COVID-19 and Bell’s Palsy: I wish she was my patient.

When a friend sends me a video about a vaccine reaction and the next day multiple patients mention the same video to me in clinic, it’s probably time to watch it, and write about it. The video I’ve linked to below is of a registered nurse named Khalilah Mitchell who lives in Nashville Tennessee, who warns about developing Bell’s Palsy, paralysis of one side of her face, after receiving a COVID-19 vaccination. It is impossible to watch the video without empathizing with her, and I encourage you to watch it if you possibly can; I’ve supplied the link below, assuming it’s still up.

Video: RN Took Vaccine: This is What Happened

Instead of going through it minute-by-minute like we’ve done so often in the past (it is very short, at just one minute and twelve seconds), I want us to dissect a few different aspects of this.


Healthy Incredulity
Bell’s Palsy: Medical Facts
Bell’s Palsy: Why I Wish She Were My Patient
Healthcare as War on Black Bodies

Healthy Incredulity

I want to start by stating that I believe this person’s story, for reasons we will get to in a moment. I think that when we develop the disposition to refuse to believe people’s stories about themselves and their experiences we place ourselves in grave peril. This is one of the common and insidious effects of the disinformation campaigns (both medical and not) that we have seen escalated over this past year; whenever someone hear’s something that doesn’t fit into their chosen narrative, they can simply say “but how do we even know if that actually happened?” Certainly, when someone (I won’t name names) consistently proves themselves to be a source of falsehood, their word becomes worthless; but to automatically treat a stranger that way, especially a stranger who is clearly hurting, is to shut ourselves off from compassion and reason in the name of protecting our own biases.

This individual is clearly distraught and deserves our empathy. But there is a balance and a tension here, because the 340,000 people who have died from COVID-19 in the US, and the 1.8 million people who have died from it around the globe, and their families and friends and communities, also deserve our empathy; and so do the many more who are still at risk. We can love both, and that may mean accepting someone’s narrative about themselves and their experiences without agreeing with their scientific conclusions. And that’s ok.

And so while I believe this person’s experience, I would be remiss if we did not start with a very brief survey of what we do and don’t know to be true from this video, for the sake of encountering this sort of viral information with our eyes fully open.

  1. We know this woman has Bell’s Palsy, or at least has visible symptoms consistent with that diagnosis.
  2. We know she is an African American woman, a group who among all demographics in the US probably has the most reason to be cautious and skeptical towards the medical field.
  3. She identifies herself as Khalilah Mitchell, a Registered Nurse in Nashville, TN
    • The Tennessee nursing board does not have any record of a registered nurse by that name.
  4. She reports that she developed Bell’s Palsy shortly after receiving the COVID-19 vaccine.
    • We do not have evidence that she received the COVID-19 vaccine.

Let’s talk about that 3rd bit, which has been homed in on by multiple fact-checking sites. There are multiple reasons Khalilah Mitchell might not be listed on the Tennessee nursing board’s online records:

  • She may be a recent graduate or have recently received her license in that state; we don’t know how long it takes for those licenses to be searchable online.
  • We are in the middle of a pandemic; she may be a nurse licensed in another state who has special permission or an emergency/temporary license to do travel nursing in Nashville.
  • She only states in the video that she is “in Nashville Tennessee.” She may well be licensed in and work in another state while living in (or even visiting) Nashville. This is not uncommon.
  • She may go by Khalilah but actually have a different legal first name; Khalilah may be a middle name or a nickname.
  • She may be Khalilah Mitchell but be registered under a different last name because of a recent marriage, divorce, etc; changing your name on your nursing license is a beast of a process, as my wife can tell you first hand.
  • She may be using an assumed name or placing herself in a different city and state, or both, to protect herself from reprisals in case this video goes viral (which it has).
  • She may be lying.

Only one of those reasons, all of which are feasible, negates her story; only one causes us to mistrust the only unprovable/non-falsifiable aspect of her story, that she did indeed receive the COVID-19 vaccine prior to developing her symptoms.

Sadly, hiding among the many people with legitimate fears and uncertainties about healthcare in general and vaccines in particular, there are dishonest people who are not above creating misleading and blatantly false information to deceive others. If this person were a known producer of anti-vaccine propaganda, disbelieving her entire story would be warranted; but I have no reason to believe that’s true, and thus have no reason to disbelieve her story, as some have done, merely because certain aspects of it cannot be verified.

So I believe her story. However, because there have been and will continue to be elaborate, malicious attempts to deceive the public about these COVID-19 vaccines, I believe we are justified in maintaining a healthy degree of incredulity each and every time we encounter one of these types of videos; the intellectually honest and important work of discerning whether the information presented is true in no way negates or cheapens our compassion for the speaker.

Bell’s Palsy: Medical Facts

I want to talk about the clinical side of medicine, and the human side of medicine. In reality we can never separate them, but we can compartmentalize them for a few moments for the sake of discussion.

Bell’s Palsy is a temporary paralysis of the Facial Nerve, the seventh cranial nerve which controls the muscles of the face. This paralysis occurs without warning, usually gets worse over 2-3 days, and then starts to improve after about 2 weeks. Usually it is entirely improved by 6 months and does not cause long lasting symptoms; but sometimes it does, and the extent of damage to the nerve likely plays a role in the symptoms lasting longer. The cause is unknown. It’s an area researchers have studied for years. A leading theory is that, like shingles, it is caused by a reactivation of a herpesvirus that lies dormant within your nerves. In that case it can be triggered by any compromise of the immune system, but also by physiologic stressors; it has been associated with diabetes, high blood pressure, pregnancy, acute viral infections, and vaccines, all of which tax the immune system (the latter two temporarily). Another theory says it is the immune system itself, in the act of fighting the virus, that causes ‘friendly fire’ damage to the nerve, and this would also explain why it is not just associated with herpesviruses but with other viruses like flu, hand-foot-and-mouth, common colds, and even COVID-19 infection itself. The immune system is also activated by vaccines (that’s how they work; they teach your immune system how to fight new viruses and bacteria it has never seen before), and so also have the theoretical potential to cause Bell’s Palsy, though careful studies have not supported an actual link between vaccines and this condition. But these are still just theories, and we don’t actually know. I treated a patient last week whose Bell’s Palsy, as far as we can tell, occurred seemingly at random.

So, do the COVID-19 vaccines cause Bell’s Palsy? It’s a difficult question to answer. In the vaccine trials, the rate of Bell’s Palsy was incredibly low: 4 in the Pfizer trial and 3 in the Moderna trial; 7 cases out of over 70,000 participants. That’s less than half the normal rate of Bell’s Palsy in the general population, which is about 35 cases per 100,000 people. The rate was higher in the vaccine group than in the placebo group, though the numbers are far too small to draw definite conclusions.

If I were to sum up the evidence for my patient or my family member, I would tell them this; getting the COVID-19 vaccine might carry a tiny increased risk of developing Bell’s Palsy compared to not getting the vaccine; but the risk is still about the same overall as it would be just going about your every day life.

Maybe that feels like a paradoxical answer, but truth is often like that. About 40,000 Americans have had Bell’s Palsy this year; very, very few of them have had the COVID-19 vaccine, but those that did may blame it on the vaccine. Those who didn’t may blame it on something else; another illness, their flu shot, stress. They may be right or they may not be, but until we understand the condition better there is simply no way to perfectly avoid it, and it is so rare and typically so benign a condition in the long run that basing our medical decision making on it is unreasonable, both as physicians and as patients (and please remember, I am both, just like every other doctor you know). If you get the COVID-19 vaccine, you are extremely unlikely to develop Bell’s Palsy; no more or less likely than you are to develop it in the coming year anyway. What you are much, much less likely to develop is a severe or fatal case of COVID-19.

Bell’s Palsy: Why I Wish She Were My Patient

Reading that last section, you may think I’m going to say “I wish she were my patient because I could help her understand that her Bell’s Palsy probably wasn’t from the COVID-19 vaccine.” Um, no. My experience has taught me that, for better or for worse, once someone has formed a firm mental association between an event or intervention and deeply distressing symptoms, that association is incredibly difficult to break; even when there is absolutely no plausible link between the two, which is not the case here. Not to digress too far, but I commonly try to break those associations in exactly two situations: first, when my patient has linked their negative experience (or that of a loved one or friend) to a medication or treatment that is actually going to be life-saving for them, or relieve a great deal of their suffering, and there is actually no causal link between them. And second, when the patient has incorrectly linked a negative medical outcome to some perceived failure of theirs. I have at least one or two conversations a month with women who have had miscarriages and have definitely assigned the blame for that tragedy to themselves for some action or omission that couldn’t have caused it; some bump they went over on the road a few days before, a drink of alcohol or a cigarette they smoked before they knew they were pregnant, getting their nails done or taking a dose of an over the counter cold medicine. We spend a long time talking about the causes of miscarriage, because if possible I want to help them let go of that shame and self-blame they’ve have been carrying, and will carry, their entire lives. Those are the circumstances where it is worth it to me to really try to convince my patient that the medical facts really do override their perceived association. With this woman in the video, if she were my patient and we developed a trusting relationship over many years, maybe at some point we would be able to have a frank and honest discussion, looking back, about whether or not that Bell’s Palsy was really caused by the COVID-19 vaccine, and help her loosen that association; but telling someone who is suffering “you are probably wrong about why you are suffering!” is not just an exercise in futility, but a failure in empathy as well.

No, the reasons I wish she were my patient are twofold; first, because I treat Bell’s Palsy all the time and there really are some things you can do to give the patient the best possible chance at recovery. There’s evidence for early steroids and anti-virals, and there are supportive care measures, like synthetic tear eye-drops, to protect from some of the potential long-term complications. We also talk about adjunctive treatments like facial massage, stretching, and facial muscle exercises that have never been proven but are not likely to do any harm either, and will help the patient feel they are an active participant in their treatment (I am always explicit about that last goal; we are not trying to ‘trick’ the patient into thinking they are helping to make them feel better). I print handouts for my patients all the time to help guide their own reading and research at home, and have one I like for Bell’s Palsy because it carefully explains the possible causes, the symptoms, and the prognosis. Medically, Bell’s Palsy is somewhat satisfying to treat because it usually does get better, and in general walking through an illness with someone as it improves is a lot less of an emotional burden for me than sitting with someone in the grief and pain of an illness that isn’t going to improve, which is vital work I wouldn’t give up, but is laden with moral injury.

And second, I wish I were her doctor because in this video she is clearly emotionally distraught. That is the aspect of this illness that the fact checking sources have seemed to ignore; the fact that this illness is incredibly distressing, even though it does have a good prognosis. I have read article after article in the few days since this video came out explaining that 1. the vaccine didn’t necessarily cause the Bell’s Palsy, and 2. it doesn’t matter because it’s a benign condition. But watch the video; it definitely matters to her. The embarrassment of having half of your face paralyzed, but people thinking you’ve had a stroke when you haven’t, of feeling self conscious everywhere you go; a condition can be benign medically but not benign psychologically, socially, or emotionally. When I visit with a patient for a condition like this, our time together is spent as much in counseling as it is in devising a medical plan. We sit in that sorrow, even as we provide hope that it will be short-lived. We offer reassurance but we know that our patients are not thinking about the low rate of long-term complications when they look in the mirror and see a face they don’t recognize. It’s hard. Maybe Khalilah Mitchell would still have been this distraught after our visit for her Bell’s Palsy, and maybe she would have felt some solace and reassurance; I can’t say. But as a physician, when I watch someone who is absolutely grieving over their medical condition, my heart goes out to them and I wish we had the opportunity to just sit down and talk about it.

These vaccines are the best hope we have of ending the pandemic compassionately, with less loss of life. I believe in them. They are safe, and your chances of developing a significant reaction- including Bell’s Palsy- is incredibly low. I absolutely disagree with Nurse Mitchell that these vaccines are “the worst thing ever”. She is very understandably thinking about her own symptoms and not about the millions of lives they will save. Yes, as a medical professional there is a tension between our own distress and the need to think of others before spreading information that can cause harm, as this video certainly will; as a Nurse, she may indeed be failing in her calling to care for the vulnerable by disseminating claims about the vaccine based only on her own negative experience and not on solid scientific facts. But that’s her right as a patient, and the reality is that most of us will put our own anecdotal experiences above facts when push comes to shove; if this video is sincere, then she sincerely believes she is doing the right thing by trying to protect others from what she has suffered, as ungrounded in the medical realities as that concern is.

As a human being created in the Image of God, Khalilah Mitchell deserves our empathy and compassion for what she is going through first and foremost, even as we work to undo the harm this video is going to cause.

Healthcare as War on Black Bodies

There is one last, vitally important issue that comes up in this video, and if you are privileged to have a long history of the medical field treating people who look like you extremely well, as I am, it may be so subtle that you miss it entirely. Towards the end of this short video, after discussing her personal distress and her opinion that the vaccines are terrible, she closes with this heartfelt appeal,

“Please, America, They do not care about us. Do not take this vaccination.”

I will not claim to speak for her, or to make assumptions about who she includes in “they” (big pharma? medicine? doctors? She states she is a registered nurse herself, so I do not think she can mean the entire medical field), or who she includes in “us.” Certainly she addresses all Americans, but we would be naive to think that her message of “they do not care about us” would resonate equally with everyone. People who have historically experienced and currently experience inequitable medical treatment, poorer access to high quality care and lifesaving treatments, systemic discrimination, and even therapeutic, malicious medical experimentation are going to understand this video in the context of a shared cultural narrative that already teaches that you cannot trust the medical field to have your best interest at heart. This includes women, LGTBQ+ persons, the disabled, those who are obese, non-native English speakers, Hispanics, Native Americans, and at least one group Nurse Mitchell seemingly belongs to herself, African Americans. If you need evidence of this, the instagram tag on this video, @DTR360BOOKS_, is connected to an online bookstore that specializes in works about racial justice, black empowerment, and racial conciliation. If anyone, and particularly any white people, are asking why this one minute video has been shared hundreds of thousands of times on social media, read on.

Before you click over to the ‘About the Author’ page, I’ll let the cat out of the bag; I am a white, able-bodied, English speaking male (I am not neurotypical [ADHD], but I know few doctors who actually are). Healthcare justice, especially in the area of race, is something I was able to casually ignore for a long time because it simply didn’t affect me. But it affects my patients every day (and because of that it certainly makes my life harder too, though obviously to a lesser degree), and in the last few years it’s an area I’ve come to learn more and more about. Suffice to say, I absolutely do not feel adequate to the task of writing about this topic; but I am going to try anyway.

The long history of medical experimentation and abuse of African Americans, of which the notorious Tuskegee Syphilis Study is only a link in the chain, is documented in historian Harriet Washington’s book Medical Apartheid, and elsewhere. If you have time to read this long and rambling blog post you definitely have 7 minutes to listen to her explain the connection between this long history (the word “history” does not here imply that it is over, as the recent COVID-19 death of one of my Black Physician sisters tragically illustrates) and the skepticism, doubt, and fear about the COVID-19 vaccines that exist in communities of color.

Race And The Roots Of Vaccine Skepticism

Of all the wisdom she shares in this brief interview (you should really read her books), this is the one that I think is closest to our purpose:

“I think this is a good thing to do because I think this vaccine looks as if it’s going to be safe, efficacious – just what we need. So anything that’s done in terms of encouraging African Americans to benefit from it, too, I think is a good step. However, it’s not a substitute for reforming the health care system. If we don’t reform the system, if we don’t make real, large steps toward addressing the inequities that cultivate distrust, then we’re going to have to do this every time we have a new health initiative. That’s a complete waste.”

Because of the systemic healthcare discrimination and poorer access that Black Americans still suffer from today, the COVID-19 pandemic has specifically devastated those communities, causing a disproportional number of deaths and severe illnesses greater than in any racial demographic besides hispanic/latino persons, and far greater than the impact on white communities. It is not hyperbole to say that African American communities are among those that need very high rates of COVID-19 vaccination the most to stem the tide of this pandemic and prevent further loss of life. And yet, the long history of broken trust on the part of the medical field is now paying dividends, and many in the communities that need the vaccine the most are reasonably mistrustful of a great deal of medical interventions; and especially of anything that seems new or experimental.

There are a great number of reasons to trust the safety and efficacy of the COVID-19 vaccines; they are outside the scope of this post, but I am addressing this piecemeal in my COVID-19 Vaccine Q&A. Just as Nurse Mitchel believes based on her very distressing personal experience that it is good to encourage people to avoid the vaccine, I believe based on the overwhelming scientific data that it is good to encourage my patients, friends, and family to get vaccinated. But Harriet Washington’s work was instrumental in my deciding to get the vaccine myself, which I did last week.

I am low risk, and would much rather have reserved my dose for one of my patients who needs the vaccine more than I do. I’ve written about this tension at length, and the great discomfort I have in receiving any medical treatment not available to all of my patients. But ultimately it was this quote from Medical Apartheid that made me decide to get vaccinated:

“Western physicians have adhered to a long and noble tradition of following animal studies with limited self-experimentation by researchers. This tradition may not always have been prudent, but by testing substances or procedures on themselves before experimenting with appreciable numbers of human subjects, doctors symbolically conveyed their belief that the measures were not inordinately harmful and also signaled a researcher’s willingness to share the risks as well as the glory of discovery.”

I am not a vaccine researcher, and there is no glory at all for me in people getting these vaccines. But they will protect my patients from COVID-19, and I deeply believe that as a medical field our solidarity with our patients, especially those who have been historically and actively marginalized by the medical industry, is an essential component of rebuilding trust. That means not only saying something is safe and encouraging our patients to have it done, but whenever possible taking on the potential risks within our own bodies alongside, and when necessary ahead of, our patients.

Yesterday two patients asked me about the COVID-19 vaccines and about this video specifically, both of them African American. In each case we talked about Bell’s Palsy, the vaccine safety trial data, the way vaccines work, and the history of medical abuse of Black folks in America; a condensed version of the contents of this blog post. We also talked about my experiences getting the vaccine, and my definite conviction that I would never ask my patients to consider a medical intervention I wouldn’t be willing to have done for myself or my family. Both left considering the vaccine, and at least one had definite plans to get it as soon as it was available. I am thankful, because both had risk factors for COVID-19 independent of the risk factor of belonging to a group marginalized by the healthcare sector.

This viral video is going to convince a lot of people not to get vaccinated. It shouldn’t, as we’ve discussed, but it will. My getting vaccinated will convince only a very few to get vaccinated themselves. But if I can show the band-aid on my arm to my patient and look them in the eye and tell them I believe so strongly that these vaccines can help protect our communities that I’ve had it done myself, maybe it will help a few. I can’t look you in the eye through this blog, but I hope you hear my heart, and I hope you decide to get the vaccine yourself to protect those you love and your own community, just as I’ve done.

COVID-19 Vaccine Questions & Answers


How do these vaccines work? 12/24/2020
Will the vaccines have any lasting effect on my body? 12/26/2020
What about infertility? 12/26/2020
Aren’t the vaccine ingredients toxic? 12/29/2020
If I get the vaccine, can I still transmit/spread the virus? 1/7/2021

Other COVID-19 vaccine posts and links

Intro: Talking about vaccines as a Family Medicine doctor

As a Family Medicine Physician, helping patients navigate uncertainty and doubt around vaccines has been a part of my day-to-day job since long before the COVID-19 pandemic. I have always tried to approach those conversations with patience and understanding (not that I’ve succeeded each and every time), knowing that behind their questions and even suspicion there is, without exception, a deep desire to do what is best and safest for themselves and their families. I get it; vaccines can feel scary. They are pretty mysterious for most people, and there is so much controversy over them that our intuition tells us surely some of it must be true (even though the people who creating it are often intentionally deceitful). I am a father of 4 myself and understand how strange and frightening it can feel to have your child undergo any medical procedure; but unlike an infusion of antibiotics or a dose of tylenol, or the sedated lumbar spine MRI my daughter needed for tethered cord syndrome when she was 1 year old, vaccines are given to children who are healthy to prevent future illness; it makes the decision harder, because the reason for the treatment isn’t readily apparent or at the forefront of our minds.

Vaccines are also one of the single most important innovations of modern medicine, and have saved millions of adults and children from dying of some of the worst and most painful infectious diseases that afflict humanity.

That’s why it’s incredibly important to me that my patients have the time to ask their questions and why I believe they deserve careful, sincere, and thorough explanations. So when I think about all of the medical misinformation that is out there right now around the COVID-19 vaccines and how we can possibly alleviate those fears, I start by imagining a patient sitting across from me in my clinic exam room with doubts, uncertainty, or even trepidation about these new and rapidly developed vaccines, and try to write out how I would try to answer their questions.

𝐇𝐨𝐰 𝐝𝐨 𝐭𝐡𝐞𝐬𝐞 𝐯𝐚𝐜𝐜𝐢𝐧𝐞𝐬 𝐰𝐨𝐫𝐤?

Updated 12/24/2020

When discussing vaccines with my patients, I always, always start with a brief discussion of how they work. It’s not uncommon to hear someone say “I think it’s better to rely on my own immune system” when discussing vaccine preventable illnesses. We’ll talk about this in more detail later on, but my first response is usually to help my patients understand that that is exactly how vaccines work; by relying on your own immune system.

Our immune system is designed with two strategies for fighting infections. The first is non-specific but immediate; in addition to our innate protective barriers like skin, hair, and mucous, we have cells like macrophages, mast cells, and natural killer cells that are able to detect and attack any foreign invader that the body recognizes as not being part of itself. This is a good system and prevents you from getting sick all the time; without it, we would be constantly fighting illness and infection from normal everyday exposures, just as many do who have compromised immune systems.

But even more powerful is our adaptive immunity, which is directed specifically against infections our body recognizes and has dealt with before. This is an incredibly robust system of B and T lymphocytes and antibodies that recognize the invading pathogens and kill them with a higher degree of efficiency and precision. The only problem with it is that it takes time to kick into gear the first time your body is exposed to a new infection; and then it’s a race to see whether it can become active enough, fast enough to prevent an illness from becoming severe. On subsequent exposures, that response is much, much more rapid; so much so that you usually don’t even know you’ve been re-infected with that bacteria or virus because you don’t get sick.

The principle behind vaccines is simple; what if we could safely teach the adaptive (specific) immune system to recognize the deadliest infectious diseases, so when someone is exposed the first time they can mount that powerful, targeted immune response right away and not even get sick?

And that’s exactly what these COVID-19 vaccines are designed to do, just like all of the vaccines before them; they give the body the information it needs to mount a robust immune response with the adaptive immune system as well as the innate immune system, without any possibility of causing an infection in the process. So when someone asks, “wouldn’t it be better to rely on our own immune system?” my answer is, “Yes, absolutely! And vaccines allow us to rely on our entire immune system, not just the weaker half, without even getting sick.”

