage between Evangelical Christianity and unproven and sometimes even dangerous alternative health measures, which are marketed, sometimes, with a heavy mix of pseudo-Christian spirituality.

But if this is true, what then do we do with the millions of doctors, nurses, scientists, epidemiologists, and others within the healthcare sector that are faithful followers of Jesus Christ? I think the first temptation, too often, is to treat them like they are ‘one of the good ones’; as though a Christian Physician you know personally may be a reliable source of health information, but the medical field, in general, is not. I think this is incredibly problematic. As someone whose 20’s and 30’s were devoted to medical training, I have known hundreds (maybe thousands) of doctors personally. My older children who grew up during my residency thought that “Dr.” was just a gender-neutral way to say “Mr.” or “Mrs.”.  Because of where I have trained, many of these have been believers; but just as many that I have trusted and respected have not. Yes, I have certainly met doctors I would not trust with my own care or that of my family, but these have been remarkably, surprisingly few compared to the number of doctors I have known and worked with. In general I can say that Physicians as a group have self-selected for (and certainly this has been reinforced by training) both their desire to see people well and their commitment to scientific accuracy. To be clear, some of these doctors I disagree with vehemently on issues within medicine and the associated underlying moral and societal values. Nevertheless, and regardless of the cultural misrepresentations, your doctor wants you to be healthy and is, in general, a good and reliable source of information about health and disease. If they aren’t, you should get a new doctor immediately.

As we touched on earlier, a second and similar way to treat Christian Physicians and healthcare workers is as well-meaning but ultimately misled pseudo-experts with only a narrow scope of understanding regarding the human body. This is the view pushed by many in alternative health businesses; doctors are generally altruistic or noble, but they have had the wool pulled over their eyes, their education is controlled by Big Pharma and hospital administrators, and really all they are learning is essentially spreadsheet after spreadsheet of ‘if the patient has this, give them one of these drugs (and here are the prices; pick the most expensive one)’. Medical schools and residencies exist to train doctors to create profits for drug companies. Now, this is an incredibly silly idea and we could devote as much time as we wanted to this. I could explain that I never met a drug rep until after residency, because they generally aren’t allowed to interact with medical students or residents, and have never made a medical decision based on the advice of a drug rep in my life (except for Burton “Gus” Guster, of course). I could (and should, at some point) explain the very complex and often antagonistic relationship between systems within medicine that prioritize profits over people, including pharmaceutical companies, and the physicians, nurses, and clinical staff who exhaust themselves to help their patients find something like justice and equity in their healthcare. But these are areas I am passionate about, and I’m afraid this one section would eclipse the rest of the essay entirely.

Instead, I’m willing to bet that if took a step back and consulted even your own experiences with doctors you know personally, you would realize that their knowledge, education, and personal characteristics does not seem to match this narrative. If you have physicians in your family,, or in your church or Sunday school class, or have attended high school or college with them, or have friends who are doctors- in short, if you do know believing medical experts that you would ask for input on these videos and articles being circulated- ask yourself if they are a reliable source of information even aside from their medical background. Are they the type of people who are easily duped? Do they hold to questionable morals or a low view of the truth? Do they seem to possess discernment? Essentially, are they the type of people you would trust outside of a pandemic to answer questions unrelated to viruses and immunology and epidemiological data? If they are not, I would humbly suggest that you do not turn to them now, regardless of how closely the information you need clarified matches their field of work. But if they are, I would recommend showing them the courtesy to believe that they have applied at least that same degree of critical and independent thinking and that same spiritual discernment to the endeavor that has taken up the majority of their adult lives; namely the study of human health and disease.

Finally, my advice when framing these questions: be specific. When I am asked by a friend or acquaintance to address a viral video or a healthcare related article or meme, I try to be as thorough and complete as possible (I do find that after a few thousand words of my ramblings, they usually don’t ask a second time…). This can be time consuming, but I believe it is important work, and I personally have no problem being asked a general “would you give your input on this.” Not all healthcare professionals have the inclination to be quite so verbose, and of course many of us want for the time to do so now more than ever. If you ask for an opinion on a 20 minute video or a 2000 word article, let them know what your specific question is, or what about the content you found either particularly compelling, surprising, or questionable. If you are only looking for a ‘yes this is trustworthy’ or ‘no this isn’t trustworthy’ and are willing to take their word for it without a long explanation, let them know that as well.

6. Repent (or at least, redact).

I hesitate to make this last point because there is no way to express this without sounding somewhat judgmental. I hope it is clear that I intend to hold myself to this same standard as well, and hope that when (not if) I also fall into the ‘fake news’ trap and share misleading or unreliable information, I have the courage to follow my own advice.

What do you do when you have found information available on the internet and outside of your own area of expertise to be convincing and have passed it along, and through the (hopefully) kind input of friends have later discovered it to be untrue? I think there are a few good options. The simplest is to take it down; to delete the post so that others will not either follow you into believing the false information, or else in disbelieving it themselves begin to associate you with it. I think this is the minimum standard we should expect regarding our interactions with falsehood. However, I think an even better idea is what I have seen a family member do consistently in recent years; whenever she has shared a fake article or untrue information, she has then edited her post to clarify that the information is not reliable and why. Rather than distancing herself from those mistakes she embraces them, and in doing so helps protect others against the same errors. I believe that even better than Christians being known for never spreading false information (which is surely not the case now) would be us being known for the integrity and humility to publicly repent of error and embrace truth; in fact I can think of no more Christian way to deal with such a situation.

There is one thing we cannot do. Once we are aware of the falsehoods in something we have shared or promoted, we cannot choose to cling to it because we like the way it sounds or want people to believe that it is true. I have seen this done far too often; when it has been shown clearly that a source is unreliable or has even told outright lies, I have seen friends choose to continue to endorse and share it. There are myriad reasons, from liking a few of the points that weren’t exactly dishonest to wanting people to accept the overall message even if the content isn’t reliable. As people who believe that truth is authored by our Father and that we have an enemy who is only the father of lies, we cannot be comfortable with the mingling of the two. We cannot say, “yes, 7 of his 12 points were deliberately dishonest, and maybe or 3 or 4 were fairly dangers, but I really liked the other 5 and he’s just such an engaging speaker.” We must hold to higher standards of veracity than this. If we really want to promote those other ideas we should be incredibly, unmistakably clear that the rest of the content is not trustworthy… But better still, we should do the difficult work of finding a more consistently reliable source, and say of the first only that “he is a liar and the truth is not in him.”


I will conclude with the words of our Lord from Matthew 10:16: “Behold, I send you out as sheep in the midst of wolves. Therefore be wise as serpents and harmless as doves.” This pandemic is unlike anything we have seen in our lifetimes, and it is already the number one cause of death in the United States. We are living in an era of human history when reliable, true information is really capable of saving lives and when false information endangers our friends, loved ones, and neighbors. As we seek to obey the command of our Savior, let us reflect that we may never again in our lifetimes see such a moment as this, when these two concepts are so closely linked and refusal to be as wise as serpents can lead so directly to a failure to be as harmless as doves.

Handsome Chiropractor is more concerned about masks and gloves than about COVID-19

My name is TJ Webb, and I do NOT endorse this message.

As might be expected, there are a great many videos and articles about health surfacing right now during the pandemic; it’s a topic that is firmly on all our minds, even more so than usual. Unfortunately this means there is a lot of misinformation out there. I am actually really grateful when friends and family ask for my input on health information; I think informing our communities and using our education and experience to aid in the challenging work of discernment in this area is really important work, and one of the roles we need to engage in as Physicians. That said, there is so much misinformation out there right now, and life is already so busy because of the work of fighting the virus itself, that I have pretty much given up on addressing each article or video point by point in the way I normally would. I tend to be excessively verbose so you could imagine that cutting back is a challenge for me!

First, I would say that a good place to start, really with any of these articles or videos, is to ask whether the source is a reliable source of truth, a frequent source of falsehood and misinformation, or something in between. I don’t mean that we could write someone off because they have been mistaken (even brazenly mistaken) in the past, but simply that it is helpful to know their track record of veracity as a starting place for any new claims. It is important to know if the source has, as Chesterton put it, “revealed itself as a truth-telling thing.”

With that in mind I would encourage you to do some research on Dr. Pompa as a backdrop for understanding his perspective. He is not a medical doctor or a scientist. He has a degree as a Chiropractor. A discussion of alternative medicine in general is outside of the scope of this discussion, but I will say Chiropractory is a widely varied field in terms of adherence to scientific evidence and even basic medical ethics. I have known very good chiropractors who genuinely wanted to help with people’s pain and believed their methodology was superior to (or more often, worked in combination with) traditional approaches such as physical therapy, exercise, etc. My parents see a Chiropractor to this day and he came to all of our new year’s gatherings growing up; I like him very much as a person, and I’d like to think they are mostly like that. There are also, unfortunately, some Chiropractors who have discouraged patients from following the advice of their Physicians and receiving necessary treatments, and convinced them instead that a realignment of their spine can cure everything from diabetes to cancer. I have known some to sell unbelievably expensive and entirely unproven supplements from their offices and branch into other facets of alternative medicine even more dubious. Sorry to digress; all of that is to say, we don’t know what kind of Chiropractor he was, but when he speaks on virology, immunology, and microbiology, we need to understand that he is by no means speaking as an expert, or as someone who has actually trained in those areas of study extensively (though I’ll be the first to admit that I don’t actually know how much microbiology and immunology is taught in Chiropractor school; if a Chiropractor reads this and disagrees with my assessment, please feel free to lend your insight!).