We will talk about the differences between how traditional vaccines and the mRNA vaccines accomplish this later (and whether or not they re-write your DNA). For now I’ll just say that the new vaccines are even closer to naturally acquired immunity than traditional vaccines, because they trigger our immune system almost exactly like the viruses themselves do.

Will the vaccines have any lasting effect on my body?

Updated 12/26/2020

Hopefully! That’s sort of the idea. While the messenger RNA only survives for a few minutes before degrading, the antibodies that are produced will circulate for months, and some of the other cells of the adaptive immune system, specifically the antibody-producing plasma cells, will hopefully migrate to the bone marrow and lie dormant for decades, which is how vaccines given in childhood continue to provide protection many years later. This is true of the annual flu vaccine too, by the way; the issue isn’t that those vaccines don’t provide lasting immunity, but that influenza is a rapidly mutating virus and different strains are more common every flu season. So your flu shot from 1997 or 2008 is still providing you with protection… But only against the flu strains that were chosen for the vaccine in 1997 and 2008. They’ve even done studies that showed people who survived the Spanish Flu Pandemic of 1918 could still produce an antibody response 100 years later! Coronaviruses mutate much more slowly than the flu, but it is too early to know whether SARS-CoV-2 will mutate enough or in the right way to require additional, regular vaccinations. If we can judge by the SARS and MERS epidemics of 2002 and 2012, it seems unlikely.

As far as other changes to our bodies, thankfully there is no plausible mechanism by which the COVID-19 vaccines could cause other chronic changes than the desired immune response. The mRNA only codes for a few specific proteins and cannot produce an active virus, and the fats, sugar and salts in the vaccines do little else than package the mRNA and help it get into the cell.

What about Infertility?

There has been misinformation circulating online about the vaccines causing female infertility, but these are baseless. The original claim can be traced back to Michael Yeadon, a former Pfizer researcher and COVID-19 denier who has also posted videos claiming that the pandemic really ended in late Spring, at least in the UK, because most of the population was already immune due to having antibodies to other coronaviruses, which cause the common cold (as of today there have been over 70,000 deaths in the UK from COVID-19). This is an extremely ironic idea in light of his claims about the vaccine causing infertility, as we shall see shortly. He has not worked for Pfizer since 2011, and calling him the “Head of Pfizer Research” is just as deceptive as the rest of the headline and article.

The vaccine does not contain a spike protein called Syncytin-1, at all; the article above is simply lying at that point. The actual theory claims that the COVID-19 spike protein the vaccines code for shares similar amino acid sequences with a human protein, Syncytin-1, which is important in placental development. They reason that antibodies trained to attack COVID-19 would also attack Syncytin-1, causing infertility. This is illogical and scientifically invalid for a few reasons. 

First, we have already had 80 million cases of COVID-19 worldwide and there has been no evidence of infertility as a side effect; yet the body of any infected person is going to produce antibodies against multiple COVID-19 proteins, including the spike protein in question. If the antibodies we develop against the spike protein from having the virus don’t attack Syncytin-1, there is no logical reason to believe vaccine-induced antibodies would either.

Second, we have evidence from the COVID-19 vaccine trials themselves that pregnancy occurs at similar rates between those vaccinated and those not vaccinated. The vaccine trials did not include pregnant women or women who intended to become pregnant, and all women of child-bearing age that participated had a negative pregnancy test before their first dose and committed to using a method of birth control throughout the study. Thirty-nine women became pregnant anyway; twenty-three in the Pfizer trial and sixteen in the Moderna trial, and the rate of unintended pregnancy in those who received the vaccine was about the same as in the placebo group. Those numbers are too small to draw serious conclusions, but the point is that we already have examples of women who became pregnant after receiving the vaccine, even though they were actively preventing pregnancy; in the coming months as more and more people receive the vaccines, we will have many more examples, and because this misinformation has been popular there are already studies planned to track the pregnancy rate following vaccination.

Third, the number of amino acids in the shared sequence is actually tiny; a segment of 5 amino acids, with only the first two and the last two being shared. Syncytin-1 has a full sequence of 538 amino acids, and the COVID-19 spike protein itself is 1,273 amino acids long. We have an analogy in human disease; one explanation for rheumatic heart disease following streptococcal infection is that certain proteins in the Group A strep bacteria share similar amino acid sequences with myosin, a protein found in heart muscle, allowing antibodies against the bacteria to cross-react with heart tissue. However, in that case there are not only much longer sequences of shared amino acids, but multiple sequences that repeat multiple times each. The section of shared amino acids in the case of Syncytin-1 and COVID-19 antibodies just isn’t significant, and you will find many viruses and bacteria in nature that share such similarities with a great many proteins in humans.

Finally, SARS-CoV-2 is not the only coronavirus in existence; not by a long shot. Coronaviruses are one of the main groups of viruses that cause the common cold, and you and I have both had many coronavirus infections throughout our lives. You still have antibodies to those coronaviruses, as Dr. Yeadon points out in his other videos. Every single coronavirus has spike proteins (that is what gives them their name; they form a halo, or corona, around the virus when you look at it through an electron microscope), and all of those spike proteins share as much or more similarity to Syncytin-1 as the COVID-19 spike protein, because they play similar roles in viral replication to what Syncytin-1 does in placental development (they are fusion proteins). So you have already developed antibodies against coronavirus spike proteins all throughout your life, maybe even every single year, just like everyone around you; and yet this has never been identified as a contributing factor in human infertility. 

So yes, the vaccine will have a lasting impact on your body, assuming you respond well like 95% of clinical trial participants. The lasting effects will be the same as the lasting effects of surviving the virus: immunity to COVID-19, and hopefully long-lasting immunity. The difference is that the vaccine doesn’t carry a risk of serious illness or death to you or transmission to those around you. And thankfully, neither immunity from getting the vaccine nor immunity from getting the virus itself will cause infertility. 

Aren’t the vaccine ingredients toxic?

Updated 12/29/2020

Those whom I interact with regularly who are undecided or hesitant about vaccines are typically patients and parents with sincere, legitimate questions, who deserve the time it takes to hear their concerns, answer their questions completely, and offer reassurance. But unfortunately, there are also people out there who are promoting anti-vaccine propaganda and deliberately creating false narratives. One common strategy to increase unease or paranoia about vaccinating our children is to simply list the scientific sounding ingredients and then ask, “do you really want to put that into their bodies?” Usually this approach will ignore benign sounding ingredients like “sucrose” or “gelatin”, and focus in on lengthy or scientific-sounding ingredients like “nicotinamide adenine dinucleotide” or “cetyltrimethylammonium bromide,” which register emotionally as more intimidating, less safe, and less natural. Of course we know that logically a chemical with a long name would not necessarily be any more or less dangerous than one with a short name; “ricin” has a short name, and it’s the 5th most dangerous chemical in the world (that is just an example; there is NO ricin in your vaccines. I do not want to see a bunch of memes next week claiming they put ricin in vaccines). But fear mongering is not always logical.


They might also home in on a naturally occurring and well known chemical that most people think about in conjunction with another of its uses, counting on that association alone to create fear. A good example is formaldehyde, which most of us think of in the context of embalming, but is also used in applications from color photography to deodorants; and of course, as an anti-bacterial and anti-fungal in certain vaccines. Some vaccines contain about .005 to .01 mg per dose; a 2 month old baby produces up to 200 times more than that every single day as a part of their normal metabolism (for adults, it’s more like 3,000 times more). Yet because our culture so strongly associates formaldehyde with death, merely invoking it’s name is enough to create unease.

Most of the ingredients in vaccines are there to keep the attenuated or killed virus pieces from decaying long before they are injected. Others are there to prevent the growth of bacteria or fungi in the vaccine vials themselves. Still others are used to stimulate the body’s immune cells around the injection site to make them more likely to produce an adequate response that leads to long-term immunity. All chemicals we encounter in our lives are toxic under certain circumstances; none of the ingredients in vaccines are toxic at the doses or in the manner given. I think people often forget that the scientists who design the vaccines, and the doctors and nurses that counsel patients about them and inject them, are human beings who also vaccinate ourselves and our children; we want vaccines to be safe for selfish reasons, too, not just altruistic ones.

That all applies to traditional vaccines; the new mRNA vaccines are made differently, and so they don’t need a lot of the same additional chemicals to ensure they work. In fact, what’s shocking about them is just how few ingredients they actually have. In addition to the messenger RNA molecules themselves, the Pfizer vaccine has just 4 synthetic fats (lipid nanoparticles) meant to deliver the mRNA into the cells that will build the COVID-19 spike protein, 4 salts to make sure the vaccine is at the same acidity and osmolality as the tissue it is being injected into so it can get absorbed (and hurt less), and 1 sugar, sucrose, to protect the vaccine during cold storage. 

Salt, fat, sugar. And that’s it.

Some of the substances can still cause a reaction; the leading theory right now is that the few anaphylactic reactions to the Pfizer vaccine were likely due to polyethylene glycol, a common chemical we give in huge doses for constipation, but which can cause an extremely rare, but serious, allergic reaction. This chemical is used to create the lipid nanoparticles through some Tony Stark level methods I can’t hope to understand. The lipid nanoparticles (very small fat molecules that can protect the mRNA) themselves are indeed new technology; which in science terms means about 30 years old. Over that time period their safety has been studied extensively and found to be safe, non-toxic, and biocompatible/biodegradable. And because the world is crazy, no, they are not tiny robots (but how cool would that be?!).

By contrast, “Nana Lipid Particles” are just the cookies she keeps sneaking your kids when you aren’t looking.
An article in 2016: “After 25 years of research…”
The math checks out.

I can’t claim to be familiar with every anti-vaccine meme and article out there, but I haven’t seen as much about ‘toxic ingredients’ with the COVID-19 vaccine, and I think that’s because even compared to the safe ingredients of traditional vaccines, the ingredients of the COVID-19 mRNA vaccines just sound very unimpressive, and thus feel less intimidating.

If I get the vaccine, can I still transmit/spread the virus?

This is a question I’ve heard frequently, especially from those who themselves work in healthcare or have vulnerable friends and loved ones. It is a question driven by compassion. In this blog we have been trying to address the fears and concerns that arise not only from conspiracy theories and misinformation, but also from the very small but real risk associated with the vaccines; yet I know that many people would brave whatever degree of risk to themselves (again, It’s very small) if it meant protecting their family and community. If they could be guaranteed that their choice to get vaccinated meant they could safely visit an unwell grandparent or have coffee face to face with a friend without any risk of spreading the virus, it would be a no brainer even if there was a considerable risk it might cause significant side effects like Bell’s Palsy (there isn’t). 

And I wish I could give that reassurance today, but while I can say that the chances are very good this vaccine will not only protect you but also protect those around you, we still need much more data to be able to quantify the degree of that protection. 

The point of the vaccines is to provide your systemic adaptive immune system, the part that acts powerfully and rapidly against specific disease, with the information it needs to produce the antibodies you need to keep you from getting very sick. A common misconception is that after you get say the flu shot, you can’t get the flu. It’s not true. The flu shot doesn’t give you a magical forcefield around your body that blocks flu virus, it just helps you fight it much, much more quickly and efficiently when you do get it; often to the point that you never even know you are infected, or at least only have very minor symptoms. Vaccines drastically reduce the chances of you becoming extremely ill from deadly disease like influenza, measles, or COVID-19; that’s their job. 

This is not how you get a cold.
He’s the best he is at what he does; but what he does is not immunology and pathophysiology.

This main function of vaccines is what underpins the epidemiology strategy of giving the COVID-19 vaccine to healthcare workers and the most vulnerable first. The medically vulnerable, because they are the most likely to require high levels of care, to suffer long-term problems from infection, or to die from COVID-19; and healthcare workers because as the pandemic worsens it becomes more and more important to preserve our medical workforce, and vaccinated folks are less likely to need sick time (much less become seriously ill and require hospitalization themselves) for COVID-19. The other reasons for vaccinating healthcare workers go back to courage, trust, and solidarity with our patients in the face of any new treatment. We are prioritizing vaccinating the vulnerable instead of say pathologic extroverts because the effectiveness of the vaccines at preventing significant illness is known (90-95%), but their effectiveness at preventing transmission is still unknown. 

So how do we find out so that Dustin can get his vaccine? Well, the big question mark is IgA antibodies. Most of the research on antibody production from COVID-19 vaccination focuses on IgM and IgG because they predominate in the blood and represent, respectively, our short-term and long-term antibody protection against systemic (whole body) illness. But IgA is the main antibody in the mucous membranes; your mouth and throat, nasal passages, lung surfaces, and digestive track (it’s also the antibody responsible for passive immunity transmitted through breastmilk), and we know that the IgA response to infection is a big, big part of what neutralizes the virus and decreases transmission in those first 10 days of symptoms. If the vaccines “only” cause a significant IgG and IgM response during that post-vaccine exposure to the COVID-19 virus, it will prevent severe infection; and may still prevent enough viral replication to slow transmission. But if it produces a strong IgA response too (or a strong enough mucosal IgG response), it will almost definitely neutralize any live virus in the upper airway as well, making transmission as unlikely as severe illness. In other words, the degree of IgA response is a strong predictor of whether the vaccine protects those around you as well as it protects you.

This is an old graphic; IgD definitely has a function. I just… Don’t understand it.

Because of this, researchers are already studying the degree of production of mucosal IgA against COVID-19 in vaccine recipients, with some promising results, and at least one intranasal vaccine (which produce a very strong IgA response) is under development. And while the best information we could get would be to see exactly how well someone develops IgA and neutralizes the virus by studying them when they are exposed to COVID-19 after vaccination, it’s sort of hard to catch people in that window. In the end we will probably have to settle for epidemiology data instead; carefully watching to see if clusters of infection occur around exposed, asymptomatic vaccinated people at the same rate that they do around unvaccinated people. That will take time, but if and when it becomes apparent that vaccinated people really aren’t spreading the virus to those around them at all, that will be the point I’ll stop wearing my mask, practicing social distancing, and washing my hands (fine, fine; I’ll keep on washing my hands).

I realize this was a really long-winded way of saying “I have no idea,” but I want to conclude with a few reasons you should get the vaccine even if your main concern is not spreading the virus to others. First, there is already a lot of good data that supports the idea that these vaccines will provide mucosal immunity (and thus decrease transmission), both from studies of the COVID-19 vaccines themselves and from our much more robust knowledge of vaccines in general; it’s hard to say anything with much confidence yet because we’ve had these vaccines for such a short time, but I’m pretty optimist they will. We’ve followed these principles for years; we recommend everyone around a newborn be vaccinated against Pertussis (whooping cough) because the newborn can’t be, and we know that vaccine-derived herd immunity works even for viruses that are primarily spread through respiratory particles. Second, there is no conceivable mechanism by which they would increase transmission. The vaccines cannot make you produce live virus (at all) so they can’t make you contagious, and if you are exposed to COVID-19 later on your body will still respond with a mucosal immune response whether it is augmented by your vaccine or not (and it probably will be); the vaccine won’t stop that. And third, by preventing a severe systemic illness, the vaccine will decrease the amount of time you are shedding virus and prevent transmission in some of the most high-risk settings; aerosol producing procedures like nebulizer treatments or intubation in the hospital. And by preventing symptoms like coughing and sneezing the vaccine will make you less contagious when exposed to the virus, as long as you are still following other transmission control measures like wearing a mask and quarantining after exposure.

IgA response due to ChAdOx1 nCoV-19 vaccine (the tall red columns are good!)

So no, unfortunately being vaccinated against COVID-19 does not give us carte blanche to schedule giant indoor parties, throw away our masks, and treat the pandemic as if it were over; but they are a huge step in that direction, and in addition to protecting ourselves they do have a fair, if yet unproven, chance of protecting those around us too. And besides, if you don’t get vaccinated, how are you going to get your government tracking microchip?

Bad joke, sorry.

Other Vaccine Posts:

No Vaccine Selfie Yet or “Why I am uncomfortable getting vaccinated”

“𝐀 𝐂𝐎𝐕𝐈𝐃-𝟏𝟗 𝐕𝐚𝐜𝐜𝐢𝐧𝐞 𝐰𝐢𝐭𝐡 𝟗𝟓% 𝐄𝐟𝐟𝐞𝐜𝐭𝐢𝐯𝐞𝐧𝐞𝐬𝐬… 𝐓𝐞𝐥𝐥 𝐌𝐞 𝐀𝐧𝐨𝐭𝐡𝐞𝐫 𝐁𝐞𝐝𝐭𝐢𝐦𝐞 𝐒𝐭𝐨𝐫𝐲.”

Dr. Emily Smith, Friendly Neighbor Epidemiologist Vaccine Series

1. Herd immunity and vaccines: Vaccines 101 –
2. Vaccine distribution info and how well do the current vaccines work? –
3. Whoa, these were made quick, right? How can we make sure they are safe?
4. When will I get the vaccine? Who decides who gets a vaccine first? And, a note on solidarity versus individualistic thinking. –
5. Myth-busters for vaccines (we talk about fertility questions, 5G/micro-chips, fetal cells, and why the mRNA won’t change your DNA) –
6. Explaining the FDA review and talking about the final Pfizer study results.
7. Should we be worried about the side-effects seen in the UK? –
8. Let’s talk about the FDA panel meeting-
9. Reflections on the EUA Pfizer FDA meeting –
10. Pfizer EUA approval, vaccine ingredients, and recommendations –
11. Pfizer vaccine Q&A –
12. Will I have to get a shot every two months? Should I worry about mutations?
13. Info on the Moderna vaccine –
14. Let’s compare the Pfizer and Moderna vaccines –

What happened to the Flu?

You all remember what it was like in January and February before the COVID-19 virus had come to the United States, and before we began to treat it like a pandemic. It seemed like everyone was getting the flu, just like any normal year. The flu shot for that flu season only had about a 45% efficacy- not the worst we’ve ever had, but certainly less effective than we’d hoped- and hospitals were busy treating children, adults, and elders for complications of Flu A and Flu B. And then a couple of short months later…. *POOF!* It was like the flu had just disappeared. We didn’t hear about it anymore, nobody was talking about it; everything was COVID-19.

In March and April we began to see memes questioning why the flu had seemingly gone away. And then a few weeks after that… The memes were gone too, like magic! And for 7 whole months nobody mentioned or thought about the flu. Until a couple of weeks ago, when memes like this began to circulate again:

Isn’t is wonderful?

And although it’s only December 15th and the people posting these memes and #whereistheflu conspiracy theories are shooting their shot a bit early, I think now is a great time to answer the question, “Where is the flu?”

-What does a normal flu season look like?
-Why doesn’t the ‘where is the flu’ theory work?
-What did happen to all the flu cases?
-What would you have to believe for these memes to be true?

What does a normal flu season look like?

The reality is that there’s really no such thing as a “normal” flu season. While different strains of influenza circulate in our communities each year, they are all unique in their own horrible ways, and we can’t predict ahead of time when we will have a mild flu season, like in 2015-2016, or when we will have a terrible flu season that threatens to overwhelm our healthcare systems like in 2017-2018, the worst I’ve experienced as a physician. But we can draw some generalizations about flu season:

  • It’s going to happen during the Winter.
  • People are going to die.
  • It’s going to suck.

I hate the flu, and even if we as a society have mostly relegated it to sitcom B plots and ‘man cold’ jokes, the reality is that it’s a killer, and I have patients with chronic respiratory diseases, compromised immune systems, or just poor overall health that I worry about every single year as flu season begins to ramp up.

We typically expect flu season to begin in early Winter, usually November, peak between December and March, and typically to be ended by April. A late flu season might last until May, but that’s fairly rare. However, the last flu season we’ve seen peak in December was back in 2014, and for the past 6 years it has been in January, February, or even mid-March.

So while I’d never fault anyone for trying to get work done early, those ‘Where are the Flu?” memes really would make more sense in January or February, when we would be expecting flu season to be peaking. Nobody finds misinformation claiming that doctors are padding the COVID-19 numbers with flu cases convincing in June and July, so I’m sure they wanted to take advantage of the cold weather for as long as possible.

And honestly I hope we are still seeing those “where is the flu?” conspiracies in February and March because the flu cases stay ridiculously low. That would be a lot better than internet memes saying “oh man, remember back in 2020 when we only had one deadly respiratory virus epidemic to deal with?”

Why doesn’t the ‘where is the flu’ theory work?

Let’s go back to that first meme at the beginning of the article, which deserves a bit more of our attention. It comes from the WHO FluNet, and anyone in the world can go to that website and look at reported flu cases for any date range going back to 1995. The first thing you’ll notice about the image is that it is on the order of tens of thousands; each major division of the Y axis is 20,000 cases. The image is supposed to convince you that the WHO just forgot to record flu cases at all as a part of this big hoax, but still published their flu numbers with empty charts for the whole world to see. Pretty incompetent conspiratoring if you ask me. But the truth is, that seemingly empty section of the graph is not empty; the 2nd image below is that same ’empty’ time frame, just with a smaller scale.

This is still an incredibly small number of cases, but it demonstrates the same week-to-week and seasonal variability flu cases normally follow; that part of the graph isn’t empty, and the data checks out.

In this context, the original image is suppose to convey two ideas; either that doctors have stopped checking for the flu altogether, or that they are ‘stealing’ flu cases and filing them under COVID-19.

The first is easy enough to answer; we haven’t stopped checking for the flu. I’ve just logged onto our electronic health record and I have a message from a colleague about a positive Flu case. We are ordering the tests, and some of them are positive. How reliable flu testing is at baseline is a topic for another day; at the very least it can be compared from year to year to help us understand how relatively bad the flu season is. As a physician I rarely order flu tests, but I’m not the one driving this data; and in fact, with COVID-19 causing similar but not identical symptoms to influenza, I’ve personally been testing for flu more in 2020 than in any year before, because differentiating between flu and COVID-19 is now an additional utility of the flu test; I know several clinicians who are doing the same. We can look at the CDC numbers to see if we are outliers here in Waco, or if doctors are in fact still testing for the flu.

So far, labs that participate in CDC influenza monitoring have tested 232,452 Americans for the flu. At the same point last year, the number of tests reported was 265,670, but instead of having only 496 positive results and a 0.2% positivity rate, we had 15,027 positive results and a 5.7% positivity rate. And while this clearly does not include all flu tests that have been ordered since September, it is a representative sample. So we know that doctors at ordering the tests; the tests are just negative.