Further, I think it bears pointing out that he is no longer practicing Chiropractory. As best I can tell, his license with the Pennsylvania board of Chiropractors has been on probation since 2014. To be fair, this was due to “moral turpitude” over a civil issue (which you could google if you wish, but I won’t share the details of the case here) and not due to issues related to his practice (this is of course assuming I have the correct Dr. Daniel Pompa, Chiropractor. I am ready to retract this information if someone is better at google than me and it turns out to be a different guy!). He currently works as a “cellular healing” and detox consultant and, as far as I can tell, all around alternative health huckster. His website and blog are absolutely full of dubious claims (though I’ve seen worse) and, of course, are oriented around a (presumably) expensive and unproven service that he can provide. Only Dr. Pompa has the key to unlocking your cellular health!

So, what’s the most we can say about Dr. Pompa so far? We know he trained in a fairly mainstream, regulated alternative medicine field, but is no longer able to practice in that field for legal reasons unrelated to chiropractory itself. We know that he now works in an entirely unregulated field of holistic healing/alternative medicine and puts himself forward as a “cellular healing and detox” specialist, which are not real areas of medicine. We also know that he is a very gifted communicator. He is handsome and well spoken, he dresses well and is likable on video, and most importantly he uses the combination of “common sense” arguments and pseudo-science vocabulary that is what makes alternative medicine seem especially convincing; the terminology all seems like the right type of terminology, but there is nothing here that you could say ‘well that doesn’t make sense’ to (in contrast to what C.S. Lewis says about things that are actually real; “the problem is not simple and the answer is not going to be simple either”).

So, with all of my initial apologies about brevity, I find myself out of time and having not even addressed the video itself. To be fair, I didn’t know that there would be so many cautions to share about Dr. Pompa when I first started to research his career. Honestly, that ought to be enough; he is someone who has made a career out of selling unproven treatments based on empty scientific-sounding vocabulary and personal presence alone, once ‘mainstream alternative medicine’ would no longer allow him to practice, and his video above is convincing, where it is convincing, primarily because of these two factors. But I do believe that it is worth addressing the content of the video itself, and if you’ll give me leave I will attempt to do so in a few hours after my children are in bed!


I’ve watched the video a couple of times and taken down a few quotes, but I’d like to start with a short preamble: It’s really not all that bad. Please understand, I’m not saying it’s true; if I were a fact checker I would have no choice but to categorize it as “fake.” But my standard for misinformation has probably shifted a little during this pandemic, and this video is pretty benign overall. Like so much of the alternative health industry, it is an uneven and patchy mingling of truth and falsehood, so you couldn’t say “everything he said is dead wrong.” This is one of the problems with this industry; people who are in it REALLY believe in it, much of the time, and often have a few scientific facts or principles down but without any supporting context or science education, so they easily believe entire narratives that are built up around those few isolated truths.

I’m also not quite sure why he’s making the video. I suppose that in his line of work fame and notoriety do lead directly to financial success, and we are seeing a lot of people in alternative healthcare trying to use the pandemic to make a name for themselves and be seen as an expert. There’s certainly plenty of evidence of that in the video, from him saying ‘bottom line the experts have missed it’ to ‘this study confirms my point’ and lots of other subtleties of language intended to convey that he is the true expert on health and the poor guys at the CDC and WHO just don’t know any better. So, maybe that’s part of it; that is certainly the name of the game in that industry. But I’d like to overall give him the benefit of the doubt and say he really believes his message and wants to get the information out there; maybe I’ve been duped because he’s just so darn handsome so I’d like to believe him.

The problem is that it just isn’t reliable information. There are a few extremely egregious falsehoods, and we might as we’ll get them out of the way now.

“They’re looking at the death rates just sinking around the virus, saying ok it’s probably more like 0.1% at best, which is basically the same as the regular flu.”
“The bottom line is the experts have missed it.”