That leaves us with the flu cases being stolen somehow. One way for this to happen is for the flu analyzers to be calibrated to call flu tests negative so we can count them as COVID-19 instead (and by logical extension, the COVID-19 machines calibrated to detect flu and call it COVID). The problem with that is that every lab has a different strategy for testing these two viruses. Many labs use completely different machines to test for COVID-19 and flu, and their flu machines have been utterly uninvolved with their COVID testing strategy; untouched, with no updates or software downloads that would cause them to stop detecting flu. There are even lots of clinics that don’t test for COVID-19 at all; have they had their rapid flu tests updated to stop detecting flu, and are now just going through the motions of collecting flu swabs to make some other lab’s COVID-19 results more believable? It’s not just far fetched because of the unbelievable extent of involvement such a conspiracy would require, but because so many people would have to be a part of it even when they are far removed from the COVID-19 testing process and apparently have nothing to gain.

A more parsimonious theory is that the tests are being run as normal, but the CDC is changing the numbers. We track flu tests in the US to determine the positivity rate and understand when flu season begins, when it peaks, and when it ends. We use other metrics like excess mortality to really understand the full impact of a flu season and estimate the number of cases. Right now, the laboratory result tracking is telling us that there just isn’t appreciable community transmission; but what if the CDC has moved all of the positives over to COVID-19? By this point last year there had been 15,027 positive flu tests reported to the CDC. In that same time period this year, we’ve had 9,755,813 new COVID-19 cases (including me!). So those flu cases would represent approximately 0.15% of all of the new laboratory confirmed cases of COVID-19 reported in the US since monitoring for the new flu season began at the end of September. Shifting the flu tests we track to COVID-19 wouldn’t just be a dishonest and transparent strategy for inflating the pandemic numbers, it would also be entirely ineffective and unnecessary. If they just reported flu cases like normal, the COVID-19 numbers would be almost exactly the same, and they’d be far less likely to get caught. If you are trying to embezzle millions of dollars from the bank, you don’t cook up a fake set of books and then turn around and stiff your customers a couple of bucks when they come in to cash their checks, too (I am currently in the market for a much better financial analogy. Please send suggestions to

Claiming that the COVID-19 numbers are being inflated with influenza cases also does absolutely nothing to explain two important facts about the pandemic; the pattern of cases over time, and the number of deaths. If we were ever to see even a fraction of the number of deaths due to seasonal influenza that we are right now from COVID-19, especially this early in flu season, we would be dealing with the worst flu since the Spanish Flu of 1918. If that were the case, the flu itself would be a pandemic exactly as bad as COVID-19… So why all the pretending? The numbers also don’t fit the pattern of seasonal flu at all. Look on the graph below and tell me when ‘they’ would have switched to using the flu to generate COVID-19 numbers. October 10th? That’s when cases really began to climb, and that’s too early for flu season. What about the cases in April, or the nationwide surge in July?

The “What Happened to the Flu?” conspiracy is extremely weak because not only does it have no explanatory power, it also has to be combined with multiple other conspiracy theories (like “the doctors are lying on the death certificates“) to work at all.

I think a lot of people find the apparent absence of the flu convincing, and I think I understand where they are coming from. Most of us aren’t used to thinking like epidemiologists. I’m not. We know people who had COVID and were fine, just like we know people every year who get the flu and are fine. If we know someone who died of COVID, as I do, it’s a tragedy; just like it’s a tragedy if we know someone who died of influenza. But we aren’t actually very good at looking at the world around us and intuitively understanding the scale of a normal flu season versus the scale of a global pandemic. So noticing a decrease in one is enough to allow us- if we really want to be convinced- to dismiss or explain away the other; until we actually look at the real numbers.

What did happen to all the flu cases?

The reality is that the CDC and the WHO are reporting such a small number of positive flu tests because… there are a lot fewer cases of the flu. And although experts have told us to expect a particularly light flu season for months, it begs the question; is it really possible for it to be this light?

The answer is yes, thankfully, and for some very good reasons. First, as we’ve been saying, it’s still very early in flu season; we just don’t know how bad the peak will end up being yet, though these early numbers are a very good sign. Second, flu vaccination rates are actually higher this year than last. With the flu vaccine typically being between 40 and 60 percent effective, even a modest increase in flu shots will result in millions of fewer cases. But more importantly, we can expect a light flu season because every single measure we use to decrease COVID-19 transmission decreases transmission of the flu too. Decreased indoor gatherings, wearing masks that block respiratory particles, a significant portion of the population working from home, doing remote learning, and sheltering in place; all of these are going to decrease transmission of influenza even better than transmission of COVID-19. Why better? Because the flu is less contagious, for one thing; it is less efficient at spreading from person to person and therefore it is easier to mitigate with masks and distancing. But even more important is the fact that some of our strategies that are only modestly effective for COVID-19 are actually very effective for influenza.

Take symptom monitoring for instance. Right now every school, daycare and university, and most businesses, are carefully monitoring their students and employees for infectious symptoms like cough, nausea, and fever, and insisting they miss school or work and see a doctor if they are ill. Because COVID-19 is spread even by people who are asymptomatic or who have not yet developed symptoms, this strategy is only effective for symptomatic COVID-19. There is also a long lead time for COVID-19 during which a pre-symptomatic patient can spread the virus before they are sick enough to screen positive and be told to stay home; the incubation period of the virus is up to 14 days or longer, with most people developing symptoms around day 6-7 on average. Prior to this, they are at work and school and don’t realize they can infect others. That’s why this strategy absolutely has to be paired with excellent contact tracing and quarantine for close contacts. But our contact tracing system in the US failed early on, and between American individualist culture and misinformation and conspiracy theories about the virus, quarantine of close contacts has been the single hardest measure to generate buy-in for.

Contrast this with influenza, which has a 1-4 day (average 2 days) incubation window and is far less transmissible in asymptomatic or pre-symptomatic patients. By the time a person is able to spread the flu, they have symptoms of the flu. In normal years a fever or vomiting might cause them to stay home, but they can continue to work or go to school with mild to moderate flu symptoms like cough and sore throat; but not in 2020, when even the social condemnation attached to coughing in public is enough to keep a lot of us at home when our allergies are acting up. Keeping people who feel well in quarantine because of exposure to the virus was always going to be a hard sale, even when that advice is based on solid epidemiology principles. Fortunately, slowing the flu doesn’t depend on that particular strategy.

Is that enough memes? That feels like more than enough. You get the idea.

It also bears pointing out that the mitigation measures for COVID-19 actually have worked, and are working. Those who want to minimize or deny the realities of this horrible pandemic are fond of pointing to the early models that predicted greater than 1 million deaths in the US and asking, “what happened to all the deaths?” But those were predictions about what would happen without mitigation, and having already reached 307,000 deaths with extensive mitigation efforts, those early numbers now feel like low estimates instead of end-of-the-world scenarios. Because strategies to reduce COVID transmission are being followed or ignored to more or less of a degree not in different states or cities but in different houses on your street (and even by different people in your own house), we will never really know which mitigation measures were most effective or how effective they might have been with higher engagement; but it is clear that even with actual levels of adherence, they are even more effective for the flu than for COVID-19, which makes perfect sense when you compare the characteristics of the two viruses.

What would you have to believe for these memes to be true?

Finally, I want us to really stop and ask ourselves, if these memes and commentaries were true, what would we have to believe? First, let’s reiterate that the people creating these mean one of 3 things:

  1. Where are the flu cases? The flu cases are there, but doctors and the CDC have decided to ignore them altogether.
  2. Where are the flu cases? A lot of the tests for COVID-19 are actually positive tests for the flu, but they aren’t being reported that way.
  3. Where are the flu cases? Oh wow! It’s so wonderful that we aren’t seeing much flu activity right now.

Since we can rule out the 3rd one (even thought it is, actually, the one supported by the facts), it has to be some combination of the first two. And in order to find those ideas convincing, here’s what you have to believe.

Warning: Most of what follows is sarcasm.
(so please don’t quote me on any of this out of context)

– Your local clinic doctors (including me), who hate the flu and COVID-19 and have lost patients to both, are waking up every morning, going into work in full PPE, and seeing patients for cough and fever.
– They are spending 10-15 minutes talking face to face with patients about COVID-19, about the safety precautions and how to do isolation and quarantine, what red-flags to watch out for, and offering heartfelt reassurance and telling their patients not to be afraid, but to stay vigilant in monitoring their symptoms. Sometimes they are even praying with them at the end of those visits.
– This is all a waste of breath and they know it. It’s a big sham, and they are play-acting their part. They know full well that whether their patient has a cold, or seasonal allergies, or the flu, they are going to call it COVID-19 anyway (and go ahead and ignore the fact that we are telling people ‘hey I think this is actually just your allergies’ all the time. If we wanted to inflate COVID-19 numbers we could do it all day long. But we don’t and we aren’t). They’ve spent all these years trying to help people fight disease, and now they are going to spend their time lying to people, leaving them less prepared for and knowledgable about the disease they actually have. And because they don’t give you a new patient panel when you sign up for a global conspiracy, they are actually lying to the same people they’ve spent all of those years trying to help as their primary care doctor.

I realize this is the worst possible gif and the opposite of my point.
I just really like this movie.

– They order a COVID-19 test and the nurse collects a sample and brings it to the lab tech, who places it in a machine to test for COVID-19; maybe they are also running a flu test for that patient. But the flu analyzer has been programmed to call the flu test negative and the COVID-19 analyzer has been programmed to call the flu COVID instead. Why test for anything at all; why not just call a certain percentage positive and have done?
– The clinic doc gets the fake COVID-19 test back and tells you it’s positive, and advises you to isolate for 10 days. This is because they… Hate your job, I guess, and want to make you stay home so you won’t get paid? I mean, I write letters for patients to help them get work accommodations for their medical conditions all week long, and I even call managers, bosses, and HR reps to make sure my patient isn’t at risk of losing their job because of a medical issue. I’ve helped people with their depression and anxiety every day for years, a lot of it because of financial difficulties. I’ve even connected people with legal resources so they could fight to keep working when they were wrongfully terminated because of their health. But sure, I guess it makes sense that I want my patients to face more financial hardships and want their lives to be worse. That’s what really lights the fire under us to make all those sacrifices in medical school and residency.
– The doctor knows you have the flu, but instead of seeing if you are one of the people that might benefit from Tamiflu (it’s not as good of a medicine as you might think), they withhold that medicine because offering it to you would give away the game, and of course their commitment to this fake pandemic is greater than their commitment to helping their patients or their Oath.
– You ask the doctor about your young children; are they going to be ok? Even though they know that children under 5 (including two of my own), and especially under 2 are at high risk for complications from the flu, they go ahead and offer fake reassurances. “I don’t want you to be afraid,” they say, “thankfully, your children are at much lower risk from this virus than even a healthy young adult.” That probably eats at them a bit, lying to you about whether or not your kids are in danger; but they are just really committed to this conspiracy.

– Meanwhile, by the way, their colleagues in the hospital are spending even more hours and making even more personal sacrifices to treat incredibly sick hospitalized patients. Instead of treating them like normal pneumonia, flu, and heart attack patients, they are calling them all ‘COVID-19’ and treating them with steroids, prone positioning, anti-virals, and convalescent plasma; all to maintain the ruse. It wouldn’t look good for the numbers to only be bad in clinic.
– Finally it’s time for the doctor and the nurse and the lab tech to send their fake lab results to the county health department, and then on to the CDC. Here the CDC, rather than reporting fake numbers that perfectly match their false narrative, will carefully tabulate the fake lab results they’ve received from all over the country, throwing in a few positive Flu cases and different flu strains (including some their experts didn’t recommend we vaccinate against) just for good measure. Seems like an awful lot of trouble.

Also, by having an incredibly mild flu season and diverting all of those flu numbers to COVID-19 (even though, again, they aren’t really needed), they allow graphs like the one in this article that make it really obvious to any conspiracy theorist on the internet what’s going on. Such an intricate conspiracy, but so poorly executed.

And why do we do all of this? Well, because fear of the pandemic helps shutdown the economy and hurts your political candidate, according to one theory (I still don’t know how they convinced all of my conservative, Republican doctors to go along with it). You would think there’d be an argument that two contagious killer viruses might convince people to stay home even better than one… Or, according to another theory, to sell COVID-19 vaccines for big pharma. Because everyone knows I get daily instructions from my pharmacy sales rep masters, instead of, you know, barely tolerating being forced to occasionally interact with them so I can get some free insulin samples for my patients. I suppose flu shots just aren’t as profitable.

Not you Gus! I didn’t mean it.

Which brings up another good point. Besides the doctors and nurses and lab techs and of course the CDC, who else would need to be complicit in this scheme? Well, Hoffmann-La Roche Inc. and Gilead Sciences, for one, the manufacturers of Tamiflu. I don’t prescribe it much myself, but during flu season it’s one of the most commonly prescribed medications. That company also makes Remdesivir, one of the medicines used for certain COVID-19 patients; but only in the hospital. Bad work on their accounting department, sacrificing most of their sales from a widely prescribed outpatient medication to focus exclusively on an inpatient medication prescribed only for some patients.

I’m not willing to put anything past drug companies, but it does seem like allowing for a ‘normal’ flu season would at least help them hedge their bets a bit. Then again, Tamiflu is available as a generic now too, so maybe this is a corporate high risk, high reward gamble. Let’s move on.

Who else would have to be complicit in it? These guys:
Sanofi Pasteur, Inc
Seqirus, Inc.
GlaxoSmithKline Biologicals
Protein Sciences Corporation
MedImmune, LLC

Recognize them? Those are the top manufacturers of seasonal flu vaccines, and none of them has a COVID-19 vaccine (at least not one close to being approved). The companies that make the two vaccines currently approved or about to be approved for COVID-19, Moderna and Pfizer, do not have seasonal flu vaccines.

You write the script. Powerful, multi-billion dollar pharmaceutical companies that have lost the race to create a vaccine against a hoax virus (or didn’t even try), and now are missing out on all of that sweet, sweet COVID money. They know it’s a hoax and more than likely have some proof. So what do they do? They expose it for what it is, involving their competitors in scandal and allowing them to grab a greater market share and keep their flu vaccine as the most important vaccine of 2020. Except that’s not what they’ve done; if you go to any of their websites, you are going to see messages saying, basically, “good job on developing those COVID-19 vaccines you guys, we are rooting for you.” Sincere? Who knows. But definitely not the type of corporate warfare you would expect if they knew the virus wasn’t really that dangerous and were missing out on all the fear-monger profits.

Now, I know what you are going to say. ‘Fine, maybe it isn’t the doctors and nurses, maybe it’s just the CDC and the WHO. And hey, thanks for not including me in your global conspiracy. Let’s say that this is a regular flu season, or even a particularly bad flu season. That means that say hundreds of people a day are dying (or 3,000, if you are saying all COVID-19 cases are really the flu), and hundreds of thousands are getting the flu, and the doctors are… What? Too dumb to know the difference? Too lethargic to figure out what’s flu and what’s COVID-19? If we aren’t in on it, then we are either too dumb or too complacent to notice it; you know, the two primary things doctors are known for, being stupid and lazy. Every day at our COVID-19 outdoor clinic I hear the same conversation between doctors that are floating there to help; “have you guys seen much flu yet?” And every day I hear the same answers; “not really” and “I’ve had a couple.” If we were in the midst of a bad flu season right now and it were being covered up, you’d have hundreds of thousands of doctors, nurse practitioners, physician assistants, nurses, and all sorts of healthcare workers blowing the whistle, not just a couple of drug reps posting their text messages on Parler. Instead what those clinicians are saying is, “COVID is really bad right now. Please wear a mask. Our hospitals are overwhelmed; thank God the flu isn’t bad right now too.”

“Why Don’t Doctors…?”

A friend re-posted this meme and the list of questions below recently, and I want to clarify at the outset that they were interested in a response from their friends in the medical field, not trying to perpetuate the misinformation, nonsense, and deliberate misrepresentations the original author is promoting. While it takes only a sentence or two to ask a nonsensical or disingenuous question or blast some ridiculous health misinformation, a careful and satisfactory answer will probably take a bit longer. Because of this, I’ve decided to tackle these one question at a time over the next few weeks, and will update this blog post with my responses as I go.

One last preliminary; we should recognize two things about the comic above, besides the fact that it’s pretty standard COVID-19 misinformation (“ooh they want you to wear a mask but nobody will tell you to be healthy! No medical expert has ever recommended people exercise before!”). First, it has pretty much nothing to do with the rest of the post. Second, it’s a riff off of the comic below from Mike Baldwin, author of the Cornered single-panel newspaper comic.

Mr. Baldwin is an apolitical cartoonist, and I can’t find anything in his writings that would give me the impression he would endorse this list of complaints about doctors; but of course I can’t find anything to disprove it either. There is one comic where a doctor had removed someone’s entire intestine because his “stomach was all tied up in knots,” so take from that what you will. Still, if the original author is going to start this whole thing off with a stolen and poorly revised comic strip, best to give some credit to the actual cartoonist (whose original comic was more poignant anyway).

We Have Questions”

12/6/2020: Why don’t doctors tell you to take magnesium instead of stool softeners (which dehydrates the bowel)?

Before I even dive into these, I have the definite sense that the number of “Wait, What?!” moments I encounter in responding to this post is going to be extremely high. In fact, with just a cursory glance at this long list of “questions,” I’m really not sure whether the “Wait, What?!’s” are going to outnumber the “Um… We Do’s”. I think I’ll keep score. 

This post is a good example of both. 

Um… We Do
First, let’s be clear what they mean when they say ‘why don’t doctors tell you to take magnesium?’ Surely they mean a laxative compound like Magnesium Citrate or Magnesium Oxide, the active ingredient in Milk of Magnesia. These are commonly used over-the-counter laxatives, and I think we can give the benefit of the doubt that the original author is not here advocating for anything like high doses of magnesium salts like Mag Gluconate or Mag Chloride, typically used to treat magnesium deficiency, as a first line treatment for constipation. Your kidneys will thank you if you don’t overdose on magnesium supplements.

And assuming that this is indeed the form of magnesium they are discussing for constipation, of course we recommend this to patients- when it is indicated. When a patient comes to me with complaints of constipation, the first thing I do is listen to the history of their constipation, including what they’ve already tried for it and whether it was helpful. This helps me both to diagnose whether their constipation is actually due to an underlying medical condition that will need additional work-up, and to make sure that I am not recommending treatment options that they have already tried and found to be ineffective. In general, here are my recommendations for constipation, and usually in this order:

  • Increased water intake, increased exercise and walking, dietary changes. 
  • Increased dietary fiber, including either food sources or fiber supplementation. 
  • Stool softeners including colace, which are more gentle than laxatives but generally less effective.
  • Laxatives, ranging from dietary options that include sorbitol (prunes and prune juices) to polyethylene glycol and milk of magnesia or mag citrate. 
  • Combination stool-softener/pro-motility agents like sennosides.
  • Finally rectal suppositories and enemas, not because they are a worse option than the others but because the patient will pretty much only try these if they have already tried everything else and are now truly desperate. 

Because my patients’ time is valuable and I trust them to make good healthcare choices with appropriate advice, we usually briefly discuss the risks and benefits, potential side effects, and stepwise strategy for all of these types of agents; I don’t tell them to drink more water and do some lunges and see me in two weeks if they still haven’t pooped. So it’s fair to say that while Milk of Magnesia or Mag Citrate are not by any means my go-to medications for constipation, I do talk about it as an option with patients very regularly (ha, ‘regularly’. Get it?) If these medications are both readily available OTC medications that you can buy at your local pharmacy and are commonly discussed with patients, why did the OP decide to focus in on it as the one hidden, secret treatment for constipation that doctors won’t tell you about? I don’t really know, but probably because it sounds more natural to invoke an element like ‘magnesium’ than “Sodium 1,4-bis(2-ethylhexoxy)-1,4-dioxobutane-2-sulfonate”… Though I usually shorten this to ‘docusate’ and in fact (in the spirit of full disclosure) had to google that chemical formula (obviously). And in the alternative health world, unfortunately, sounding natural and crunchy is too often more important than the actual efficacy, side effect profile, and safety of the treatments being recommended. One should ask, why didn’t the author complain that doctors recommend magnesium laxatives and stool softeners instead of increased water intake and yoga, both of which have been proven to help with constipation?

Wait, What?!
Before we move on, we should also address this “dehydrates the bowel” aspect of the post. Because of the beautiful and very intricate fluid homeostasis the body maintains, there’s really no such thing as ‘gut dehydration’ outside of two situations; total body dehydration, which is of course associated with constipation but also a whole host of temporary and potentially chronic problems resulting from poor blood flow and oxygen delivery to vital organs; and medical conditions that result in dysfunction of the normal transport of fluid and ions into the intestinal lumen, such as in Cystic Fibrosis where deficiency and dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein results in decreased free fluid (and bicarbonate) in the gut and thus accumulation and alteration of intestinal mucous and eventual obstruction. So what are they talking about here?

As best I can tell, they must be referring to the fact that some medications commonly used for constipation work by drawing free fluid into the lumen of the gut from the intracellular space by changing the osmotic gradient of the intestines. While it’s true that this could lead to total body dehydration if the fluid is not replaced with oral hydration, most people who are taking medications for constipation (and all that are following their doctor’s advice and don’t have contraindications) will be increasing their fluid intake as well. The more likely risk is diarrhea, abdominal cramping, and bloating. Which medications do this? The ones that contain magnesium, among others. But not all agents work that way; some actually work by increasing the peristalsis of the intestines (similar to how exercise helps constipation), while others help the thickened, firm stool mix better with the free fluid and fats that are already in the intestinal lumen, which is exactly what that fluid is there for in the first place. Here’s a handy chart so you can see how each of these agents works:

So if you are going to complain that anything that mixes stool and fluid together in order to ease bowel movements “dehydrates the guts,” you are going to be complaining about some of the gentlest, safest, and most natural approaches to constipation, including things like upping your fiber intake and cooking with olive oil. If you wanted to go the pulling-fluid-into-the-intestinal-lumen-through-osmotic-changes route, you could definitely go with the magnesium citrate or the magnesium hydroxide the original author is talking about; but let’s not pretend like they are the crunchiest or most natural options available when you had to walk past all of those sorbitol rich prunes, pears, and apricots in the produce section on your way to the pharmacy to buy them.

Um… We Do: 1
Wait, What?!: 1

Why don’t doctors tell you to change your diet when you have heart burn and indigestion instead of you taking Prilosec (which causes more heartburn, colon cancer, osteoporosis and leaves food fermenting in your body)?

Why don’t doctors tell you that HERBS heal? That FOOD heals? 

Why don’t doctors teach you how to lower toxic chemicals in your home when you have constant headaches and allergies? Fragrances and chemicals cause toxic buildup in our cells and can cause more allergies and headaches!

Why aren’t you informed by your doctor that if you eat a grapefruit everyday, it will lower your blood pressure naturally and you don’t need (pills)(this is why a person can’t eat it while on blood pressure meds)?

Why doesn’t your doctor tell you to take activated charcoal for headaches, bloating/gas, skin issues, colds, the flu, food poisoning (activated charcoal bonds waste and toxins and safely removes them from the body)?