-I have no idea where he got this information from. Maybe he heard it somewhere but misinterpreted it? The ‘no more dangerous than the flu’ line seemed to have quieted down for a while as the pandemic spread, but has resurfaced as social distancing and containment measures have proven effective; it’s a very easy thing to say when you don’t have family and friends who are in the ICU or have died from the virus, and in many places there are so few severe cases that it’s easy to believe that COVID-19 “wasn’t actually that big of a deal”, as though the pandemic 1. Hadn’t already killed over a hundred thousand people, and 2. Was already over and done with. This is something public health experts and lay people alike have been saying since the beginning; if the extreme measures we take now actually work, people will say they weren’t necessary. In places where the healthcare system is particularly overwhelmed, the case fatality rate remains above 5%; astronomically higher than seasonal influenza. In places where the healthcare system can cope with patients at a more routine pace, without running short of either Physicians, Nurses, other support staff, or equipment, the rate is much lower; but still on the order of 2%, not 0.1%. This is an incredibly deadly disease, and before anyone buys into the conspiracy that this was all hype pushed on us for this purpose or that, they should open themselves up to the images and stories coming from Washington, New York, Louisiana, Italy, and Spain. I am sure we will soon enough be told that those people were all “trauma actors.”

The biggest question mark in all of this, of course, is the lack of universal testing. Our testing policies so far have been driven by test scarcity, and there has ALWAYS been the assumption that as more testing on asymptomatic or minimally symptomatic patients occurred we would find a large cohort of people who were more or less healthy despite having the virus. But we are still very, very early into having this sort of testing anywhere, and from colleagues in healthcare system that DO have universal testing policies I am hearing that they just aren’t seeing many asymptomatic carriers. So although we will not be able to come to a final estimate of the death rate from this virus until all is said and done, so far it is too early to see the drop in the death rate due to asymptomatic cases that we all have expected.

“But because they are attributing many different conditions to Corona it’s probably even half that.”

-It’s hard to know what he means, but I believe he is referencing the conspiracy theory that someone is either inadvertently or intentionally inflating the death rate for COVID-19 by attributing deaths due to other conditions to the virus. I’ve addressed this in detail a few days ago on another Facebook post; I am happy to share it with you if you would like.

“Now we know it was a narrow group of people that were truly at risk for this virus.”
“You can tell from my past videos that I am not one to have been fearing the virus.”
“People are realizing that it’s not as dangerous as we thought and they want to get the antibodies…. Because if this mutates we could all be at risk.”

-This is a bit revisionist. He is making it sound as though we initially thought that every person had a big risk of ending up hospitalized or dying from COVID-19 and now we know it is only people with certain risk factors such as age, other medical conditions, immunocompromise, etc. This is actually the exact opposite of the true history of our understanding of COVID-19, and it was shocking when reports of death in young healthy people began to come out of Europe and then began to occur in the United States as well. Of course older people with medical problems are at higher risk; that is true for any infectious disease. But this is a virus that is, in fact, dangerous even for people who are young and healthy. We are ALREADY all at risk.

As far as the second quote goes, please do not be fooled; this disease is dangerous enough that TRYING to get the antibodies “naturally”, by intentionally being exposed to the virus, would be incredibly foolish and irresponsible. Vaccines were invented because some diseases are so dangerous that taking a chance on the live, unattenuated pathogen is the same as gambling with your life.

“They put things into place not understanding the risks…”

-I’ve included this because, briefly, I think it illustrates this concept of setting oneself up as an expert that is so common in these videos. The idea here is to convey that the people in charge, the epidemiology experts and virologists and the people who have actually spent years and years studying human disease and microbiology and human immunology, all meant well but just didn’t know or understand what he does. He goes on, as we’ll talk about below, to discuss the hygiene hypotheses of autoimmune disease and the ‘dangers’ of wearing masks, and if you connect the threads it really seems as though the physicians and researchers who have recommend ways to slow the spread of the disease just aren’t familiar with the principles he is referencing, which is of course preposterous. Please note, however, that he is releasing this video NOW instead of 2 or 3 weeks ago; now that the “things they put in place” have actually shown some measure of success, he has the luxury to say that none of it was necessary.

The Hygiene Theory

After this, we finally get into the real meat of his argument. He starts by quoting a study, “having fewer sanitary amenities in childhood is linked to a lower risk of having inflammatory bowel disease.” This is a basic concept of the hygiene hypothesis, that exposure to certain microbes is necessary and decreased exposure leads to multiple disease, including autoimmune disease. This is a valid scientific theory with a good bit of evidence. Like most things in medicine (or for that matter, most things in real life period), it is much more complicated than it is presented here. It would be dangerous, for instance, to presume that because some bacteria, viruses, and fungi are important to our growth, development, digestion, and the functioning of our immune systems, that therefore ALL such microbes are healthy and beneficial and we were wrong to want to protect ourselves from them. Concluding that because exposure to more microbes is linked to decrease in risk of inflammatory bowel disease, we should expose ourselves to ALL bacteria and viruses including the one that causes COVID-19, would be particularly illustrative of the clinging to a few points of medical data without actually understanding them that we talked about before, which is so emblematic of this industry.

“The whole point of all of these studies is that more the viruses, bacteria, and pathogens you are exposed to the healthier your immune system is.”

-I cheated there, because I knew he was going to say that already as I was writing that last paragraph. What he’s done is taken one category of disease and one set of risk factors for those diseases, and conflated them with all of human health in general because the words happen to be the same. Because disease, bacteria, and microbe all appear in both discussions of the hygiene hypothesis of autoimmune disease and in concepts related to infectious disease, he believes that data from one can be used to negate data from the other. It is a basic failure to understand the concepts and even the terminology that is being discussed. To put it more simply; he is stating that because some bacteria are good for us, bacteria can’t be bad for us. He probably doesn’t really believe that, but the implication is that if your immune system is healthy enough then everything that would make others sick will just make you stronger.

The failure here is to distinguish between viruses, bacteria, and fungi in general, and pathogens, which are viruses, bacteria, and fungi (and other fun little guys) that cause diseases in humans. Avoiding pathogens that can make you sick is the most basic way of avoiding dying from some of the most painful and devastating killers in our fallen world. It’s the reason we don’t eat raw pork and why we wash off a cut. It’s a very basic concept that is taught even in high school biology, and it isn’t confusing to anyone in the medical field. It isn’t really confusing to anyone at all, until the obfuscation occurs in videos like this. The alternative health industry, and particularly those sectors of it that are focused on ‘restoring natural immunity’ and establishing healthy gut flora, etc, need to convince you that they are the only ones that really understand these concepts, so they obscure simple ideas, minimize complicated ones, and conflate terminology until they have a version of our complex immune systems and interactions with the world around us that is almost, but not entirely, completely untrue. They would like you to believe that everyone else is confused; that doctors think all bacteria are bad and want to sterilize your microbiome and gut flora with antibiotics and hand sanitizer, and can’t distinguish between the presence or absence of an infectious disease. There was even a video recently where an alternative health partisan claimed that doctors don’t study the immune system in medical school at all, which is obvious nonsense. And in trying to convincing you, they do convince themselves.

“Before this we had the hygiene theory: run from bacteria, kill all the bacteria”
“Let’s not throw a whole decade of research out the window”

-Again, just to be clear, the hygiene hypothesis IS the theory that decreased exposure to microbes increases the risk of certain diseases. And the theory and research around it has been around for decades. I find it concerning that he keeps exactly inverting the concept of the one scientifically valid theory upon which he has built his entire pseudo-medical philosophy, and then calls it a failed theory that we have to abandon. In his defense, it is a misnomer, since avoiding non-pathogenic microbes has nothing to do with hygiene.

“If I was going into a group of people that was at risk I would wear a mask….”
“It wasn’t about killing bacteria and viruses and pathogens, it was about living with them.”

-You might notice, as you watch the video, that he frequently shifts between treating the virus as something to take seriously and something we should live alongside and go ahead and ‘get antibodies’ to as early as possible. We haven’t really beaten this thing yet, so I don’t think that the people making these ‘it isn’t so bad’ videos can be quite so brazen in saying that the virus isn’t dangerous, no matter how much data their audiences are generally willing to ignore… at least, not yet. He is willing to tell you that you should keep your grandmother or immunocompromised friend safe by wearing a mask around them, but at other times in the video he encourages you to touch your face and implies that we need to take this opportunity to get exposed before the virus mutates. In 2-3 months we will see many articles and videos of people telling us that we missed our chance to have “COVID-19 parties” and that this is because big pharma and their pawns, doctors and nurses, want to suppress our natural immunity so they can sell vaccines. But those videos will have to wait until people stop dying from this virus. SARS-CoV-2, at least for the time being, still has to be respected as a pathogen.

“The hygiene philosophy failed. The antibiotic era, hand sanitizers, all of it has FAILED.”

-Let’s be clear; hygiene measures associated with germ theory have saved more human lives than any other intervention in medical history (vaccines and antibiotics are also in the top 5). It is ludicrous to say that hygiene doesn’t save lives. There are places in the world and in the United States where we STILL see the devastating effects and widespread disease and death associated with lack of access to clean water and basic hygiene measures. This is a privileged belief from every standpoint; chronologically, geographically, socio-economically. Living in a hygienic environment with potable water and clean, nutritious food, he has the gall to say that hygiene is a failed concept. He would like us to use the word ‘hygiene’ as a synonym for his red herring of ‘sterile’ and believe that doctors and public health experts want us to never be exposed to the world around us, which is patently false. He then wants to conflate the hundreds of years of excellent hygiene and microbiology work that has been done, which has saved billions of lives, with his own narrative that if they had their way doctors would have us all living in white rooms wearing gloves and afraid to let our kids play in dirt. Why? Because thoroughly undermining generally altruistic physicians and nurses that practice actual evidence-based medicine is very good for the alternative health business.