Why don’t doctors tell you about herbs and herbal teas to support immune and digestive functions (different herbs help different organs do their jobs to keep the body healthy)?

Why isn’t your doctor suggesting that you take a probiotic daily (this boosts immune function, helps clean and balance the bowel, helps regulate absorption and elimination, and keeps colds and allergies at bay)?

Why don’t doctors teach the value of breastfeeding instead of telling you to use formula instead? Breastmilk is a baby’s very first defense in health outside of the womb! It adapts to what a child needs at each individual feeding, and is THE MOST powerful thing that builds and supports an immune system in a baby. 

Why doesn’t your doctor provide you with any in depth information or package inserts for your vaccines before injecting yourself or your child (they don’t disclose that there are aborted fetal cells, cow cells, African monkey cells and dog cells, along with many other adjuvants like mercury and aluminum and formaldehyde…. none of which are beneficial to the body)?

Why don’t doctors teach you that you store negative emotions in your physical body which can cause you physical pain and sickness, instead of saying you need a (pill) 

(emotions play a very significant roll in our total health, without tools to help navigate our emotions, we can easily become ill)? 

Why don’t doctors tell you when they take a whole organ from your body, that you’re still going to suffer, you just will suffer in a new way (organs are all useful, we need them for many reasons, and most organs can be healed completely without removing anything)?

Why do they set up protocols for prescriptions that most of them wouldn’t even take themselves? 

Why don’t doctors take a real role in helping people live better lives?

COVID-19 Vaccine Misinformation (minute-by-minute analysis)

After weeks of COVID-19 misinformation being a secondary or minor issue- to me because we have been so busy actually diagnosing and treating the virus, and to the country in general because election misinformation was much more interesting- I suddenly find myself with more pieces of misinformation to write about than I could possibly make time for. There is this meme that probably needs some attention as people who haven’t complied with mitigation measures since March threaten non-compliance with any future mitigation measures because the mitigation measures they already didn’t comply with didn’t work (because they didn’t comply with them). If I get time I’d love to explore that a little further (and, I should hope, a bit more graciously than I did in that last snarky sentence).

This reminds me of the great Chesterton quote; “Christianity has not been tried and found wanting. It has been found difficult; and left untried.” Could we say the same thing about self-quarantine, shelter in place measures, and especially lockdown efforts? And what then shall we say about wearing masks? “It has been found slightly inconvenient and inexplicably controversial, and tried only begrudgingly and inconsistently?”

There’s also a discussion that we need to have, as a nation, about how this pandemic didn’t go away on November 4th and isn’t going to go away when we have a new president in the White House. This virus is pitilessly apolitical. It doesn’t care about Republicans and Democrats, the electoral college, lawsuits in Pennsylvania, or any of the other big problems facing our democracy (did I just include Republicans and Democrats in the list of problems facing our country? Yes, yes I did). In an election year, and particularly one this contentious, there was never any chance that information and understanding about the pandemic would fail to fall out along party lines. Now that the election is over, is it possible for us to drop our politicized misinformation and as a countrymen find some common ground on which to fight this deadly virus together? Probably not. But it doesn’t mean I can’t rant about it for five or six thousand words.

But I think the most pressing is the video I’ll share a little way below, which was sent to me by a Facebook friend. It’s a short misinformation video about the COVID-19 vaccines that are being developed and, like most misinformation, is an amalgam of half-truths, deliberate misrepresentations, and outright lies. It’s very short and I’ve posted it here in it’s entirety with the hope that you will read the accompanying discussion and not just watch the video.

Will I get the COVID-19 Vaccine?

Let me start with a statement that might be a bit controversial; while I’m obviously strongly leaning that way, and hope I have the decision put before me as soon as possible, I haven’t absolutely decided whether or not I will get the COVID-19 vaccine once it is available. That might sound like heresy coming from a doctor, particularly when we are currently in midst of the worst wave of the deadliest pandemic of our lifetimes.

But let me explain what I mean. While it’s encouraging to hear that the new vaccine from Pfizer is 95% effective against this very, very deadly virus, and while a safe and effective and widely accepted vaccine is the best and quickest route we have to beating the COVID-19 pandemic without even more massive loss of life, I remain at heart and by training a scientist, not a science fan; I default to skepticism of any new discoveries or developments until I have reviewed the evidence for myself. With regards to the COVID-19 vaccines that have been in development over the past year, I am like most physicians cautiously optimistic. Before deciding to have the vaccine administered to myself and my four children, however, I plan to review all the data that I can in order to ensure my choice is as informed and sound as possible, just like I would for any medication, surgery, or any other intervention my doctor recommends (or, for that matter, any treatment or medication that I recommend to my patients).

“But Dr. Webb, this is exactly what anti-vax parents are doing when they refuse vaccines.”

Yeah, except that it isn’t. At least, not generally. You see, when I say I plan to review the data I mean the actual data from the clinical trials and independent studies, not misinformation and propaganda. If you are like me and have the privilege of scientific training that allows you to independently parse the information contained in published clinical trials, you probably have no desire whatsoever to outsource this type of academic work to people who do not have that training and who are approaching the information with blatant and unabashed bias. But if you do not have the background to do that work yourself, you still deserve the same degree of reassurance and comfort before choosing to accept a vaccine or have it given to your children; it is just less likely that you have access to the resources you need. The anti-vaccine movement knows this and it is in this gap- the gap between the confidence you need for such an important decision and the degree of explanation, information, and reassurance that you are generally given– that they do their best (or most effective) work.

Who is to blame? Well, obviously, I am. Your local doctor, your pediatrician, your PCP; we carry the burden not of fighting propaganda, the blame for which rightly rests on those creating and spreading it, but of helping you become resilient against propaganda and misinformation through patient-centered health education.

So I am begging you, if you are at all wary of or uncertain about a COVID-19 vaccine, and if you do not have the technical background or family/community resources you need to review the source data independently, ask your primary care doctor. Maybe even give them a heads up when you schedule an appointment so they can look into it beforehand (they probably already will have). If they are active on social media, ask them if they would be willing to write about it and share it openly. Some primary care physicians, like Dr. Ben Brashear here in Texas, believe so strongly in this type of work that they have devoted a large amount of their time and energy to helping their patients and other readers navigate these issues through their clinic websites and social media pages. I think this is the single most effective way to combat Social Media Misinformation; with a hundred or a thousand or ten thousand doctors and scientists in small towns like mine or Dr. Brashear’s helping patients whom they have already built a trusting doctor-patient relationship with navigate what information is reliable and what isn’t.

And of course, on the off-chance that over the past 6 months of my writing these blog posts you have somehow decided you actually trust me, I’ll plan to write a short post about my decision on the vaccine as soon as I’ve decided, for certain, what to do for myself and my family.

I should also point out, while we are dispensing with preliminaries, that this post is not designed to be an overview of the research and development of the various COVID-19 vaccines. For that I will point you to my hero, Baylor Friendly Neighbor Epidemiologist Dr. Emily Smith.

“The ChAd Vaccine” Video Minute-By-Minute Discussion

0:12 Share this everywhere!

I’ve been doing this sort of misinformation debunking work as a hobby for about 8 months now and I’ve come to recognize some of the language or verbiage that ought to make us extremely suspicious that the information we are about to be given is not necessarily reliable. The speaker hits several right out of the gate:

  • This is a fact.”
    • In my experience, things that are facts don’t need the disclaimer “this is a fact.” Both for people spreading misinformation and those of us fighting it, the goal has to be to lay out such a clear and compelling case for the facts that the rhetorical sledgehammer of “I’m telling you the truth, I wouldn’t lie to you” is as unnecessary as it is hollow. If someone finds this verbiage convincing, it is likely because they are anxious to be convinced; and it should put you on your guard. “Let your ‘Yes’ be ‘Yes,’ and your ‘No,’ ‘No.’ For whatever is more than these is from the evil one.” -Matthew 5:37
  • Share this everywhere.”
    • Similar to the last point, I believe that most people giving reliable, expert advice or guidance will never ask you to “share” something they have written. Why? Because the burden of demonstrating that an issue is so important and pressing that it should be shared broadly lies again with the author, and lies in the substance and veracity of the arguments, not with the mere desire of seeing their assertions disseminated broadly. Nevertheless, I do recognize that “share this now” is a part of our vernacular now and used by almost everyone of a certain generation on back; but I think it is most suspicious as a herald of misinformation when it is accompanied by….
  • They will take this down.”
    • I sure that at some point something I write, either here or just on just on social media, will be taken down or marked as inaccurate; and when that happens I will probably throw a fit like I’ve seen others do. Until then, I will hold onto the sanctimonious belief that only those intending to spread misinformation feel that it is necessary to preface each video, meme, and essay with “this will be removed” or “they don’t want you to know this.” Who, exactly? The expansiveness, complexity, absolute loyalty, and conflicting goals and values of all of these conspiracies you believe are striving to prevent you from seeing some silly video are really beyond belief. The reality is that most scientists don’t mind at all if you watch the Plandemic documentary or Dr. Stella Immanuel’s speech on capitol hill; what matters is that you know going into it that this misinformation has already been disproven, and that you are armed with the understanding and data you need to work through and decode it. This presents an easy enough decision for me; my goal of helping you sort through this misinformation is best served when it is accompanied by the source material, and posting the video alongside the discussion is a no-brainer. But I think it’s a much more difficult decision for Facebook, Youtube, and Twitter, because they have to worry about the viral nature of this misinformation and the real potential for harm, and can’t accompany every repost or upload with a detailed analysis. Allowing lies to circulate without any disclaimer or precautions to protect those that are easily deceived is irresponsible and cruel; it submits to the whims of anyone with any lie to tell or anything to sell. But the very act of censoring or cautioning about misinformation also serves to reinforce the narrative of oppression; the last redoubt for conspiracy theorists is to use the very censure called down onto themselves for the unreliability of their assertions as proof of their veracity. It is a poor sort of fortress to be sure; yet there are far, far too many who see it as the last citadel of truth.
  • And, saddest of all, “Share to all of your Bible groups.”
    • We will talk about the specifics of what misinformation or misrepresentations in this video specifically might appeal to certain streams or factions within Christianity, but for the time being all I can do is grieve, as a follower of Christ, that a video or meme about the pandemic being spread primarily or at a higher velocity within Christian circles is so often a sure sign that it contains little truth and much that is meant to deceive and disrupt efforts of self-sacrifice and self-denial on behalf of our neighbors and community. I have written about how I believe the Church ought to respond to misinformation and why, but it really does feel as though we are behind the World in this area, both in our discernment and in our charity. Lord Jesus, please teach us to be as wise as serpents so that we might be as harmless as doves!

0:26 “Share with… Anybody that doesn’t want aborted fetal tissue fragments put into them.”

This is actually a major claim of the video and the most compelling topic of discussion of the three the speaker introduces, and we will cover it more extensively in just a couple of minutes. For now, let me just say that it is a fact that the COVID-19 vaccine, or any vaccine for that matter, does not contain any aborted fetal tissue fragments! Share with your Bible group, they will take this down!

It also won’t change your DNA, but we’ll get to that too.

0:40 This is the packaging of the AstraZeneca COVID-19 vaccine.

I have not seen the packaging of the AstraZeneca vaccine or any others for COVID-19 and have no reason to believe this individual photoshopped this package (and compelling reasons to believe they are not capable of doing so, as we shall see).

0:59 “It’s called Chad”

ChAdOx1 stands for Chimpanzee derived Adenovirus-vectored vaccine developed by Oxford University. The 1 means it’s the first of multiple Chimpanzee derived Adenovirus-vectored vaccines for COVID-19 that Oxford is working on.

It does not stand for “Chad- whatever that is, zero, or whatever it is- times one.”

1:19 Go to

Research Square is a fine website, just be aware anything you read there is in pre-print; it hasn’t been finalized or peer reviewed yet. That’s the whole point of the website, for people to get feedback before they publish.

1:21 “I want you to learn to do your own research.”

The speaker claims that she wants her viewers to “do their own research” and begins well enough by directing them to Research Square, a reputable website where you can find original sources. But within about 10 seconds she has transformed “doing your own research” into something about as academic and reliable as a Wikipedia binge (or exactly as academic and reliable, since a Wikipedia binge is exactly what it is); googling random words you don’t understand and reading about them, then deciding what you think they mean without any background or context. It’s hard to tell whether she is being intentionally deceptive here, or if she really believes that she has attained a solid grasp of these concepts through the methods she is espousing.

That’s not what research is. In the context she is using it, ‘doing your own research’ at minimum means using the amazing, abundant resources of the internet to learn more about the concepts being discussed, and then using that new knowledge to get yourself over that first hump in the Dunning-Kruger effect and figure out 1. what you need to learn next and 2. what the limits are on how much you can actually learn about this on your own. The good news is, as long as you are humble in your assessment of your own understanding, you can also use that knowledge to 3. verify the reliability of whomever you go to to learn more.

We’ve all done this before, haven’t we? When I wanted to talk to an HVAC specialist about a problem with the air supply plenum in my crawlspace, I studied the anatomy of different HVAC systems, read some discussions on HVAC forums, and watched several videos that addressed similar problems. When this didn’t fully solve my issue, I called the specialist; and I used that research, mixed with a healthy appreciation of my own general ignorance on the topic, to both improve my understanding of his recommendations and to inform my gut decision on whether to trust his expert advice or get a second opinion (for anybody who is curious, he said the squirrels shouldn’t be living in there and he’s coming out to take a look on Monday. Based on my independent research, I’ve decided I believe him… though the squirrels have been waging a fierce misinformation campaign).

I’ve written (though not yet published) about this before; I want my patients to use Google. Really. And then I want them to come and talk with me about what they’ve read so I can help them get further beyond the point they could by themselves. Like I said in the article I’ve written that nobody else has access to:

“Most of all we went to school to become very, very good at parsing information about the human body and its diseases, and when it comes to the research you’ve brought in that is the primary way I can help; by helping you sort out which information is actually going to affect you and which isn’t, which you should worry about and which you shouldn’t, and what the underlying motivations might be for the people that published it. I’ve spent countless hours looking at research and studies and clinical trials and have become very good at determining when a study design is too flawed or data is too skewed to be reliable, when there is a strong bias that makes the data suspect, or when a conclusion is not supported by the evidence as it claims. If you are a scientist or a researcher or have training in those areas you may be able to do the same, maybe just as well or better; but for most people that isn’t the case, and it would be a little silly to trust your doctor when they offer one of the services they are highly trained for, such as looking at your child’s ear and determining if there is a bacterial infection requiring antibiotics, and not trust them when they offer another service they have been highly trained for, such as telling whether the research you’ve brought in about the human body is reliable or not.”

1:28 “Don’t rely on us or anyone else, do it yourself!”

This is so subtle and clever that I just wanted to point it out briefly. “Don’t rely on us or anyone else” when doing your research is an attempt to level the playing field between the different sources you might listen to, and it seems so reasonable on the surface.. Don’t listen to me, or your doctor, or a scientist, or an epidemiologist or researcher, only listen to yourself. The problem is that, at least in the viral version of this video, we have no idea who this lady even is. Telling you not to take her word for it or your doctor’s implies those two sources of information are equally educated, informed, and reliable; this from a lady who just called it the “CHAD Zero Times One Vaccine.”

1:49 “Google every single word on here.”

Again, that’s not “research.” If you need to google some of these words to know what they mean then by all means do so; but that is the pre-research prep work, not the research itself. Thinking you understand a concept because you looked up the definition of a word is unmitigated folly, as she demonstrates in a few moments.

1:58 Recombinant DNA doesn’t mean they are reprogramming your DNA. At all.

The speaker and her assistant begin their “research” by looking up the term “Recombinant DNA” on Wikipedia. Wikipedia is great, and one of my favorite things about it is that most articles are written at a level that most lay people can understand (except the math ones. Yikes). So I think if you want to follow the speaker’s advice here and read that wikipedia article, you should. I’ll wait.

But the thing is, she doesn’t actually read it in this video, does she? She only reads the first sentence and then, despite her prior warnings, asks you to take her word on what that sentence means. But listen to the way she says it! The emphasis, the alarm, the righteous anger as she enunciates “molecular cloning” and “genome”! She spits the words out as though it were self-apparent how evil they are, without seeking (or asking you to seek) any additional understanding of what they actually mean. Just one googled word in, and she has entirely abandoned her ‘method’ of research; don’t google every single word in this article that you don’t understand, just take it on her authority that this is bad, bad stuff. She tells you earlier not to be intimidated by scientific terms; but here she actually wants you to be frightened by them.

If you actually read that article, you will quickly realize that the idea she implies here (and stated explicitly earlier on), that recombinant DNA reprograms your genetic code, is actually complete nonsense. In fact, it’s exactly the type of nonsense you would expect if someone’s entire understanding of the science involved was gained through googling random words and reading the first sentence only of wikipedia articles.

The Recombinant DNA got him!

Recombinant DNA describes how the vaccines or medications were developed, not what they do once they are inside of you. Just look at the ‘applications’ section of that same wikipedia article; rDNA technology has been used to develop insulin, accurate testing for HIV, and safe growth hormone for patients with pituitary failure, not to mention interferon therapy for cancer, treatments for cystic fibrosis, and TPA, a life saving treatment for strokes and heart attacks. None of these therapies change your DNA. Saying recombinant DNA therapies change your DNA is like saying that Mashed Potatoes mash you if you eat them. No, the potatoes were mashed during the preparation phase so that they would be delicious for you later on; you don’t get mashed, they do. DNA of fungal or bacterial or animal cells was changed in order to develop these treatments, so that they would be safe and effective for the people who need them.

Since I’m waxing eloquent here, I’ll give one more analogy. It’s like my first and only experience in debate club back during Freshman year of college. The topic was “is preemptive war justified.” The first team to debate, the “for” team, got to define the terms of the debate and chose to argue that preemptive war was justified because nations have the right to defend themselves if they are the victims of a preemptive attack; so preemptive war, “war initiated by a preemptive attack,” was 100% justified… on the part of the nation that was attacked first.

They changed the very definition of the term to suit the argument that was easiest to defend; they were arguing for retaliatory or defensive action instead of preemptive, because it was a much simpler position to defend. And the only problem with that is that words have meanings, Keith!

Sorry, I may still have some baggage to work through there. But that’s exactly what this speaker is doing too; changing the meaning of the term ‘recombinant DNA’ and just hoping you won’t notice or indeed read the very article she has pointed you to herself.

There is one more part of this discussion, and it doesn’t have anything to do with what she’s mentioned here, but intersects with this idea of “reprogramming DNA,” even if I don’t think she has the science background to realize it. Here she’s focused on rDNA, but you’ll also hear discussion about mRNA; messenger RNA, the genetic sequences that organisms use to instruct cellular machinery to build proteins. The two vaccines that have recently shown such promise, from Pfizer and Moderna, both use mRNA technology. Traditional vaccines provoke an immune response, teaching your body to produce it’s own antibodies to fight the infection, by presenting your immune cells with non-dangerous particles of the virus that it can recognize and then build antibodies against. Each of these viral particles has to be produced in a lab and enough of them have to be preserved and injected to ensure some are picked up by your macrophages or dendritic cells and then presented to your lymphocytes (T and B cells) to make sure that you really do develop the ability to mount a robust immune response when you exposed to the virus for real later on.

The mRNA vaccines do the exact same thing, only instead of injecting the deactivated viral proteins directly into your body, they only inject a code for them; a code that teaches the machinery in a few of your own cells to build and release the proteins needed to produce the desired immunity. This outside mRNA hijacks the cellular machinery to produce the proteins needed for immunity without any of the proteins that cause illness; and the rest functions just like a normal vaccine. This is the same naturally occurring ‘technology’ that mRNA viruses use themselves. This is great news for people who want to acquire natural immunity; by mimicking the action that the viruses themselves use, which in turn produces our immune response to them, these vaccines have become the closest you can possibly get to acquiring immunity naturally without actually running the risk of getting sick and infecting others. Instead of getting a deadly mRNA virus from a cough or sneeze, you get a safe mRNA ‘virus’ from a vaccine, and from it your body’s own immune system learns how to kill the deadly virus.

This video below explains these concepts really well, starting at the 1:53 mark.

Again, this mRNA technology doesn’t change your DNA. It just sends a message to some of your cells with a set of instructions, just like any common cold would. Your chromosomes, your genetic code, are unaffected; the vaccine doesn’t even interact with them. If an analogy would help, imagine someone ‘hacked’ your network printer at the office. Normally you are the only person who prints to this printer; you write the document on Word or Notepad (judging you) on your computer and then hit “print,” and the signal goes to the printer, which prints the document. But one day you walk in to find that someone else has been printing things to your network printer. That doesn’t mean that they’ve hacked your computer, it just means they have used your paper and ink (and toner! those monsters).

And what did they choose to print? A detailed set of instructions on how to protect your networked printer from hackers. Big Cybersecurity, at it again.

3:00 “We used direct RNA sequencing to analyse transcript expression from the ChAdOx1 nCoV-19 genome in human MRC-5 and A549 cell lines.”

Here is where we enter what is, I think, the heart of what has drawn most people to this video. I think we can quickly dispense with one piece of false information before entering a more important discussion. The ChAdOx1 nCoV-19 vaccine does not use the MRC-5 cell line. This is an inherent problem with both the ignorance of the speaker (and here I do not mean to be insulting, but merely mean the lack of actual education and experience in the field in which she puts herself forward as an expert) and the deep flaw in her ‘method’ of research. This article is not from the vaccine manufacturer at all; it’s from an independent lab that used these human cell lines to study the vaccine after it was produced. You can find the full text here and read it for yourself. The manufacturers did not use those cell lines. In telling you all about the MRC-5 cell line and warning you that;

One thing [the ChAdOx1 vaccine] definitely has is the lung tissue of a 14-week-old aborted caucasian male fetus.”

Narrator: “It doesn’t.”

the author is stating an absolute untruth based in her own haphazard and unreliable method of trying to find scientific information and uncover medical conspiracies. If her “research” methodology has left her unable to even grasp the basics of who is doing the study and why they are doing the study, or the difference between making a vaccine and studying a vaccine that has already been made, why would you possibly trust her method of research? For that matter, why trust her at all, when she has proven herself so unreliable? Even her assistant, the enigmatic Claire, tries to offer some clarification that the cell line used in the study has been replicated over and over again since the 60’s; that the researchers did not actually abort a child and then collect its cells to study the vaccine (or make the vaccine, as she mistakenly believes); but that attempt is ignored by the main speaker.

What about fetal cell lines in medical research?

Despite the speaker’s severe misunderstanding, and regardless of the tired horror tactic of trying to get you to visualize fetal parts being injected into your children in order to illicit a visceral reaction (there are no aborted fetal parts or fetal cells in vaccines, even the vaccines developed using human cell lines), this is an important question and I think we should spend some time on an actual discussion of it, instead of the sensationalized and inaccurate rage that characterizes its treatment in the video.