“The true risk of what we’re calling the new normal.”
“People with masks and gloves”

-Please wear masks. Please treat the virus like it can cause terrible respiratory failure and kill you, because it definitely can. Nobody is recommending you lysol your house daily (but please do it to the kitchen counter if you are cutting raw chicken, because Salmonella is a bacteria that IS a pathogen and can also make you sick). Your kids can play in the mud; they can do it today, if you’ve got some mud in your back yard and nobody has been over to cough on that mud. Wearing masks every day of our lives, not hugging each other, avoiding social gatherings, avoiding dirt and trees, and cleaning everything we touch are not practices that have ever been espoused by Physicians or public health experts. Taking precautions as individuals when we are ill, and as a society right now because a particular, new, deadly virus is currently spreading in our communities and threatening to overwhelm our ability to care for those affected, is something we espouse; and I believe that, regardless of what some people might want us to believe, most of us have the common sense to see the difference.

Memes for Dr. Shiva Ayyadurai

I had hoped at some point this week to write a rebuttal to the incredibly deceitful and frankly quite silly “Dr. SHIVA Ayyadurai, MIT PhD Crushes…” youtube video that has been shared so widely by my facebook friends. I still hope I get the chance, but it’s about 16 minutes long and each minute has about 2-3 nonsensical statements, outrageous falsehoods, or outright lies. In the meantime here is a good start from a fact checking website:

https://leadstories.com/hoax-alert/2020/04/fact-check-biological-engineer-did-not-offer-medically-supported-information-in-viral-video.html?fbclid=IwAR2qmsSs0zMGsXtq0Q3QaAjFMgEiVeAjYDoQ-o8EfR8JkmUXmOn-SbNXmRE

So, I haven’t had the chance to write about it yet… but I did make some memes.

What happened to all the deaths that AREN’T from COVID-19?

I’ve seen this meme and the sentiments expressed therein posted around the internet, and from spending some time in ultimately futile arguments with the people sharing them, I am slowly coming to the realization that the “I wonder why” might actually be rhetorical. When I’ve tried to explain “why” so they don’t have to wonder anymore, it seems like maybe they thought they already knew the answer. In fact, shockingly, it seems that rather than a sincere question about medical statistics, they are actually implying that the COVID-19 death rate is being inflated for political or other purposes. So rather than continuing to offer my explanations to people who have sort of already decided they don’t want them, maybe I will offer them to you, who at least might find it a little interesting.

One word to begin with; one possible implication here (which has been stated explicitly elsewhere) is that Physicians are falsely attributing deaths to COVID-19 that are really caused by other diseases, in order to inflate these numbers. You will have to ask the conspiracy theorists for more details. For instance, what agenda are the doctors trying to forward here? If this is an anti-Trump thing, how did the libs manage to convert all of the 60 year old docs I work with that get mad when I turn off Fox News in the doctor’s lounge? If this is to give the current government more emergency powers or something like that, how did they convert the physicians I know who went into medicine to further social justice? We are a pretty diverse group here in doctor land, and if somebody has managed to recruit us all into a nation-wide conspiracy, I’d like to attend that person’s TED Talk. The medical community could use more people like you! The insurance companies, healthcare administrators, and pharmaceutical companies have been callously taking advantage of our compassion, energy, and time for years, and we, our families, and especially our patients are the ones who end up paying for it. So once you are done with your COVID-19 conspiracy please stick around and help us get organized!

To be clear, I have never heard of a doctor lying on a death certificate. It happens all the time on TV shows so it must happen in real life, right? And it probably does, at least sometimes. But if it does, it’s because that individual clinician has failed the integrity test, or more often the cognitive dissonance test, and described the events of the patient’s death in a way that diminishes or obscures their culpability. If that’s the case it really is shameful, and there are failsafes and powerful analytical tools in place (although I honestly believe, not used often enough) to ensure that the events of a patient’s death, especially an unexpected death, are really and thoroughly understood. I will say, most of the Physicians I know are more likely to swing the other way; to take on too much personal responsibility, to assign too much blame to themselves when a patient passes. We carry our dead around with us for years, and very, very often there wasn’t anything that anyone could have done differently. When there was, hopefully we have learned from it; but the pain may last nearly as long as the lesson. But all that to say, the idea of doctors across the nation suddenly embellishing death certificates and medical records to make a virus we HATE seem even more dangerous than it already is seems pretty ridiculous, aside from being just blatantly not true.

Of course, there are people who will be quick, especially when speaking to a Physician personally, to remove this culpability by one degree of separation; maybe it isn’t the doctors themselves but hospital administrators or bureaucrats, or the ‘deep state’ officials at the CDC and WHO, who are falsifying the data. Weary unto death, all I can answer is “fine, maybe.” There’s only so many layers of conspiracy theory I can personally unpack for someone. Listen, you won’t find many people who spend more of their time fighting medical bureaucracy than I do (I’ve written Hamilton rap parodies about it), but please consider the sheer number of people who would have to be in on it; governments across the globe and all across the political spectrum, Trump allies and critics alike, the army of scientists and researchers and analysts at these big organizations, most of whom stand to gain absolutely nothing by falsifying data and who have deep seated personal convictions about the integrity of their work, just like you and I do, and who probably have to be very careful talking about politics around the office because they have diverse and sometimes volatile political leanings, just like your office does. Not to mention the hundreds of thousands of Physicians, Nurse Practitioners, Physician Assistants, Nurses, CNA’s, Respiratory Therapists, and other healthcare workers around the globe who are sharing their personal stories from the hospitals they actually work at every day. I mean, thank you for extending the courtesy to not believe I am personally a dishonest, corrupt conspirator; but pretending that each physician you personally know just happens to be “one of the good ones,” but are ultimately naive and have the wool pulled over our eyes, really isn’t much better.


The real answer to this meme is a lot more straightforward, and quite frankly a lot more worrisome, at least for a Family Medicine Physician like me. You see, these “other” causes of death that this meme is talking about don’t typically cause death all at once, suddenly, all on their own. Most chronic conditions that statisticians point to as “leading causes of death”, like chronic lung disease, diabetes, and even most types of heart disease, won’t cause you to just suddenly die (again, especially certain cardiac conditions are an exception to this). If a person passes away suddenly and has Diabetes listed as a cause of death, you won’t hear their doctor tell the family, “well, you know, sometimes this happens when you have diabetes.” With most chronic diseases, death from that disease is going to be preceded by a sub-acute deterioration and/or an acute exacerbation, often triggered by other acute illnesses, lapses in care, and other factors. In fact, there will usually be multiple cycles of recovery and deterioration before the hospitalization that leads to their passing, depending on the specific medical condition and the patient’s wishes and planning for end of life care as that condition worsens.

In this way, most chronic conditions can, from a mortality standpoint, be thought of as severe medical vulnerabilities; if managed well, it is usually still going to take an event or acute illness of some kind to kill you, but those medical conditions make you that much more vulnerable to those events and illnesses. I have seen older people with congestive heart failure go into acute respiratory distress from pulmonary edema a few hours after eating salty movie theatre popcorn. I have seen poorly controlled diabetics rapidly deteriorate after just a few missed doses of (now unbelievably overpriced) insulin. I have seen cancer patients quickly pass away following a pulmonary embolism, a blood clot that formed in their lungs because the cancer makes their blood hypercoaguable. And of course, we have all seen countless men and women with COPD and CHF pass away from complications of the flu, which a younger person without similar comorbidities might have been able to weather at home. However, unlike other medical vulnerabilities (poverty, lack of transportation, living in a food dessert, marginalized status, etc.), these medical conditions are typically listed in the medical record under distinct diagnostic codes and are listed under the sequence of events in a death certificate. Because of this, it really is possible to track the degree to which these diseases are implicated in death over time. But these diagnostic codes are not mutually exclusive; if a Physician believes that a patient’s Diabetes and Congestive Heart Failure directly contributed to their death from Pneumonia, all of these would be listed both in the patient’s medical chart and in their death certificate. So depending on whether you are examining data for immediate causes of death, contributing causes of death, or underlying causes of death, you are going to get some drastically different data sets. Hypertension and kidney disease, for instance, are much more likely to be contributing factors to death than immediate causes of death.

So, with all of this background information, where are all of the deaths from stroke, heart attacks, and pneumonia? Well, I think there are four likely (and non-mutually-exclusive) answers to this.

1. You might notice that in contravention of the icanhazcheesburger act of 2014, this meme doesn’t actually cite any sources; nor have I seen any data sources that suggest the actual death rate attributable to standard leading causes of death have actually decreased. This may simply be a falsehood, pure and simple. Are you surprised? Welcome to the internet; I’ll help you build a geocities site. I’ve searched for data actually showing that over the last 2 months there has been a drop in all-cause mortality or non-covid-19 related mortality either regionally or nationally, and it just doesn’t seem to exist. If you have it, please send it along; I’d be very happy to sit down and pore over it with you (over zoom). If anything, and here’s where we really get controversial, there’s plenty of evidence that the statistics may actually BE UNDERESTIMATING mortality attributable to COVID-19. But that’s outside the scope of this entirely too long already post.