I am a pro-life doctor. Like most physicians my views on abortion are nuanced, deeply felt, and strongly based in the lived experiences of my patients. Since this video was designed to spark a visceral reaction among pro-life people in order to make them more susceptible to vaccine misinformation, I think the issue of abortion and fetal cell lines in research warrants discussion on this blog post. I have helped prevent countless abortions, both through providing high quality women’s health services, often to women who otherwise would not have good healthcare access, and by providing compassionate listening, patient-centered care, and judgement free counsel during the most tumultuous times of an unintended pregnancy. There are those that will argue that doctors shouldn’t be pro-life, that my moral opposition to abortion means I can never truly provide unbiased guidance and information to a woman facing this most difficult and painful decision of her life, or that I am somehow unable to respect my patients’ autonomous decision making in this area and help them leave my office more empowered than when they came in. I don’t believe that matches the experience of my patients. I might argue that informed consent, a core principle of medical ethics, is impossible without a robust patient-focused discussion of the medical realities and practical alternatives surrounding the decision to terminate a pregnancy, and that there is reason to believe that these conversations are too often sacrificed or short-circuited once the specter of abortion first arises. It is a debate for another day, to be sure, and with many of the physicians who hold the opposite view I nonetheless share a strong mutual respect, born of proven care for and dedication to our patients, that overrides even our deeply held reservations on this issue. Even on the question of abortion and consent itself, we both believe, based on all of our medical training and the high degree of altruistic concern we bring to our jobs, that we are striving to do what is best for our patients; to help them in the way that is best for them and most consistent with their own stated goals and deepest felt wishes.

Many medications and vaccines use fetal cell lines. The reason is simple; human cells typically work best for studying and developing treatment for human diseases, and fetal cells have unique characteristics that allow cells to achieve, or nearly achieve, cellular immortality; allowing the same cells to be replicated over and over again without any need for additional cell lines to be collected. There is no question that this is a challenging ethical and moral area for pro-life scientists like myself, and strongly pro-life physician and multidisciplinary healthcare organizations, like the Christian Medical and Dental Alliance (CMDA), have discussed and written extensively about it. Here are a few articles CMDA has published, written by conscientious physicians of deep, theologically sound Christian conviction. I hope you will weigh their words and reflections with at least as much gravity as a random person on the internet telling you to “pray big” and share her video with as many “christian-loving” people as possible.

Christian Medical and Dental Alliance:
Am I My Brother’s Keeper?
By Dr.
Amy Givler, MD, FAAFP

Christian Medical and Dental Alliance:
Is Vaccination Complicit with Abortion?
By Dr. Gene Rudd, MD

There are a few salient facts you should know about this area of medicine.

  1. No children are aborted or have been aborted for the purpose of developing medicines or vaccines. The sensationalism that some forces in the anti-vaccine movement are willing to engage in knows no bounds, and it is not uncommon to hear the propaganda that these unborn babies were actually aborted for the purpose of being used in medical research. This is simply wrong. The few unborn children whose cells (or accurately, copies of copies of their cells) are regularly used in medical research and development were likely aborted for the same reasons that most abortions occur; the unbelievably difficult balance of perceived goods and anticipated challenges faced by a woman who had not intended to become pregnant. These mostly occurred in the 60’s and 70’s, and cell lines (copies of cells) derived from those same aborted fetuses have continued to be used ever since without the ‘need’ to derive new cell lines from abortions occurring today. For instance, HEK 293, the actual cell line used in the development of the ChAdOx1 vaccine, was derived from an abortion in The Netherlands in 1973; we simply do not know the story of the woman who chose to have this abortion, or the reasons behind her choice.
  2. There are no fetal cells in vaccines; not even in vaccines developed using fetal cell lines. Vaccines are not a ‘mix’ of fetal cells and viral particles, not by any stretch of the imagination. When fetal cell lines are used to grow viruses that infect humans in the vaccine development process, it is distant to the final product of the vaccine, which has also been through multiple rounds of purification. The human cell lines are used to grow the virus and deactivate it; they are not included in the actual material injected through a syringe to produce an immune response in our bodies.
  3. Not all vaccines use human cell lines. There are vaccines for almost every vaccine preventable illness that are designed using methods that even the most rigorous pro-life groups consider ethical. When the anti-vaccine movement tries to convince you that all vaccines are suspect from a pro-life perspective, they are rather co-opting a pro-life position for their own aims rather than being a legitimate part of the pro-life movement.

Like the CMDA doctors above and most pro-life physicians and scientists, and even the Vatican, I believe that using vaccines and medications not developed using fetal cell lines from aborted human beings is strongly preferable whenever possible, and that this is an area where continued economic and moral pressure can encourage pharmaceutical companies and research institutes to pursue alternative means of developing novel treatments to human disease. However, the principles of whole-life pro-life ethics also dictate that a treatment or preventative measure developed in part through material derived from a past harm through abortion, with no potential to cause further harm in this same way but massive potential to prevent loss of life (including unborn human life) is still, clearly, a moral good; a position even Popes have affirmed. In saving the lives of a great many people from a single death that would not have been prevented regardless, we derive the greatest possible moral good from what was an undeniably tragic situation for all involved.

For pro-life persons, accepting a vaccine that was developed from fetal cells collected 50 or 60 years ago makes them neither complicit with nor promoting of a depreciation of human life. But seeking treatments developed using alternative means may send a message to pharmaceutical companies that these issues are indeed dear to their hearts and that their collective will is that these methods in research would become a thing of the past.

And the great news for staunchly Pro-Life people is that not even all effective COVID-19 vaccines use fetal cell lines. Neither the Moderna vaccine nor the Pfizer vaccine, the two that have been recently publicized as 95% effective against COVID-19, used fetal cell lines in development or production. The question of fetal cell lines in medical research and development is an important one; but it is not likely to be an issue when getting vaccinated for COVID-19, assuming you have some degree of freedom in which vaccine you choose.

4:23 “This is what they want… They KNOW this vaccine is going to hurt people or kill people so badly.”

A few things here.

  1. If there is a way to kill people not so badly, please let me know. We could be on the brink of a medical breakthrough here.
  2. Who is “they” anyway?

She jumps around so much in this video that the viewer is left to assume, just like with the MRC-5 discussion, that this last bit is screenshot from the original papers from the vaccine manufacturer; that the people making the vaccine have, in their published study, asked the universe at large to supply them with some sort of computer program or something to help them sort through all the people they intend to maim or kill. We’ve talked before how conspiracy theories rely on this weird paradox where shadowy conspirators are both incredibly clever, subtle, and nigh-invulnerable but also so clumsy as to announce their real plans in such a way that some random person on the internet can piece it all together with a 5 minute video. Pfizer or Moderna publishing “please help us, our excel spreadsheets aren’t robust enough to keep track of all the victims we are after” at the bottom of their research would certainly fall under this phenomenon.

But this isn’t from the vaccine manufacturers. It’s from the Medicines and Healthcare products Regulatory Agency (MHRA), the British counterpart of the FDA. And it isn’t from a research paper, it’s from their contracts division, announcing the technology services they are hoping to contract with as they anticipate the release of these vaccines.

Why would the MHRA or FDA want to track possible adverse reactions to a new vaccine?
Because it’s literally their job.

And why would they anticipate a “high volume” of reported adverse reactions?
Because we are in the middle of a highly politicized, deeply contentious global pandemic; billions of people are going to get these vaccines, and some of them are going to have very mixed feelings about it. Adverse reactions to vaccines range from the common but mild to the serious and extremely rare, but reported or perceived reactions are all over the place. I saw a patient yesterday who believed that his flu shot had caused him to feel fatigued and sore the next day (it had), and also to have six days of diarrhea and loss of taste and smell two weeks later (it hadn’t). He tested positive for COVID-19, the true source of his symptoms. I’ve also had patients who believed their flu shot gave them COVID-19, which is utterly impossible.

Vaccines feel scary; they are sciency and mysterious and they are going into your body, and you are taking someone’s word for it that they are safe and a wise decision. I get that. A new vaccine is even scarier, and a new vaccine for a virus that is deadly, has changed our entire lives over the past year, and is surrounded by a thick haze of misinformation and conspiracy theories is even scarier. Some of the folks getting that vaccine are going to do so, probably to keep those around them safe, only after warring within themselves over it (even I told you I’ve still got some research to do before I’m fully satisfied with the decision). For some of those folks, anything medical that happens to them in the next few months might potentially feel like the negative fallout of that one difficult decision. The point of the MHRA using an AI tool to augment their ability to analyze that data is so that they don’t miss any real adverse reactions hidden in all of that noise; to make sure that if the vaccine is dangerous after all, despite the safety demonstrated in clinical trials, they discover it as quickly as possible. Again, because that’s their job. This is evidence that the people tasked with making sure the vaccines are safe really do take that role seriously; not evidence that someone is planning to hurt you and wasn’t sneaky enough in hiding their intentions.

5:01 “I don’t know how you do it, I’m not technical.”

After watching the same 5 minutes of these folks pointing a shaky phone camera at their computer screen and pulling up various image preview programs and web browsers over and over again while writing this blog post, I can now verify that this is the single most true and reliable statement in the entire video.

It looks like I’m just being cheeky at this point, so I guess it’s time to stop there.

Don’t Be Afraid of COVID-19.

The following is a short repost from social media.

Well, call me triggered.

I’m a Family Medicine Physician, and every day for the past 3 months I’ve seen patients for COVID-19. Every day for 3 months, I’ve told every patient I’ve diagnosed with COVID-19, with the exception of the few I’ve sent directly to the hospital because of the severity of their symptoms, the same three things:

1. Don’t be afraid of COVID-19.

I say this to my patients for a few reasons. First, because I am mostly seeing patients in the outpatient setting, my patients and I have the privilege of emphasizing this point. Second, for many patients who have a mild to moderate severity course of COVID-19, anxiety is a very real issue, and I want to make sure that while they are recovering they are not sitting at home wondering when the virus is going to get them. Most people who get COVID-19 don’t end up in the hospital (as we have been saying since the beginning of the pandemic), even fewer end up in the ICU or die from the virus (as we have been saying since the beginning of the pandemic). The virus is very, very dangerous, but our brains are bad at statistics; just because this is the most dangerous viral pandemic since the Spanish Flu of 1918 doesn’t me that your individual chances of dying are high or that getting deathly ill is a foregone conclusion. If I were mainly seeing very sick patients in the hospital or ICU I wouldn’t be saying this as much; we would be talking more about treatment and response than about the patient’s anxiety about getting sicker, though the latter certainly deserves our time and attention in any clinical setting. When a patient is struggling to breathe, “don’t be afraid” is a theological statement rather than a clinically valid reassurance, and it typically gives way to “I am with you; I am here and I am going to do my absolute best for you.” But in the outpatient setting, talking with patients who are worried about how COVID-19 will affect them and their children and their friends, “don’t be afraid” is an extremely important part of the conversation.

2. If you have the following symptoms, go to the hospital.

As important as “don’t be afraid” is, it is equally as important to talk about what we call emergency and return precautions. Yes, for most people COVID-19 is not deadly; but it is for some, for many in fact, and we do not have any perfect way of predicting who will have a more severe course. For my healthy patients in their 20’s and 30’s, the chances of ending up severely ill are extremely low; yet people who are medically just like them- same age, same paucity of risk factors- have died from the virus. The same for parents who are worried about their children; children are at extremely low risk from COVID-19, yet some children have died from the virus. I can look my young, healthy patient in the eye and honestly tell them I expect them to be fine; but I cannot promise them that they will be, and that’s a vital distinction. So with each and every patient, in addition to reassurance, we talk about what to look out for. Shortness of breath. Chest pain. Severe malaise and fatigue, even syncope; passing out or almost passing out from the toll the virus is taking on your body. We talk about oxygen levels if they happen to have a pulse oximeter at home, and signs of hypoxia if they don’t. We discuss both the reasons they would come back to see me in clinic and the reasons they would skip my clinic and go directly to the Emergency Department instead. With my older patients or patients who have known risk factors (most Americans, in fact, including myself, considering that risk factors for a more severe course of COVID-19 include hypertension, diabetes, obesity, chronic lung disease and other very common ailments), this discussion is even more important, because even though the odds are still in their favor, their ending up in the hospital or dying from COVID-19 is not nearly as unlikely. I want my patients to be free from fear; but I also want them to be equipped with the knowledge they need to make sound choices if their symptoms do worsen.

3. Please keep the virus from spreading to others.

This piece of guidance is no less important than the previous two. If you are healthy and young and your chances of dying from COVID-19 are very low, that’s really wonderful; but self-isolation during your illness is still the responsible, kind, and charitable decision because not everyone is as lucky as you. The case fatality rate of COVID-19 is much higher than even very deadly illnesses like the flu, and it is very, very contagious. With each and every patient I discuss the precautions they can take to keep the virus from spreading to their own family, and of course the responsible social decisions like sheltering at home during their contagious window and alerting their close contacts so they can self quarantine. It’s one thing to tell yourself that you’ve only exposed other people at similarly low risk to yourself, but once you have spread the virus to someone else you have no control of whose grandmother, whose father in poor health, or whose immunocompromised child it spreads to from there. I said before that we are bad at intuitively comprehending statistics; the COVID-19 virus, like most illnesses, is unlikely to cause death to any given individual regardless of risk factors, but is extremely deadly in aggregate; containment is still our best strategy for keeping the 210,000 deaths in our country from doubling or tripling by the end of this pandemic. The reality is that most people get this; most people I talk to understand the need and are concerned about keeping their families and communities safe. But there is a counter-narrative being promoted by some that rejoices in defying all calls for caution, sober mindedness, or charity when it comes to COVID-19, and so the reminder from me, the doctor actually seeing the patient face to face in clinic, becomes that much more important in case my patient has been lured by these cruel and irresponsible ideas.

These are the three pieces of advice, the three categories of discussion that I have with each and every patient. It is time consuming; it appropriately turns what might be a 5-8 minute visit into a 10 or 15 minute visit. It requires careful explanation of statistical and clinical concepts that might be challenging. It is worth it, because the proper way to approach a diagnosis of COVID-19 is with caution on behalf of others and preparedness rather than fear for yourself and your family, and it’s my job as a Physician to equip my patients with the knowledge and tools they need to approach the virus this way, even in the face of anxiety and rampant misinformation.

So when I see someone with a platform like President Trump’s endorse the first point of not being afraid of the virus, follow the second point of going to the hospital when his symptoms escalated and he experienced hypoxia and shortness of breath, and finally utterly disregard and contradict the third point of taking precautions on behalf of others, I am, I think very understandably, upset. Because when a doctor or a nurse survives COVID-19 (and many haven’t), contracted by putting themselves in harm’s way every day and despite taking maximum precautions to keep themselves and those around them safe, they rejoice that they are now able to dive back into the fray, fighting the virus with no less caution but somewhat less stress and anxiety for their own health, knowing that reinfection is very likely a rare occurrence. But when the president contracts COVID-19 by ignoring all precautions and survives it with the help of state of the art high-level hospital care, expensive and experimental treatments, and a private team of doctors and nurses, his first statement after leaving the hospital is one that builds upon his long-standing guidance and example of not taking precautions or acting to protect those around you, despite neither you nor your family and community having anything like the medical access that helped him.

Please keep yourself and others safe. Don’t be afraid of the virus, but please act in charity to those around you by taking reasonable and proven precautions like wearing a mask, maintaining physical distancing, and engaging in sound epidemiological principles like getting tested if you are ill, self-quarantining if you are exposed, and honestly and proactively participating in contact tracing if you are diagnosed.

Edit #1:
I will go ahead and anticipate a couple of objections to this post. First, some people are going to claim that the facts I’ve shared here are inaccurate; that the ‘CDC admitted’ that only 6% of the deaths were actually from COVID-19, or that the fatality rate is actually lower than the flu, or some such nonsense. For people who still believe these pieces of COVID-19 misinformation, there is no shortage of good explanations and rebuttals available on the internet and I suggest finding and reading one. For people who don’t mind a long and mediocre rebuttal over a good one, I’ve written a few myself over at

Second, some people are going to look at this tweet from the president and say, “but TJ, he isn’t discouraging caution or telling people to take COVID-19 less seriously! He just said don’t let it dominate your life, that could mean lots of things!” To those people I will say, along with Doctor Archibald from Veggie Tales, “Stop being so silly!”

When I tell my patient “don’t be afraid” after reviewing their vital signs, asking about their symptoms, carefully examining them and listening to their heart and lungs, and carefully talking through emergency precautions and transmission control measures, they are absolutely not confused about what I mean. And nobody in America is confused about what the president means when, after months of promoting misinformation, minimizing the pandemic, shirking transmission control guidelines even to the point of endangering his secret service and staff during his own illness, refusing to wear a mask (and then only wearing one intermittently and with a wink at mask truthers when he does), he then says to ‘not let it dominate your life’. And nobody will be surprised when the ongoing unwillingness of our national leadership to take the pandemic seriously, and encouraging others to do likewise, results in more cases, more severe illnesses (and associated suffering and medical debt), and more deaths.

Edit #2:
On the same day that I posted a short essay titled “Don’t Be Afraid of COVID-19”, Dr. Emily Smith, Your Friendly Neighborhood Epidemiologist, posted a short essay saying that Yes, We Should Be Afraid of It. Now, Dr. Smith is so much smarter than me that this would normally be enough to make me immediately delete my post; but thankfully, it turns out we are saying essentially the same thing, despite the seemingly contradictory essay titles. To understand what Dr. Smith and I mean when we say you should/shouldn’t be afraid of COVID-19, go and read her essay where she discusses the difference between unhealthy fear and wisdom, the latter being something our national response to this very deadly and dangerous virus has been sorely lacking.

𝐒𝐨, 𝐰𝐡𝐲 𝐬𝐡𝐨𝐮𝐥𝐝 𝐰𝐞 𝐛𝐞 𝐚𝐟𝐫𝐚𝐢𝐝 𝐨𝐟 𝐂𝐎𝐕𝐈𝐃? 𝐁𝐞𝐜𝐚𝐮𝐬𝐞 𝐭𝐡𝐞 𝐬𝐜𝐢𝐞𝐧𝐜𝐞 𝐭𝐞𝐥𝐥𝐬 𝐮𝐬 𝐰𝐞 𝐬𝐡𝐨𝐮𝐥𝐝. 𝐋𝐞𝐭’𝐬 𝐝𝐞𝐟𝐢𝐧𝐞 𝐰𝐡𝐚𝐭 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐟𝐢𝐫𝐬𝐭 𝐭𝐡𝐨𝐮𝐠𝐡. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐰𝐢𝐬𝐞, 𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫 𝐚𝐧𝐝 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲, 𝐝𝐞𝐛𝐢𝐥𝐢𝐭𝐚𝐭𝐢𝐧𝐠 𝐟𝐞𝐚𝐫. 𝐓𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐢𝐧 𝐫𝐞𝐜𝐤𝐥𝐞𝐬𝐬 𝐛𝐞𝐡𝐚𝐯𝐢𝐨𝐫 𝐚𝐧𝐝 𝐜𝐚𝐮𝐭𝐢𝐨𝐮𝐬 𝐰𝐢𝐬𝐝𝐨𝐦. 𝐈𝐭’𝐬 𝐭𝐡𝐞 𝐫𝐞𝐚𝐬𝐨𝐧 𝐰𝐡𝐲 𝐰𝐞 𝐭𝐞𝐥𝐥 𝐨𝐮𝐫 𝐜𝐡𝐢𝐥𝐝𝐫𝐞𝐧 𝐧𝐨𝐭 𝐭𝐨 𝐭𝐨𝐮𝐜𝐡 𝐚 𝐡𝐨𝐭 𝐬𝐭𝐨𝐯𝐞 – 𝐭𝐡𝐚𝐭’𝐬 𝐧𝐨𝐭 𝐮𝐧𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐟𝐞𝐚𝐫, 𝐢𝐭 𝐢𝐬 𝐰𝐢𝐬𝐝𝐨𝐦.

Dr. Emily Smith, PhD, MSPH


One thing that has become predicable throughout the SARS-CoV-2 pandemic is that any story, any recommendation, any development, or any piece of data that can be interpreted as meaning that the danger of COVID-19 has been inflated, misrepresented, or exaggerated by medical experts will be interpreted that way by a large percentage of our population. This is no longer surprising, but honestly it’s also completely understandable. We all hate this pandemic. Whether you are working on the front lines in clinic or in the trenches at the hospital treating COVID-19 every day, whether the virus has harmed or killed a friend or family member, whether your job or business has been affected, or even if you just really miss people, we are all ready for this to be over. The hard path forward involves biomedical research, redoubling mitigation efforts that we are all exhausted of, and at this point, modifying holiday plans and preparing to deal with the quagmire of cascading clinical probabilities that are required to fight the virus in the midst of cold and flu season. But the quicker and easier path to getting rid of this hated virus is undoubtedly to just choose not to believe in it at all. And while this “just don’t believe in it” approach is likely to be about as effective as it has been for any of the other problems I’ve tried it for (taxes, bills, excess carbs), I am sympathetic to the appeal of it. If the pandemic has not affected you directly- or maybe even if it has- it may be very tempting indeed to buy into a video like Plandemic, which tells you that the whole thing is just a government conspiracy, or into the America’s Frontline Doctors‘ video which tells you that there is already an easy and inexpensive cure if you just drive to the see the right doctor. Life can be normal again right now, these sources say; all of your hopes are true and all of your caution and privations can finally come to an end. I’m not saying it’s right, I’m just saying I get it.

But what has been surprising- and consistently surprising, to me at least- is which wild facts people will latch onto to create these false narratives. Before today, I would never have expected this paragraph from the CDC’s weekly updates by select demographic and geographic characteristics to be the next cause of viral misinformation:

Yet here we are.

What is the claim being made?

If I chose to end this blog after today, I would feel I had really come full circle; my very first blog post was about the myth, popular late in March (and persistent even today), that doctors were lying on death certificates to make the virus seem more dangerous than it really was. Today’s myth is that analyzing the diagnostic codes on death certificates –those incorruptible sources of reliable data- reveals that the virus isn’t actually very dangerous at all, and the CDC has just admitted to it. Bypassing the irony that this later misinformation is being circulated by exactly the same people who have been sharing the first for months, we can spend today’s blog post (48 hours late as usual, this time because our internet was out all day yesterday!) analyzing these claims. They seem to have taken two forms.

The first, and more moderate, is to claim (or at least strongly imply) that because 94% of deaths from COVID-19 also had other diagnostic codes listed on the death certificate, it means that people without ‘underlying medical conditions’ are not actually at a very high risk of dying from the virus. And in one sense this is true, even if this new data from the CDC doesn’t actually really have anything to do with that. Your Local Epidemiologist says this better and more succinctly than I can:

And she’s absolutely right; we have been saying this from early in the pandemic. But not just saying it; thinking it and believing it, too. Every decision I make as a physician, from admitting someone for COVID-19 to starting or stopping a medication, referring them to a specialist, or even recommending exercise or lifestyle changes has to take into account their medical history (and a host of other factors). While there are some symptoms we can warn everyone about, the counseling and support we provide for patients seeking evaluation and treatment of COVID-19 has a lot to do with their individual risks from the virus and how it might manifest in their lives based on their age and other medical conditions. This 6% misinformation became viral just yesterday, yet if you asked any doctor last week they would have already told you that the younger and healthier you are the less likely you are to end up in the hospital or die from COVID-19, and the more medical complications you have the more concerned they are about you having the virus. I know because this is exactly what I was saying to people in clinic last week, and the week before that, and the week before that. Yes, many young and otherwise healthy people have died tragically and shockingly from complications of the virus; but this is still a rare occurrence on the whole compared to the number of young, healthy people who have had the virus. When I counsel people at low risk of complications from COVID-19, we of course talk about the signs and symptoms they should watch for that would trigger a trip to the ER, like chest pain and shortness of breath; but I also want to make sure they aren’t sitting at home, anxiously wondering when the virus is ‘going to get them’. I want them self-isolating; I don’t want them to be afraid. But this relative reassurance towards the young and healthy is actually undercut ever so slightly when you combine headlines like these with the actual data being reported from the CDC, which I’ve included below.

When you look at the other diagnostic codes listed in the table above, you will notice that codes like E78.2 and I10 are listed; high cholesterol and high blood pressure, respectively, both conditions I’ve been diagnosed with in the past (and probably still have, if I would ever go get a check-up. Doctors really do make the worst patients). At 35 and having never spent a night in the hospital as a patient in my life, nobody would call me high risk for complications of COVID-19. In fact, if I contracted COVID-19 and died of it this week, two things would happen. First, my blog would probably get a lot more hits for a couple of days (and this paragraph in particular would seem very bitterly ironic). But second, I would be held up as an example of how being young and in relatively good health is not a perfect guarantee of safety from the virus. Yet I would be a part of the 94%, not the 6%.

The reality is that in saying “94% of COVID-19 deaths had underlying conditions,” these stories are adding nothing to and are in fact dumbing down the more sophisticated knowledge we already have, and share with our patients daily, of the most important risk factors and conditions that predispose someone to COVID-19 being a likely threat to them. They are meant to lure you into a false sense of security, because it’s so easy to think they mean somebody else besides you (even if you do in fact have some of those diagnoses, like I do) and a relatively small group of people. But when I look at the chart, I realize that even I fall into that group with “2 or 3 underlying medical conditions” that they are saying 94% of the COVID-19 deaths occurred in; in fact, most Americans do. And when a statistic includes me, privileged to be in pretty good health as I am, but also my patient battling metastatic kidney cancer and my patient suffering from both CHF and COPD, maybe it just isn’t a very useful statistic in the first place.

But the more dishonest and blatantly ridiculous claim, which has absolutely no justification, is to say that only the 6% of deaths with just COVID-19 listed on the death certificate actually count as COVID-19 deaths. Take this one Facebook poster who has been widely shared, who had the gall to take this to the next step and “calculate” that only 9,210 people had “actually died from Covid.” Probably because she was willing to put a number on the deaths, this post has been shared 21,000 times on Facebook; but it’s hard to believe that someone with a doctorate degree, any doctorate degree, could have such little grasp on basic statistics.

No, No, No.

This post entirely misrepresents everything within our complex understanding of medicine regarding the impact of medical comorbidities, the myriad causes and steps leading to death in COVID-19 or any other illness, and even the very process of completing a death certificate. In her estimation, Dr. Hesse is saying that a diagnostic code on the death certificate other than COVID-19, literally any other code, is sufficient evidence that the patient did not die from COVID-19. This is not only preposterous and dishonest but also just plain silly. We are going to explore these issues more thoroughly in the next section, but briefly, just look at the chart above and begin googling ICD-10 diagnostic codes for yourself to test the logic of her interpretation. Yes, I can absolutely believe that some of the patients whose death certificates reflect both COVID-19 and also diagnosis code C71, Malignant neoplasm of brain, may actually have died from the brain cancer and were only found to have the virus incidentally. We can’t tell from the data if that did in fact happen, or how many patients might have such a presentation. But with COVID-19 being an acute illness and brain cancer being a chronic illness, the disease and treatment of which also predisposes you to infectious illnesses, it is at least as reasonable to assume that the majority of patients who died from “COVID-19 and brain cancer” actually died from COVID-19, which they were more vulnerable to because of their pre-existing brain cancer.

But Dr. Hesse’s assertion that only the 9,210 “COVID-19 only” deaths should count also has to stand up to scenarios like, say, any hypothetical patient who was certified as dying with COVID-19 and R09.3, Abnormal sputum, or COVID-19 and N20.0, Kidney stones. Again, we can’t tell from this data whether any such patients with only those codes exists; but neither can Dr. Hesse, and for her argument to be valid, each and every possible diagnostic code included in the chart above would, if added to a COVID-19 death certificate, nullify COVID-19 as a primary or contributing cause of death. That is what she is saying, and it is obviously ridiculous. What this error betrays is a complete misunderstanding, whether intentional or accidental I know not, of how death certificates are completed and the information they are meant to capture. Even though it means a longer essay, I do think it’s worth taking the time to revisit this again.

What information do we include in a death certificate?

Once you have been trained to complete death certificates (and have actually done it), this “6%” argument is not even momentarily tempting or convincing. I know what you are thinking; “but TJ, we haven’t been trained to complete death certificates, so you are asking us to trust you with this area of specialized knowledge we don’t have access to.” Well good news reader, the Texas Department of Health and Human Services, DSHS, has got you covered. If you want to understand this 6% statistic from the CDC, I highly recommend that you watch from 1:44 to 3:08 of this video.

Sorry, the secret tutorial video they released after COVID-19 is password protected.
Also, that was a joke.

Obviously each state will have its own version of this software, but they are all intended to convey the same information; the death certificate is not a high-stakes multiple choice interrogation asking the doctor, “What disease caused the patient’s death? Was it COVID-19 or heart failure? ANSWER THE QUESTION!” Rather it is an opportunity to distill the sequence of events leading to the patient’s death, recorded in greater detail in the medical record, into a structured narrative that explains how they died. When a doctor includes coronary artery disease on the death certificate, they are not making a political statement or a value judgement, but rather an honest reflection of the part this disease played in the patient’s death based on their medical knowledge and their intimate understanding of the progression of illness as the patient’s treating physician. And it is exactly the same with COVID-19. Moreover, this is not something that the physician derives a financial benefit from or an opportunity to defend the medical care the patient received (in fact, I have listed iatrogenic injury on the death certificate when I felt that my own mistake or that of another medical professional contributed in some way to the death of the patient), but rather something that is important for public health information and, in various ways, important to the family of the deceased.

Briefly, I’d like us to complete a medical certification for a death certificate together, again using my hypothetical death from COVID-19 as an example. In this scenario, let’s say that I get sick with cough and loss of taste and smell this week and am diagnosed with COVID-19. Around day 10 of my symptoms I begin to experience chest pain and shortness of breath, and I go to the ER. There I am found to be hypoxic and my chest x-ray shows bilateral peripheral consolidation consistent with ARDS. they begin to treat me with dexamethasone, remdesivir, and oxygen. Over the next few days my respiratory distress increases and, even allowing some permissive hypoxia in order to avoid intubation, the doctors simply cannot keep my oxygen level within safe parameters; they make the difficult decision to intubate me and put me on a ventilator. I am ventilated in prone positioning using the latest and best evidence-based ARDS/COVID-19 ventilation strategies from the genius doctors over at EmCrit and PulmCrit. Unfortunately, I continue to become progressively, severely hypoxic, and eventually suffer cardiopulmonary arrest. Resuscitation is attempted but ultimately efforts to revive me prove futile; the lungs are not compliant, effective ventilation still cannot be achieved, and return of spontaneous circulation is impossible. I’d make a joke about making the life insurance check out to my wife, etc. at this point, but honestly when I reflect on how many people have died from this sequence of events over the past six months, it’s pretty sobering. I’ve made myself sad just now thinking about all of the families that have lost a mother, father, sibling or grandparent in exactly this way.

Once I’ve died, the doctor treating me will have to record it in a death certificate; we can use the Texas system, since it’s what I’m familiar with.

Here in Part I we list the immediate cause of death. In my case, it’s going to be cardiac arrest. Because this is technically the immediate cause of death in every death except those caused by brain death, some doctors would leave this out. Since resuscitation efforts were made and the arrest was a distinct medical event, I would probably include it, but an argument could be made either way. Next we need to describe the events that led to this. I’m not going to include respiratory arrest because I would feel it was a bit redundant, and besides, I was already not breathing on my own when the cardiac arrest happened since I was on a ventilator. Instead, I would say the arrest was due to respiratory failure. The respiratory failure was due to ARDS, Adult Respiratory Distress Syndrome, and you could make a case here for including viral pneumonia as well. Finally, the ultimate cause of this cascade of complications is my infection with COVID-19.

Next I would need to list any other contributing factors in Part II, and here is where the quandary usually comes in, because now I have to decide whether my high blood pressure and high cholesterol belongs in Part II, “other significant conditions contributing to death but not resulting in the underlying cause,” or in Part I further down in the chain of events. In this case it’s easy; my high blood pressure is a significant medical issue and made me at higher risk from the virus, so it belongs in Part II; but it didn’t cause me to get COVID-19, so it doesn’t belong in Part I. My chronic right shoulder pain didn’t contribute at all and gets left off the death certificate. These decisions aren’t always easy; sometimes a condition did lead directly to death in chain of events that are causative narratively even if not pathophysiologically; for instance a patient who is hospitalized for a hip fracture and then develops sepsis from a central line. The hip fracture didn’t cause the infection that kill them, but it was a direct part of chain of events. But what about the vertigo that caused the fall that caused the hip fracture; does that belong in Part I or Part II? I have a physician friend who works in hospice care who completes death certificates almost every day (I have completed maybe a dozen); he says this is typically the hardest decision point when it comes to completing a death certificate, deciding what was really a cause and what was ‘only’ a contributing factor. Still, it’s straight forward enough in my hypothetical case, and we can finalize my death certificate as follows:

Cause of Death – Part I:
a. Cardiac Arrest.
b. Respiratory Failure.
c. Adult Respiratory Distress Syndrome.
d. COVID-19.

Cause of Death – Part II
-Hypertension, Hyperlipidemia

So, for young, relatively healthy me who died from the most stereotyped and straightforward case of severe COVID-19 I can conceive of, we have 5 other diagnostic codes listed on the death certificate between direct cause conditions and contributing conditions. Contrast that to what a Texas death certification with only the diagnostic code for COVID-19 -the only types of death certificates Dr. Hesse believes count as COVID-19 deaths- would have to look like:

Cause of Death – Part I:
a. COVID-19
b. ________________________
c. ________________________
d. ________________________

Cause of Death – Part II

My friend, the hospice doctor, has completed over 500 death certificates (a conservative estimate) since finishing residency a few years ago. He says he has included just one diagnostic code alone maybe twice. What Dr. Hesse sees as the ‘real’ COVID-19 deaths, these 9,210 death certificates without any other documented diagnoses, I see as an anomaly; I am forced to ask myself how that many death certificates were complete in what I consider to be such an incomplete and insufficient manner. I have two theories, aside from some doctors simply not giving the proper attention to the task that they should have or not understanding the importance of completing the death certificate thoroughly. One is that some of the doctors who have been taking care of patients in this pandemic simply might not be familiar with how to complete a death certificate. This pandemic has brought doctors out of retirement and graduated 4th year medical students months early to shore up the frontlines; surely some just haven’t had even the 5 minutes of training from the video above and don’t know how to complete the forms properly; frankly it’s a low priority in their training right now. But second, some of the death certificates for COVID-19 patients have been completed by doctors who were incredibly overwhelmed. When we consider places like New York City, where doctors and nurses were dropping from exhaustion during shifts and barely had time to document at all, and were seeing multiple deaths per shift, each and every shift for weeks, it is reasonable to expect that some of those doctors no longer felt that taking the extra time to document a complete death certificate series of events was a priority. I can’t argue with them; it wouldn’t be. As important as the death certificate is to the patient’s family and for public health purposes, it is a low priority in a crisis when your time would otherwise be spent taking care of living patients or trying to shore up your own physical and mental reserves. If this is the case, the doctors who typed “COVID-19” and submitted the death certificates probably had no idea that such an action would contribute to even more dangerous medical misinformation threatening to extend the pandemic a few months later; a lesson in unintended consequences.

So what do all of these other codes mean?

There are many ways to interpret the diagnostic codes listed in the comorbidities table from the CDC’s latest update. We could spend hours in speculation, wild surmises, or careful parsing and analysis (if you’re a nerd) to try to recreate the narratives of the deaths represented by this data. The amount of analyzing, explaining, and even guesswork we could devote to this is endless. But briefly, I’d like to explain how to understand the majority of these diagnostic codes and the diseases, conditions, or symptoms they represent by considering them in three large categories.

Other ways of describing COVID-19.
The first category that these “other diagnostic codes” fit into is simply other ways of describing the symptoms and complications of COVID-19 itself. If I treated you in the hospital for a CVA (cerebrovascular accident; a stroke), but I also added on diagnosis codes for right arm paralysis and slurred speech, you wouldn’t review the medical record and say, “see, I wasn’t treated for stroke after all! They were treating me for right arm paralysis and slurred speech and just added that ‘stroke’ code on because Dr. Webb probably gets some sort of kickback for it.” The paralysis and the slurred speech delineate more specifically which stroke symptoms you experienced; their inclusion creates a more complete record of your presentation and treatment. In fact, it isn’t at all uncommon to have multiple diagnostic codes that actually say the same thing, due to different doctors and different departments interacting with your medical chart and, again, for the sake of completeness. If I have already added “slurred speech” to your chart, the neurologist later adding ‘expressive aphasia’ doesn’t actually add anything to your medical record (except a little reminder that she’s smarter than me); but it might be more appropriate to document it this way for the referral to speech therapy she is ordering for after your discharge, or to have this diagnostic code associated with the MRI. The synonymous diagnostic codes are repetitive, but it doesn’t necessarily follow that they are redundant

Now apply this logic to death certificates and COVID-19. We’ve already discussed that most doctors would like to be as complete and thorough as possible with death certificates and that it is somewhat odd to list only one diagnostic code without providing a fuller narrative. When we see diagnostic codes like J96 (respiratory failure; 54,803 cases), R09.2 and I46 (respiratory and cardiac arrest, 3,282 and 20,210 cases respectively), and J12.9 (viral pneumonia, unknown number of cases, but contained within the “Influenza and Pneumonia” group), all the doctor is doing is using additional diagnostic codes to clarify the events affecting the patient’s lungs that led to death. In fact, it would not be inappropriate to include all four of these codes for many COVID-19 deaths, because the natural history of viral pneumonia due to COVID-19 leading to respiratory failure and eventual arrest is unfortunately far too common. The same applies to codes like A40 and A41, Sepsis (14,053), which is not even a diagnosis in itself but a syndrome describing the body’s systemic reaction to infection, and many of the “all other conditions” codes like R09.1, pleuritic chest pain and R09.0, hypoxemia.

But the most obvious example is J80, Adult Respiratory Distress Syndrome (21,899 cases). This is literally the severe respiratory syndrome caused by COVID-19, yet people like Dr. Hesse who claim to have evaluated this data carefully did not include these deaths in their “real” COVID-19 death count. To be clear, if a patient’s death certificate listed only COVID-19 and ARDS, these medical misinformation hucksters wouldn’t count them; that patient died of ARDS, they would say, not COVID-19. It’s like saying someone didn’t die from falling off a plane without a parachute, they died from the landing. It’s the bad dad joke of medical misinformation and the clearest piece of evidence we have that those originating this narrative are either extremely unqualified to interpret this information… Or else are not in earnest with their conclusions, but instead are pushing misinformation intentionally from what motivations and purposes I cannot say. 

Conditions that really do make COVID-19 more dangerous.
Much of the work I have seen refuting the “6%” misinformation so far has focused on the concept of comorbid conditions or medical comorbidities. Simply stated, these are diseases or conditions that make us more susceptible to other disease processes or more likely to have complications from them. Some of these diseases are also extremely dangerous in themselves, and others are primarily dangerous because of their role in predisposing to other conditions. A good example of the former is Congestive Heart Failure (I50, 10,562 cases). This is an extremely dangerous, chronic disease that has a fairly low 5 year survivability from the date of diagnosis (average of 62%, but as low as 48%, in African American men because of healthcare disparities). You can absolutely die of complications from heart failure, but it also increases your risk for many other diseases and infections. It is both a primary cause of death and a comorbidity, and without a more detailed dataset or an intimate understanding of each case, we cannot possibly say how many of the 10,562 people who died with both COVID-19 and heart failure died from heart failure complicated by COVID-19, from COVID-19 which they were more vulnerable to because of heart failure, or from a more complex clinical picture that involved heart failure, COVID-19, and other contributing factors. But is this information going to change anything for us? The medical misinformation spreaders want you to believe that all 10,562 of the people who died with both heart failure and COVID-19 died at the time they would have from their heart failure with or without a viral pandemic. They want you to believe this based on nothing other than the fact that it fits a more comfortable narrative; but it flies in the face of what we are hearing from doctors, nurses, family members, and patients of those with heart failure about the way that COVID-19 affects those who are already suffering from these types of chronic illnesses.

Other examples in this category include renal failure (N17-N19, 13,693 cases), COPD and other chronic respiratory disease (J40-J47, 13,780 cases), and quite a few of the “other conditions and causes” listed, such as N04 (Nephrotic Syndrome), L93 (Systemic Lupus), and of course B20 (HIV), just to name a few. The people spreading this misinformation are putting the people with these illnesses at greater risk, specifically, by either pretending that COVID-19 is not a threat to them (the “only 6% count” crowd) or by seeming to claim, callously, that caution as a society isn’t warranted on their behalf (the “94% had comorbidities” crowd).

But within this category we also include diseases that are not likely to kill you on their own, and which would have almost certainly been included on the death certificate due to the physician’s conviction that they made the patient more susceptible and less able to resist the complications of their COVID-19 infection. These include Obesity (E65-E68, 5,614 cases), Alzheimer’s disease (5,608 cases), and of course other types of dementia (F01 and F03, 18,497 cases). Do we really believe that a patient with COVID-19 and obesity listed as their causes of death have died from obesity, and that their having COVID-19 was a coincidence? That is not something that happens. Dementia in particular is an interesting conundrum, because with COVID-19 harming so many people in nursing homes it is potentially not only a physical risk factor, which it most certainly is, but also an epidemiological risk factor; many doctors might include a patient’s reason for living in an assisted living facility, such as dementia or disability, within the death certificate as part of the narrative of how the patient came to be exposed to COVID-19, the same way we might list arthritis on the death certificate for a patient who suffered a heart attack during physical therapy. Again, these are not competing diagnoses that draw responsibility for the death away from COVID-19, but rather a fuller picture (that is, as full as can be told with diagnostic codes alone outside of the full medical record) of the patient’s story leading up to their death.

Finally, a few categories of disease deserve some extra discussion, and those are diseases that could cause death all on their own but almost certainly didn’t for the patients reflected in these death certificates. Hypertension (I10-I15, 35,272 cases) is incredibly common and usually leads to longterm organ damage rather than acute crises, but can present with severely elevated pressures that lead to stroke or another vascular event. However, this would typically be indicated with the diagnosis code I16, hypertensive crisis or I16.1, hypertensive emergency, which are specifically not included in the diagnostic codes for the hypertension group in this table. It is possible that this is just a common coding error on death certificates, but I doubt it; if the physician believed that the severity of the patient’s hypertensive crisis led directly to their death, they would likely take pains to emphasize this on the death certificate; applying a code for essential or secondary hypertension instead suggests that they regarded it as a comorbidity or at most a contributing factor. Diabetes (E10-E14, 25,936 case) is another example. Diabetic Ketoacidosis (DKA) is a severe metabolic disorder that often requires ICU level care; but this is primarily due to how labor intensive it is to treat, and the mortality rate remains low. These 25,936 people who had both COVID-19 and diabetes did not die from DKA, which accounts for less than 2,500 deaths annually. Instead, both diabetes and hypertension, just like dementia and obesity, are comorbid conditions that make the patient more susceptible to and likely to experience worse outcomes from other diseases, and as such their role in this list of additional diagnostic codes on COVID-19 death certificates is the same as their role in death certificates for patients who die from stroke, heart disease, and influenza; yet no-one is claiming that because a patient had high blood pressure and diabetes, their death from the flu didn’t count.

Conditions that might have nothing to do with COVID-19 and might have actually caused the patient’s death (maybe)
Finally, we have conditions that, based on the diagnosis code alone, we know to be incredibly dangerous and also to be common causes of death. Some of these, like certain cancers (C00-C97, 7,415 cases plus some of the ‘all other conditions’ group) we can treat similarly to heart failure or COPD; they may predispose you to COVID-19 or raise the risk that your COVID-19 course of illness will be severe, or they may be immediately dangerous in and of themselves and be worsened by COVID-19 or not. If someone wants to ask how many of the thousands of deaths that included a cancer diagnosis were actually caused or hastened by COVID-19, and how many just happened have the virus during the days leading up to to death from a terminal malignancy, I think it’s a fair enough question; though from what I’ve heard from friends who provide hospital and hospice care, the former does seem to be very common. In the latter cases, if such cases are at all common, the additional suffering from COVID-19 must be felt in other ways; in the barriers it places to those individuals being surrounded by family and friends as much as possible during their final days. 

We could legitimately ask the same question for some other diagnoses on the list; heart attacks and cardiac arrhythmias (18,103 and 9,812 cases respectively), pulmonary embolism (I26, contained in the 8,743 “other disease of the circulatory system”), and strokes (I60-I69, 7,653 cases) are all very deadly on their own. However, unlike with cancer, which has no known or proposed causal relationship with COVID-19 aside from immunocompromise, the virus is known to cause a hypercoagulable state that has caused all of the above pathologies. How many of the deaths that involved these diagnostic codes were due to these conditions and how many were in turn due to COVID-19 is known only to the doctors, nurses, and family members that were involved in their care. Attempts to make absolute statements that these deaths simply were not caused by COVID-19 (despite the doctor writing the death certificate feeling they the virus did in fact contribute to the death) because another dangerous disease was also involved are based entirely on a desire to minimize the danger of the virus, and not on any interpretation or analysis that can be legitimately conducted from this set of data.