2. In some ways, we do expect death due to certain conditions to decrease during a pandemic. Social distancing means less travel and thus fewer accidents. Fewer parties and social events generally means fewer deaths from accidental drug overdoses and alcohol. Other more subtle factors are likely at play; less travel also means fewer patients who take a 5 day trip and forget to pack their blood thinner or insulin, and less eating out probably means fewer diet-related episodes of DKA or CHF exacerbations. Of course other causes of death, such as those related to suicide, domestic violence, and child abuse may go up; it’s too early to see all of the ramifications of the drastic measures we have taken to fight this terrible disease. The cost has yet to be counted.

3. The data does show that COVID-19 is “now the leading cause of death in the United States” as one news source put it (google it; I won’t clutter up this post with link after link). Does that mean that deaths from heart disease and chronic lung disease are down? Is that because doctors or administrators or the CDC is “recategorizing” these deaths as COVID-19 deaths? No. A great number of those COVID-19 deaths ARE deaths from heart disease, chronic lung disease, and uncontrolled diabetes, just as a great number of deaths from the flu are ALSO deaths from heart disease, lung disease, and diabetes. These vulnerable patients that have these diseases are the very same people we are trying hardest to defend with social distancing and innovative healthcare delivery and isolating suspected and confirmed COVID-19 patients. Doctors and nurses aren’t ‘wondering why people aren’t dying’ from these diseases anymore; they are seeing them dying from these diseases making them significantly more vulnerable to complications of COVID-19, and desperately trying to protect them. Data that shows the full set of contributing factors will still show these diseases; but you might see the underlying cause of death data be more readily available, because slicing data in a way that minimizes the impact of an actually terribly deadly virus isn’t particularly helpful in the middle of a pandemic. What we want to know is how dangerous is this virus to ALL of our patients, even and especially the ones we worry about already.

4. Finally, regardless of this meme’s failure to give any sort of statistical support, I highly suspect that there are patients who might have been in the hospital right now for their heart failure, their lung disease, or their cancer who aren’t because of the Pandemic. This is due to a lot of factors, but all of them boil down to a necessary but dangerous shift in treatment thresholds and an overwhelmed or potentially overwhelmed medical infrastructure. ER doctors have a higher threshold to admit patients to the hospital because, even more so than at normal times, they are safer from infection at home; the risk-benefit ratio has shifted. Clinic doctors are handling more than ever before over telemedicine and other innovative care options, but that transition in itself is going to mean that things are missed because the routine is disrupted. Where are the hospitalizations and deaths from heart disease and lung disease, from strokes and diabetes? They are there as part of the COVID-19 hospitalizations, certainly; but we are terribly, terribly afraid that they are also at home, with the worsening of their condition going unnoticed, and that by the time this pandemic is over and normal life resumes it will be too late to intervene. All of us are afraid of a second spike in COVID-19 deaths if social distancing measures are discontinued too soon, but we are also concerned about a third spike; a spike of all-cause mortality and morbidity from the disruption this pandemic is causing to our normal modes of treating patients. That’s why we are working around the clock to figure out the best way to take care of the patients under our charge while at the same time preparing for and fighting the battle with COVID-19. Maybe you are tempted to look at this last point and say, ‘see, this means we should open things up and get back to normal life!’ That would be a costly decision in terms of human lives; what good does it do to catch someone’s worsening glycemic control a month early if in doing so you’ve exposed them to a virus that will kill them in 2 weeks? We are having meetings daily and working past midnight to try to figure out how to do both; to care for the chronic diseases and catch the lurking threats early, and yet protect the patient from the known enemy that has already claimed AT LEAST 23,604 lives in the US alone since February 29th. It’s a moving target, but we are still in the middle of this fight, and for the physicians and nurses on the ground politics has nothing to do with it; we are fighting for our patients. That is, for you.

So please, from your facebook friend who also happens to be a doctor, think twice before sharing memes or youtube videos that imply we are all part of some big conspiracy (wittingly or otherwise) to inflate the pandemic and hurt this group or undermine that politician. I promise you we are all far too busy.


Edit: Please forgive typos, I have patient calls to do before bed and won’t re-read this monstrosity.

Edit 2: For anyone who cares, I’ll try to address that youtube video sometime this week. You know the one.

Edit 3: A colleague shared the original article, which would have answered the tweeter’s “I wonder why” if she had bothered to read it. It is written by another MD experiencing the ‘calm before the storm’ of social distancing measures in areas where the peak hasn’t hit yet, just as we are here in Waco. He mainly talks about the concepts I’ve discussed in explanation 4 and 2 above, in that order, and encourages people NOT to delay emergency care for other diseases or conditions out of fear of the virus, which is good advice.

What he does NOT do is imply that someone is alternating cause of death in reports.

You can read it here: https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html?fbclid=IwAR2qO2ip3oihI9-cix00xQaVCPOKjORW4uIcX5GJEJsU9GaUfbJTEI3ore8#click=https://t.co/HOX2Tc5PWt