My friend, an ER Doc in New York

The final set of diagnostic codes we need to look at are the 5,133 included in COVID-19 death certificates under the category “Intentional and unintentional injury, poisoning and other events.” We don’t know which codes specifically show up in these death certificates, but much like the other ‘other’ catch-all categories it contains diagnoses ranging from S00.37XA, Other superficial bite of nose (a diagnosed I received today courtesy of my 16 month old), to X95.9, Assault by firearm. What is going on here? Much like the “other” diagnostic codes we talked about above, there may be any number of reasons that some of these codes might be on a COVID-19 death certificate. Some may be complications that arose in the hospital, such as SO6.9, Intracranial injury, when a COVID-19 patient experienced a syncopal episode and hit their head. Some may be part of a historical narrative, for instance a patient who experienced a prolonged hospitalization following a V03.10XA, Motor vehicle collision injuring a pedestrian, which ultimately ended when they died from respiratory failure due to COVID-19 contracted in the hospital. Again, without access to the actual death certificates, medical records, and medical staff who treated these patients we simply do not know what circumstances or patient history necessitated the physician to include both COVID-19 specific diagnostic codes and codes for accidents or intentional and accidental injuries in the same death certificate; but it absolutely does not stretch the bounds of credulity to believe that such circumstances do indeed occur.

Nevertheless, I want to cede this point to the conspiracy theorists, if only for just a moment. What if we do “admit” (as ridiculous as it is, and with apologies to the families of the individual people whom these death certificates represent) that each and every death certificate listing one or more of these accidental and non-accidental injuries represents a patient who died from some horrible accident, with COVID-19 just tacked on but clinically silent? You see, since the beginning of the pandemic the conspiracy theorists have been telling us, with no evidence, that “if somebody gets hit by a car they are calling it a COVID-19 death” and “if someone gets shot, they call it COVID-19 to inflate the numbers.” This data, from actual death certificates, now shows that the maximum possible number of such falsified death certificates tacking on COVID-19 to an accidental death is 5,133; compared to 183,000 deaths from COVID-19 and an estimated 80,000 total deaths from accidents in that same time frame. And again, that’s assuming that no other possible explanation exists for those “other accidental and non-accidental injuries” contributing to a person’s death from COVID-19.


Many of the diagnostic codes listed don’t fit easily into just one of the above categories, because we just don’t know enough about the history of the people whose battles with and deaths from COVID-19 are represented here. We don’t know, from this data set, whether the physician completing the death certificate was indicating a new stroke as a primary cause of death, or an stroke that lead to a rehab stay where the patient contracted COVID-19. We don’t know whether diabetes was listed because it was poorly controlled and played a major role in the hospitalization, or whether it was well controlled and was only included because that physician knew that diabetes is a risk factor for the patient’s unfortunate bad outcome from COVID-19 infection. We also have no idea what to do with codes that are so benign in themselves that they don’t really seem to have a place on a death certificate at all, yet the physician clearly regarded as an important part of the patient’s history leading up to their death.

But what we do know, with certainty, is that this new data released from the CDC does not mean. If you’ll spend just a few minutes really looking at the data, at the ages and the conditions mentioned, you will realized that it cannot mean that 94% of the people who have died from COVID-19 were incredibly sick, incredibly frail, and incredibly old people with many other diseases who would have died soon anyway; that argument is as bankrupt in its analysis of this data set as it is ugly in its callousness. That is not what the CDC means when they tell us that 94% of death certificates listed ‘more than one diagnostic code’ or contributing factor, as we’ve clearly demonstrated above. And even if it were (and it’s not), it would not somehow mean that the lives lost to COVID-19 were less valuable; those who see this false idea that 172,000 of the 183,000 people who have died from COVID-19 were sick already as a compelling reason to stop mitigation efforts need to carefully consider whether their only motivation for taking caution has been their own personal health and safety this entire time… And then try to understand why that has not been the sole or primary motive for the rest of us; that the safety of those around us, including the medically vulnerable, is actually sufficient reason for some inconvenience and even sacrifice on my part.

And we also know with certainty that no real scientist, statistician, epidemiologist, or physician, and certainly no one who actually treats patients on their death beds and then completes death certificates to capture the complex and detailed medical events of their final days would ever believe the idea that the 6% of death certificates with only COVID-19 listed as a cause of death represents the “real” death told of this horrible virus; at least not without some herculean effort of intellectual dishonesty and self-deception.

Please keep comparing COVID-19 to Human Trafficking (Part 2).

Trigger warning for human trafficking, rape and sexual assault, sexual abuse of children, and exploitation.

The big question we didn’t address yesterday (well, two days ago now) is whether the people making these comparisons between COVID-19 and cancer or diabetes are doing so because they truly care about those medical problems, like the nurses and doctors who treat them and the patients and their family members who are affected by them every day do, or just because they happen to find them convenient comparisons for minimizing or dismissing concerns about the pandemic. And while using a lifelong illness that causes real suffering like stroke or cancer for rhetorical purposes is a bit calloused, I can’t say I find it truly morally repugnant the way I do when the same thing is done, if indeed it has been done, with human trafficking and modern day slavery. Recently, I have started seeing a few different memes/images shared on social media making just such a comparison; but I believe they have very different degrees of merit and, I’m afraid, might be coming from very different places in terms of degree of actual sincere concern about the very real problem of modern day slavery.

Human trafficking is a truly evil industry. Some of the people who have shared these memes have quoted conservative estimates of 25 million slaves worldwide today; I believe the ILO estimates that are closer to 40.3 million, though even that was back in 2016 and the number is likely to be even higher now. This includes 5 million people, 99% of whom are women and girls, who are victims of sex trafficking and forced sexual exploitation. In addition to being robbed of their freedom and dignity, the men and women affected by modern day slavery suffer extensive medical and psychological problems that can last a lifetime, and many are subjected to nearly constant physical, sexual, and psychological violence, torture, and dehumanization. It is one of the worst offenses against human beings occurring today, and its cost in human lives and suffering is incalculable. In one sense, there can be no comparison between human trafficking and COVID-19, because even the suffering from a respiratory virus that claims your life would be preferable to most of us compared to what is endured by victims of modern day slavery.

I first heard about modern day slavery from my friend Michelle Palmer, co-founder of the blog Tuesday Justice, back in 2008, my first year of medical school. That next year we became involved in grassroots organizations in Denver involved in raising awareness about human trafficking and modern slavery both in the United States and internationally. In medical school I hosted film screenings, attended academic conferences on human trafficking and training with the FBI and GEMS on commercial sexual exploitation of children (CSEC), and once even sat next to the author of The Vagina Monologues on a committee focused on professional collaboration to fight human trafficking in the city and state. When we moved to Waco I got involved with Unbound and eventually became one of their medical professional trainers. Over the last few years myself and one of my clinic partners have trained hundreds of physicians, nurses, other healthcare professionals, and Texas medical students to use their calling in medicine to recognize the signs of human trafficking and help address the unique medical and support needs of survivors, in addition to treating survivors of human trafficking and modern day slavery in our own clinic.

Last week, that partner and I both spent a significant number of hours in full PPE, in the 90-100 degree heat, evaluating, testing, and counseling patients for COVID-19. In 2 weeks, I’m going to lead a group of family medicine residents in a discussion of human trafficking cases; I will be working in the COVID-19 clinic that morning and that afternoon. I recognize that all of this sounds dangerously akin to self promotion, but the reality is that given my privileged position as a doctor and the scope of the problem, I feel that I’ve personally done very little towards combating either COVID-19 over the past 7 months or human trafficking over the past decade. That’s not my point. My point is that there is not a competition of awareness, focus, advocacy, or effort between the fights against these two assaults on our fellow Image-Bearers of God. The people who are fighting human trafficking are often the very same people fighting COVID-19.

And I humbly submit that memes which suggest otherwise may, in fact, be made by people who care about neither.

The Bad

I wanted to start with this one because I believe it’s somewhere in the middle in terms of both dismissiveness about COVID-19 and creating a false opposition between COVID-19 and Human Trafficking advocacy. The meme makes two claims; first a statistics claim about the relative risk of human trafficking and COVID-19, and the second a claim about the increased danger to children posed by masks because it perpetuates trafficking. Let’s look at both.

Though the numbers don’t usually matter much in posts like this one, I always like to know where they come from if possible. I went to the original source, an Instagram user who, apparently, works to promote “vaccine education, toxin free living, and government corruption.” I love it when people have eclectic interests.

At least she’s upfront about it.

Unfortunately, she doesn’t list where her numbers come from or how she ended up with this ratio of 66,667 children sold to human traffickers for every one child that dies of COVID-19, and I’m going to admit that it seems a bit high even to me, someone who leans towards more liberal estimates of human trafficking. The biggest problem with her numbers is that nobody actually knows how many children and adults are bought, sold, and enslaved through human trafficking each year; it’s an illegal, hidden, underground industry and the best we can do is estimate. It’s also very easy to misunderstand what the numbers actually mean; for instance, when experts say that an estimated 200,000-300,000 minors in the US are victimized through commercial sex trafficking each year, this is based on a much smaller number of actual reports, data from homeless youth and runaways, the personal narratives of adult sex workers who entered the life as children or adolescents, internet ads through websites like craigslist and backpage, and a variety of other data sources. Unfortunately, the vast majority of children who are being exploited in this way are not known. If we used this estimate (300,000) of US CSEC victims, divided by her 66,667, it would give us just 5 children in the US to die of COVID-19; since this is nowhere close, this clearly cannot be the figure she is referring to.

The experts I trust estimate that there are about 10 million child victims of human trafficking in the world today ( this number does not include the tens of millions of child brides across the globe, nor young or old adults who have been enslaved ever since they were children), and I think this must be the number of she is thinking of; nothing else even gets us close. Working backwards, this would give us an estimate of 150 children (10 million/66,667) who have died from COVID-19 worldwide. This is probably closer to the number of children in the US that have died from the virus; the best estimates that I can put together would put that number at around 100 (it’s tricky since the best data sources I can find don’t distinguish specific ages within the 15-24 yo age group; I don’t know how many from that age group were older adolescents and how many were actually young adults). We could look at this data from every possible angle (I typed a whole other paragraph on hypothetical calculations and assumptions we could make here, but deleted it; it doesn’t add to the discussion), but ultimately we are going to come out with an estimate that is certainly more than 150 but somewhere less than 1,000 child and adolescents deaths from COVID-19 infection worldwide.

So the best guess we can make is that the original author of this meme is comparing the total number of child slaves worldwide to some estimate she has found of the total number of child COVID-19 deaths that is, at least, on the right order of magnitude. There are at least five big problems with this “calculation” of a child being 66,667 times more likely to be sold to traffickers than to die of COVID-19.

First, the 10 million figure is an estimate of current child slaves, not new child trafficking victims; the idea of ‘being sold by traffickers’ paints the situations of enslaved people around the world as a monolith and ignores the debt bondage enslaving millions of families (which is still strongly associated with physical, psychological, and sexual abuse), which is by far the most common scenario for a child slave today. It also glosses over the many forms of control and exploitation included in human trafficking that don’t involve ‘being sold to a trafficker’, which we’ll talk more about in the next section. Sensationalist language hearkening back to ‘Taken’ is not at all helpful in understanding the scope of human trafficking and modern slavery.
Second, it’s very much an apples to oranges comparison since the 10 million estimate is a cumulative total built up over many years, and the number of children dying from COVID-19 is a total from just a few months of a pandemic; it is a comparison of prevalence to incidence, two very different epidemiological concepts. The total number of children trapped in slavery and the total number of children sold into slavery since February are clearly not synonymous, but the author of this meme has treated them as the same thing; this renders her figure, 66,667 to 1, utterly meaningless, since she isn’t even comparing the things she claims she is, let alone statistics that have a logical basis for comparison.
Third, this really is a straw-man. The discussion of whether or not to re-open schools is important, and the conversations I have every day with parents concerned about the risk of their children being harmed by COVID-19 are addressing very real anxiety. We talked about this with last week’s America’s Frontline Doctors video and will be trying to address it more fully in the coming week. But epidemiologists and physicians have at no point argued that COVID-19 was now the greatest threat to children worldwide; in fact we’ve come home from each and every shift incredibly thankful that this isn’t like the Spanish Flu pandemic of 1918, when children were disproportionately affected and killed by the virus. If it were, I’d probably be living in a tent behind our fence instead just changing on the patio and dodging my children on the way to a shower as soon as I come home. Nobody is saying that children dying from COVID-19 is the heart of the pandemic, and memes like this that want to put the number of child COVID-19 deaths ‘in perspective’ are ignoring the fact that child deaths have not been the main motivator for any of our mitigation efforts.
Fourth, and most importantly, the comparison doesn’t matter. Saying that one thing is terrible and dangerous and needs to be fought against doesn’t mean other problems aren’t important. Anyone can do this trick with any two terrible problems. You can say that human trafficking isn’t important because a child is 15 times more likely to be a victim of child abuse within the their own home, or that childhood cancer doesn’t matter because children are 6 times more likely to die from accidents. Just because two things are deadly doesn’t necessitate a comparison of their badness; we can be against both. The cynical side of me says that the only reason to use human trafficking, unless you are really trying to raise awareness about it, is because advocacy for victims of human trafficking confers an immediate moral high ground, and for some reason that is something that COVID-19 deniers feel they must have. They find human trafficking convenient because it paints them as compassionate and ethical and those fighting or concerned about COVID-19 as though they were ignoring this huge human trafficking problem. We wouldn’t expect them to set-up COVID-19 against something more morally benign that harms children, for instance swimming pools or hurricanes. I’d like you to stop and think about that for a moment; think about the fact that some people have decided that their personal crusade against COVID-19 justifies using human trafficking to score rhetorical points; that they have chosen to exploit the plight of human trafficking victims, some of the most exploited people in the history of the world, for their own ends.

But I’ve been wrong before.

Fifth, though it’s not as direct a correlation as with heart disease and immunocompromising conditions like cancer, there is a potential synergy between human trafficking and COVID-19, and it has nothing to do with masks. COVID-19 has, mercifully, killed relatively very few children, but it has left some children without one or both parents, and many more without one or more grandparents; adults who, when they are safe people themselves, confer the safety, security, and support networks that are protective against human trafficking. Despite our fears as parents (I am writing this sitting across from my 8 year old who is working on her math homework) (check that; supposed to be working on her math homework), most children who are victimized through human trafficking are not ‘taken’ from their front yards or from a big crowded event; they are preyed upon by traffickers who look for social vulnerabilities; want of support, care, and love; and circumstances where children and adolescents can be controlled. The logical conclusion of any of the memes or videos or posts that call us to lessen our focus on COVID-19 prevention, regardless of motive, is more deaths from COVID-19 among adults and elders- that is, parents and grandparents- and thus more children at risk for human trafficking in the years to come.

I also said that we would talk about the claim that having children wear masks makes them easier targets for human traffickers. Besides having, as far as I know, no verification for this claim, it also relies on sensationalized concepts of human trafficking and ‘oh that makes sense’ thinking; you are supposed to envision a child being walked along the street by human traffickers with family or friends passing within a few feet and not recognizing them because they are wearing a mask. This ignores the reality of trafficking victims’ experiences and the real methods of control used by traffickers; a problem it shares, though far less gratuitously, with the memes we will look at next.

The Ugly

As bad as it is to essentially make up statistics, and as bad as it is to artificially pit against each other two things that harm children as though you had to choose between them, and as though being vocally against one meant you were in support of or deaf to the other (“You are against a fake virus, while I am against human trafficking”), there is an even more exploitative type of meme going around the internet that takes these same goals and cranks the appeal to visceral emotion up to 11. After careful consideration I have decided not to share these images on my blog; I am sharing heavily redacted versions below, trusting you will recognize the type of macro I am talking about here.

“Let’s spend 4 paragraphs figuring out where that statistic came from” said no one ever

For those of you who have been mercifully spared from seeing the originals of these macros, or the many others circulating right now, they typically show one of three types of images in paired with text minimizing COVID-19 or juxtaposing it to human trafficking; a young child with tears in their eyes and a large hand over their mouth, a terrified child with a shadowy figure standing behind them, or a small girl bound with ropes, often in a basement or darkened room. For those who have seen and shared these images, I want to ask you to do something; go delete them (or change privacy settings; you can choose whether or not to delete them in a few paragraphs) before we move forward.

These images are deeply troubling and problematic for so many reasons that its actually hard to know where to start. “Minor” issues first, as we build towards the very worst and most troubling aspects of these images.

Bad statistics/misinformation:
Trying to get people to accept false numbers or misleading statistics by appealing to emotion rather than logic is a common propaganda tactic and we don’t need it in the fight against human trafficking. The problem is big enough on its own without hyperinflating the scope of it. We talked about the ‘66,667x more likely’ above, but the other number we commonly see is 800,000; 800,000 children are reported missing each year, and the implication is that they become victims of human trafficking. The reality is that most children being trafficked in sex slavery are not reported missing because they are being trafficked by family members or are in vulnerable situations where they would not be considered ‘missing’. Most child sex trafficking victims have not been kidnapped. Moreover, that 800,000 represents mostly missing children who were found very quickly; this is the number from a 2002 study for all children who were reported missing, and includes children who have runaway or gotten lost and family abductions during custody disputes; only 115 of these were what we think of as ‘kidnapping’. Missing children, family and non-family abductions, and all forms of child abuse are serious and important issues, and they all intersect with human trafficking and CSEC to some degree; but using statistics from one problem interchangeably with that of another, or using the most dramatic possible number you can find without careful explanation or honest reflection is not helpful.

Implying silence/neglect of human trafficking issues:
Comment accompanying the second image above reads “time to change the conversation.” This can be taken one of two ways; either ‘it’s time to start talking about human trafficking’, or ‘it’s time to stop talking about COVID-19′. I suggest the real goal of this meme is the latter, because unless you’ve been living under a rock for the past 10 years, we have been talking about human trafficking. To quote a friend who has a degree in modern slavery studies and has worked in this field, even if there are often problems with the organizations that only work to raise awareness of human trafficking without offering other support services or or contributing to the work in other more tangible ways, “they have at least done a good job at that.” Whenever I give lectures on human trafficking and modern day slavery, I always begin the same way; by asking for a show of hands of how many people have heard of this problem before and feel they know something about it. There has been a substantial difference in the response to that question over the past decade. One of the great things about volunteering in this field is that it is one of the few issues where people from all walks of life and ends of the political spectrum find a lot of common ground; we all agree that human trafficking is wrong. Some of us believe that pornography is a major contributing factor (more on that later), while others don’t. Some believe that legalizing prostitution is an important step in fighting it, while others don’t. Some believe that essentially all efforts to confront human trafficking should be secular while others believe that the Church has an important role to play. But despite these differences, there is more common ground to be had here than in the fight against almost any other societal ill. And that has made for fertile ground for grassroots awareness work; telling someone about human trafficking isn’t likely to start a debate or argument. 12 years ago we made shirts that said “slavery still exists” and “27 million slaves: ask me more.” Today the awareness focus has shifted to trying to help people understand modern slavery better and, often, combatting the sensationalist and misleading stereotypes that still persist. COVID-19 has not diminished the conversation around human trafficking, and images like these set it back rather than advancing it.

There is one extremely important point that needs to be made in this section, and I think here is the place to make it. Maybe you are new to human trafficking advocacy; maybe a meme like this is the first you’ve heard of it, and you naturally felt compelled to share. And if that’s the case I want to say two things. First, is that when we are talking about why these memes are problematic and my belief that some of them were made with bad intent, I by no means mean that I believe the people who have shared them have bad motives in doing so; I know for a fact that hasn’t been the case with the people who I’ve seen share the images above. I remember the sense of urgency I felt the first time I heard about children being used as soldiers by the LRA in Uganda; I rushed to my dorm and turned off the Halo game my roommates were playing to try to force them to watch the documentary (it didn’t go well) because I couldn’t believe no one was talking about this. If you are just learning about human trafficking and modern day slavery now, it probably feels the same, and the idea that some awareness efforts aren’t helpful because the images they show or the numbers they quote aren’t quite right must seem a bit strange or overly particular. My goal here is to help you understand why they are problematic, as someone who has been where you are but has since been learning about this for years, and to help you find better resources for raising awareness, like the ones I am sharing in this blog post. And the second thing I want to say is welcome, we are glad you are here; the fight against human trafficking needs you. And the first thing we need from you is to learn more, which is work that none of us can ever actually move on from. I recommend you start with Tuesday Justice’s Primer on Modern Slavery, and then read Kevin Bale’s Disposable People.

Racist overtones:
One of the recurrent visual themes we’ve seen throughout these social media images is the presence of both a child victim and an adult abuser, and the contrast between them. The child is small, the adult large. The child is terrified, the adult commanding and ominous. And often, the child is light skinned, the adult dark skinned. I don’t have exhaustive knowledge of the human trafficking memes that have been shared recently and can’t tell you what percentage of the time this is the dynamic presented. I also can’t tell you if this is done with lighting effects or if the photographer actually recruited white children and POC men for these photoshoots, or which of those options would make it worse; frankly the idea that children were asked to pose for these photos in the first place is troubling enough. But I don’t think these choices are accidental. The history of characterizing black men as hypersexual beasts and violent rapists in order to play into white majority fears of their children and young women being abused stretches back hundreds of years to the very beginning of our nation, and it has been a common theme in lynchings throughout American history. Malcolm Foley, Baylor University Special Advisor to the President for Equity and Campus Engagement and expert on the Church’s response to lynching in America, and my pastor, spoke about this briefly in his interview with Christianity Today following the death of Ahmaud Arbery. He in turn recommends you read Southern Horrors by Ida B. Wells, which addresses this topic in great detail.

“There is hardly a town in the South which has not an instance of the kind which is well known, and hence the assertion is reiterated that ‘nobody in the South believes the old thread bare lie that negro men rape white women.’ Hence there is a growing demand among Afro-Americans that the guilt or innocence of parties accused of rape be fully established. They know the men of the section of the country who refuse this are not so desirous of punishing rapists as they pretend. The utterances of the leading white men show that with them it is not the crime but the class. Bishop Fitzgerald has become an apologist for lynchers of the rapists of white women only. Governor Tillman, of South Carolina, in the month of June, standing under the tree in Barnwell, S.C., on which eight Afro-Americans were hung last year, declared that he would lead a mob to lynch a negro who raped a white woman. So say the pulpits, officials and newspapers of the South. But when the victim is a colored woman it is different.”

Ida B. Wells, Southern Horrors

If playing into sensationalism and parental fears has little to no place in the fight against human trafficking, there is even less justification for drawing on deeply rooted generational racism. By portraying abusers as men of color and victims as predominantly white children, these images are trying to recruit some of the ugliest and most harmful racist ideas buried in the heart of our society in order to fight human trafficking; but the fight against human trafficking doesn’t want or need those racist stereotypes. Moreover, these images are portraying a scenario that is not representative at all of the reality of race within human trafficking, a crime that disproportionately affects children of color, and reinforces stereotypes that themselves go hand-in-hand with racially motivated sexual abuse of trafficking victims. I hope you’ll read the article I’ve just linked from Love 146; it’s very short and shares the stories of three survivors whose race was a selling point their traffickers used to advertise them for sexual exploitation; please take a minute and read their words.

Misrepresenting human trafficking victims:
These images are also damaging and potentially dangerous because they so deeply misrepresent the real situations of victims of human trafficking. Though chains, ropes, cages and locked doors have been used to hold child and adult victims of human trafficking, they are not the most common methods. The techniques that traffickers use to control their victims are varied and sophisticated. Traffickers use shame, fear, and physical closeness in perverse combinations to make victims feel that they are the only person in the world that can be relied on or trusted. Many times they are family members or parents of the child being exploited, and use that relationship to maintain control. Other times they move victims to another city and strip them of their phones, ID’s, and social support networks to make the world outside the trafficker’s control feel even more dangerous and foreign. They use drug addiction, financial entrapment, and poor living conditions to create absolute dependence on the trafficker as a provider. They use psychological torture and manipulation to instill in their victims a sense that they are omniscient and omnipotent; they know everyone, they have contacts with the police, there is nowhere that the trafficking victim can run where they won’t find them. They use threats of violence credible and not; if you leave, I’ll kill your family, I’ll recruit your sister into the life in your place. They forge trauma bonds that make recidivism incredibly high and prosecution against traffickers extremely difficult. These methods, and many we haven’t touched on at all, make chains, ropes, cages, and locked doors unnecessary for controlling victims.

So why does it matter if these images paint a misleading picture of how victims of human trafficking are controlled and exploited? First, because it makes it more difficult for people to notice and report human trafficking when it occurs, something these memes claim to want to promote, if they are only ever looking for physical signs of restraint and enslavement. The work of grassroots advocacy and awareness organizations involves dispelling these myths so that people can really begin to understand the complex, nuanced, and insidious forms of control that are used, and learn to spot them in their interactions with victims of trafficking. When we train medical personnel to detect trafficking, we talk about the presence of a controller, sexualized language and patient narratives that normalize sexual abuse and violence, asking judgement free questions, and understanding the adverse medical findings associated with trafficking; looking for a cage or a rope is going to miss most cases of human trafficking, and all of the cases that could be detected in a medical setting. And second, because the misconception of trafficking control methods being limited to only physical forms of restraint like the ones in these images contributes to shame and victim blaming towards survivors. When we promote the idea that all trafficking victims and modern slaves are bound by ropes or chains, we are also stating the contrapositive; if you aren’t bound by ropes or chains, you aren’t really a trafficking victim. Adolescents are arrested for “prostitution,” a crime that can’t logically exist (children cannot consent to sex; “child prostitution” is always rape), and are frequently further victimized by law enforcement. They are rejected by families and loved ones because their serial victimization and the control methods they have suffered are seen as evidence of poor moral character. Society asks incredulously, “why didn’t you just leave?”, and we tell ourselves narratives that “I would have run away if it had happened to me,” without ever trying to understand what they had to endure. It even contributes to trafficking victims’ difficulty in recognizing their own abuse, because they may believe the cultural narratives that the incomprehensible torment they have endured as serial victims of rape and psychological torture don’t count unless they were handcuffed, caged, or tied-up at all times.

Sensationalizing the sexual abuse of children:
This is the hardest one to write about, and also the reason this post is now over 24 hours late. In my opinion it’s the biggest problem with the images above. Recently the Texas Medical Board began requiring that all licensed physicians complete training in human trafficking, and the Department of State Health Services (DSHS) released standards that those trainings should adhere to. Though the training we conduct had only one major revision because of this, we used it as an opportunity to update the entire presentation and ensure it was something that protected the dignity of human trafficking victims and survivors to the highest degree possible. The one revision; removing an image of two teenage girls standing on a street corner at night. And the reason we removed that image was because of this new training standard:

I mean, it’s the first one!

I’m including this training standard because I want you to understand that my objection to these memes and my request that you take them down if you’ve shared them, and kindly call them out when you see others sharing them, isn’t based on personal distaste or a negative visceral reaction (which is exactly the type of reaction they are meant to provoke). These are agreed upon standards and the idea of these images being harmful is accepted among those who fight against human trafficking every day; it’s just hard to articulate exactly why. We call these types of images sensationalized because we can’t quite call them sexualized; there is nothing sexual about a child experiencing fear and torment. Yet the image is meant to arouse disgust because we know that, to traffickers and johns and others who sexually assault children and adolescents, these are sexual images; in fact, I think you could rightly call them pornography. These images of children with adult hands covering their mouths, or bound and terrified with dark figures standing behind them, clearly send the message, “This child is about to be sexually assaulted.” I don’t know of anything that has less place in the fight against human trafficking than images that, if seen by one of the millions of men and women who have survived sexual assault or the ordeals of abuse through modern day slavery, would potentially traumatize them further and bring to mind those violations. These images are exploitive; they take the worst, most hopeless and fear-filled moments of the lives of real people and reproduce them for use as promotional materials. The fact that what the creators hope to promote is awareness is a mitigating factor, certainly; if these images were used for literally any other purpose we would chase the people creating these memes out of town, society, and history; we would call the FBI on them and put them on social media blast. But the ends do not justify the means, and we do not need simulated pornographic images depicting the moments before a rape or the psychological suffering of a child to convince people that this is an important issue. We need survivors’ stories. We need to understand the factors that contributed to their targeting, their control, and eventually to their empowerment and escape. We need to help young men and adult men understand that “non-consensual sex” is always rape and that desire for sexual interaction with the helpless and those who cannot consent is a serious mental health condition that needs immediate treatment, not a fetish or kink that can be safely indulged in as long as the victims are far enough away. We need to understand the complex networks of organized and non-organized elements that make up the human trafficking industry. We need to fight human trafficking by uniting across political and religious lines against the exploitation of children and the sexualization of innocence, not by dabbling in it as these memes do.

The Good

I think it’s important to note that not all memes that compare and contrast human trafficking to COVID-19 are necessarily problematic. The meme above is clearly different, while though it is using COVID-19 to grab your attention it is not trying to diminish the seriousness or reality of the pandemic. Further, it links to the Polaris Project, a reliable source of human trafficking information and resources, which also operates the National Human Trafficking Hotline, a free resource that anyone can call if they themselves need help or support or to report or ask advice about a potential human trafficking situation. Some of the verbiage, like “I wonder if … people would start paying attention?”, isn’t what I would choose and maybe falls under the idea of treating human trafficking like a neglected topic, which we talked about earlier… But this is very minor and may just be an issue of generational differences in meme tone and vocabulary.

This meme also shares data instead of sensationalized images and false statistics, and doesn’t try to play on fears, racist stereotypes, or false narratives about human trafficking. Finally, it comes from a source that is beyond question focused on helping women rather than minimizing COVID-19 concerns; the Montgomery County Women’s Center in Conroe, Texas, which provides sexual assault support services including legal support, crisis intervention, counseling, and advocacy. A quick search of their social media shows that they have indeed taken COVID-19 seriously and have modified their delivery of services and planned programming to keep their staff and clients safe from the virus; once again showing that any dichotomy between caring about COVID-19 and caring about victims of sexual violence is a false one.

How COVID-19 is like Human Trafficking and Modern Day Slavery

I know that by this point the title of this post, “Please keep comparing COVID-19 to Human Trafficking,” must feel like sarcasm or a particularly flimsy misdirect; but I promise you I really mean it. For me personally there are lots of similarities, not the least of which are the real harm and destruction I have seen them both bring to the lives of human beings created in the image of God, and the work I have accepted of helping provide accurate information to replace the misunderstandings about them that lead to deep seated fears. But there are a few other ways I think the comparison between these two pandemics is actually apt, if made responsibly:

There is lots of misinformation out there.
I would hope this post is proof enough that there is misinformation on both human trafficking and COVID-19 circulating widely. I said before that the role of grassroots awareness efforts on human trafficking has shifted from telling people that slavery still exists to helping people understand what modern day slavery is really like. This is invaluable work that is done best when informed and led by survivors or human trafficking, helping those of us in support sectors and the public in general understand the nuanced and complex nature of their experiences. Just like we try to do on this blog with COVID-19 videos and other medical misinformation, organizations like Unbound, Polaris Project, and Free the Slaves carefully break down the myths, popular stereotypes, and outright lies surrounding human trafficking and then tell the real stories of survivors and victims and the real story of human trafficking and modern day slavery. This aids in awareness, victim recognition, survivor support, laws that support survivors, and a culture that treats human trafficking victims as survivors instead of criminals. Without accurate, reliable data, this work is surrounded by a fog of biases and assumptions that inhibits the work of aiding survivors; we need to tell honest stories about human trafficking because when we share trafficking misinformation, it helps the traffickers instead.

You can make both problems worse without realizing it.
We’ve talked before about the danger of asymptomatic transmission of COVID-19, and studies which have shown (though the results are open to some interpretation) that the 48 hours prior to the onset of symptoms might actually be the most contagious period of time during an infection. As someone who has done pretty good but not perfect at social distancing throughout the pandemic, I find this especially concerning; all of us need to fight the false sense of security that comes with feeling healthy at the moment, thinking about our potential exposures and at-risk contacts even when we don’t think we are sick. That’s different from living in fear; living with a healthy respect for what this virus can do to us or our loved ones is wise, not fearful. But in addition to spreading this virus directly, we can make the pandemic worse with our other actions; sharing misinformation on the internet, failing to vet our sources when we share new or emerging information, supporting policies or politicians that minimize the very real danger of the virus, and fighting against non-nefarious common-well-being policies like wearing masks in public spaces. All of this increases the risks from the virus in much more subtle ways by creating a culture that minimizes personal responsibility and obfuscates the reasonable mitigation measures we can all take.

And almost the exact set of actions have a corollary in unwittingly supporting human trafficking. You probably contributed to human trafficking (as I did) today when you purchased products that had slave labor upstream in their supply chain. Some companies are better about monitoring their supply chain for slave labor than others, and there are groups that keep independent report cards for everything from the fashion industry to your local grocery store. But while buying blue jeans, chocolate, or a new smartphone may support labor trafficking and slavery in the supply chain throughout the world, there is one auxiliary consumer industry that supports sex trafficking specifically; pornography. These two industries are indelibly linked. A culture of widespread pornography use and addiction contributes to dehumanization of and violence towards women, and fetishizes demeaning sexual interactions, sexual violence, and rape, and it feeds the demand for sex trafficking from the consumer side. But the connection runs even deeper than that, because if you have consumed pornography you have not only supported the sex trafficking industry financially but have most likely participated in the sexual exploitation of trafficking victims as well. Many pornography websites, including the largest and most visited pornography website in the world (link is to an advocacy group video about the website, not the website itself, obviously), rely mostly or entirely on user uploaded content and do not have sufficient screening criteria in place to prevent the uploading and viewing of content showing the sexual abuse of children or adolescents, or content showing non-simulated rape and sexual torture. In fact, videos are often tagged with words like “teen”, “young girl,” or “innocent” in the title, yet are still streamed from their website without additional vetting or any requirement to prove that the women in the videos are actually consenting adults. This is not a theoretical risk; the sexual abuse of teenage girls and even children being streamed from these sites has been well documented. And once these videos are available on the internet, they can be next to impossible to have removed, as we have heard from survivors who have battled to have videos of their own rape taken down from these websites.

You can fight both right now.
As a physician, I’m here to tell you that you can fight COVID-19 right now in the comfort of your own home (by, you know, staying there). Wear a mask when you leave the house, physical distance while building up your social circle, reaching out to neighbors, loved ones, and friends remotely to see how they are doing 6 months into this pandemic and if there’s anything they need. Help fight against medical misinformation that contributes to unsafe, pro-COVID behaviors and attitudes. And you can fight human trafficking right now as well. Start reading with one of the resources above and keep reading and educating yourself about this important topic that isn’t going to go away even once COVID-19 is a distant memory. Look into the ways that your clothing, your food, and your other purchasing choices might help or hurt the plight of slaves around the world. If you’ve read this post and have decided it’s finally time to stop using pornography, go to a website like Fight the New Drug to get more information, support, and resources, and find an accountability partner to download an app like Ever Accountable and quit porn alongside you. Finally, consider donating to an organization like International Justice Mission that actively works to intervene in situations of slavery around the world, and then sticks around to provide the legal and support services to guarantee that survivors aren’t re-victimized by their traffickers.

So no, there isn’t a fight between awareness of human trafficking and focus on COVID-19, and the people who want you to believe there is may well care about neither one of them; but we are in the fight of our lives against both, and since you do care, we could sure use your help.

Stop comparing COVID-19 to Car Accidents (Part 1).

Update 11/30/2020: For some reason this particular post got picked up by Google’s algorithms and ended up on the first page of results for a few search terms like “COVID vs. Car Crashes,” and so continues to get visits frequently almost 4 months later. Which is pretty cool I guess. But the big take away here is this; just like the graphs showing COVID-19 death data from March were already inaccurate and undersold the severity of the pandemic compared to car crashes by August when I wrote this post, so the graphs and data from this post are now out of date. We were at 165,000 deaths then; it’s 267,000 now. I’ll post some updated graphs below to illustrate this, but when I said in August “there is reason to believe that COVID-19 will settle in as the 3rd leading cause of death in 2020” it just so happens I was exactly correct. It wasn’t a hard guess; the gap between Heart Disease and Cancer and the 3rd and 4th leading causes of death is so great that it was a no brainer, as anyone who plays the board game Wits and Wagers will tell you. The real question is whether or not COVID-19 will overtake even Cancer and Heart Disease in 2021. I highly doubt it, especially with effective vaccines available soon and constantly improving treatment techniques and medication regimens… But it largely depends on how overwhelmed the medical infrastructure becomes over the next few months following Thanksgiving and Christmas.

Updated graphs from November 30th, 2020:

(Flu deaths not adjusted due to seasonality)

I first saw this graph on Facebook last month; at the time I was writing extensively about asymptomatic cases, death statistics, herd immunity, and other topics and didn’t have much margin to spare for it. Besides, multiple people have written extensively and well about this topic over the last several months as these silly comparisons between COVID-19 deaths and car accidents, heart disease, cancer, and any number of other causes of human death and suffering have been rampant.

But yesterday evening, when falling asleep at 7 PM exhausted and slightly delirious from what I thought might be COVID-19 but turned out to be from not drinking enough water while working at our outside COVID-19 clinic in 95 degree heat, which is not technically a COVID-19 related illness (and would not be recorded as one regardless of what the conspiracy theorists tell you), I came across a meme along the same lines and felt it was time to say something about these fallacious comparisons. I’m going to start with traffic accidents and heart disease today, for the sake of thoroughness, but tomorrow I’ll try to address the memes that really got my blood boiling; the ones comparing COVID-19 to human trafficking and modern day slavery.

Contagious vs. Non-Contagious Illnesses

You have no doubt seen some version of this argument before now. It usually has a very simple formula, which we will try to tackle one by one:

  1. Compare COVID-19 deaths to another leading cause of death.
  2. Ask why the other cause of death isn’t being talked about/doesn’t shutdown the economy/isn’t a national issue.
  3. Imply or outright state it’s because the media/doctors/the powers that be want you to be afraid for some nefarious purpose.

(In all fairness, the authors of the article above seemed to be writing it just to raise awareness about programs to help teens drive safer; the headline comparing it to COVID-19, while typical of the format this argument has taken across the internet, is seemingly just to garner clicks in this case)

We’ve seen charts like the one above, showing the “incredibly small number of deaths” from COVID-19 compared to real killers like heart disease and stroke. “See, it isn’t even as bad as the flu!” We’ve seen statistics that are next to meaningless, like “COVID-19 will only make up 5% of deaths in the US this year,” which is supposed to sound to laypeople like COVID-19 isn’t that big of a deal, but is actually a terrifying thing to hear as a physician. We’ve been asked, knowingly, why we didn’t “shut-down the economy” for H1N1 in 2009… Maybe because nobody was trying to undermine the president’s chances of re-election? We’ve been asked why we don’t social distance because of car accidents, and then been told the answer; because COVID-19 is all about creating fear.

During the SARS-CoV-2 pandemic we’ve seen physicians, epidemiologists, laypeople, politicians, and misinformation hucksters compare COVID-19 to the common cold, influenza, measles, ebola, HIV, SARS and MERS, and the Spanish Flu pandemic of 1918. While these comparisons have often been made with false statistics or poor understanding of epidemiology and thus led to incorrect, often diametrically misleading conclusions, the comparisons themselves are indeed apt. SARS-CoV-2 is a contagious, viral illness, just like those other diseases, and the danger it poses depends on how contagious it is, how deadly each individual case is, and the long-lasting sequelae it causes, just like those other illnesses.

But the comparisons in the chart above are not all apt, because most are not contagious diseases, and fighting them requires entirely different monitoring, treatment, and prevention principles compared to viruses like measles, ebola, or COVID-19. Yes, preventing diabetes would be easier if we, as a society, decided to rearrange our lives and our community norms to focus on physical activity and healthy eating, eliminate food desserts (or is it deserts? both contribute to diabetes so I’m going to leave it as-is), provide nutrition education as core curriculum in our high schools, and take any number of other steps to become a healthier nation with better and more equitable access to healthy choices overall. But those changes take a lot of time to implement. While there are plenty of ways to help in such efforts, such as shopping at grocery stores intentionally built in food deserts, places like Waco’s Jubilee Food Market, there’s very little that you can do, right here in the middle of your afternoon, to prevent someone you are coming into casual contact with from developing diabetes or heart disease today. As passionate as you are about fighting heart disease and diabetes, you can’t go to a coffee shop and start yelling about metabolic syndrome to try to raise awareness; they kick you out for stuff like that. But you can do things today to prevent the spread of COVID-19, like wearing a mask and social distancing, and a big societal push in that direction makes sense for COVID-19, where for chronic illnesses with modifiable risk factors it makes more sense to focus on sustained, long-term efforts over generations than urgent, short-term pushes.

Me at Pinewood Roasters, trying to warn people about chronic illnesses.

Moreover, diseases like diabetes and coronary artery disease don’t typically kill you all at one time. As we’ve discussed multiple times before, these chronic diseases increase your risk of multiple other ailments, including your risk of a severe case of COVID-19. Saying we shouldn’t worry about COVID-19 because ‘look how bad heart disease is’ is a bit like saying the people on the Titanic shouldn’t worry about the iceberg, because it’s really the water that ultimately killed most of them. There’s a synergy between COVID-19 and heart disease, lung disease, diabetes, and other chronic health conditions, and you aren’t doing congestive heart failure patients any favors by trying to shift the focus off of COVID-19 transmission and slowing the spread of the pandemic; that kind of approach is only going to increase the number of deaths from both conditions.

“Why don’t we shut down the economy for ________?”

But the other reason these comparisons fail is because, to the degree that the approach to treating and preventing them is similar, the responses of the media and doctors to these causes of death has been similar to that of COVID-19. Various people who share these statistics say things like, “we don’t shut down the economy over diabetes,” “we don’t close schools because of car accidents,” and “we don’t social distance and stop going to bars because of liver disease” (I made that last one up because it was the most ironic possible instance of that line of argument). Dr. Phil made this exact same argument on Fox News back in April.

But none of this is actually true, is it? One of the reasons that school gets cancelled on days with severe snow storms (or in Texas, days where someone might have seen some white stuff falling from the sky when it was the wrong season for Crepe Myrtles) is because severe ice on the roads would increase the risks inherent in traveling back and forth to schools; we cancel school precisely because there is an increased risk, above that at normal times, of people dying in car accidents. We also have tons of laws related to traffic safety, including speed limits and traffic signals, without which we could no doubt get to work quicker and be more productive, and laws about texting while driving without which doctors, at the very least, could be much more productive during our commutes. We have all of these rules and regulations in place because the danger has been recognized.

Becoming the Sorcerer Supreme occurs in less than 1 in 14 million cases of physician texting-while-driving accidents. Don’t do it.

We also have laws about cigarette advertising and smoking inside restaurants and places of business, laws regarding industrial and toxic exposures, laws about medical leave for chronic, progressive illnesses like cancer, and laws about sick leave and not being fired because of medical issues. It’s true that these laws often provide depressingly little protection for employees, but they are in place and it’s erroneous to say that we don’t “allow” these medical issues to affect ‘the economy’ or ‘our freedoms’. The one key difference is that none of these approaches are proactive the way that masking, social distancing, and strategic closings are in a viral pandemic. Things like scheduled exercise breaks and company-sponsored healthy meals are proactive ways to fight heart disease and diabetes and would definitely boost the economy if adopted widely, but they are difficult to implement and need a high degree of buy-in from both businesses and employees; they are going to require cultural changes that take time, something we don’t have a lot of in the midst of a viral pandemic. Yet the economic costs of these diseases is so great that if we could somehow drastically reduce deaths and hospitalizations from them by strategically shutting down non-essential businesses and engaging in social distancing and mask wearing for a discrete period of time, it would be an obvious win for the economy, even aside from the question of the inestimable value of those human lives. But while heart disease doesn’t work that way, contagious illnesses like COVID-19 do, and the idea that any of the measures we have adopted have been ‘overreactions’ that we ‘wouldn’t do for any other disease’ belies the fact that we definitely would if we had similar options to fight those diseases (or I hope we would; I’m probably letting my naive optimism show a little too much here).

But even apart from questions of economics, diseases like cancer, diabetes, and coronary artery disease are important topics that are talked about constantly in the news, and that millions of people like me devote literally every day of their full time jobs to fighting, preventing, diagnosing, treating, and counseling people about. COVID-19 is causing a pandemic, and it’s understandable to feel some frustration that it has sometimes seemed like the only thing the news has been reporting on; but we shouldn’t pretend that sensationalization of medical topics is new or that the media has never spent significant energy and focus on these other diseases. When something negatively effects peoples’ lives to an extreme degree, like COVID-19 and these other diseases do, people are going to read and write about it; but unlike COVID-19, the interest is more or less sustained over the years. This isn’t just true for the news; it’s true for us, too; just look at this graph of searches from Google Trends. We are always thinking about these issues, as a society, at a pretty steady rate; COVID-19 is new and very dangerous, and so we are thinking about it now all at the same time.

I am uncertain of how many of the searches for “heart attack” are related to the Demi Lovato song.

COVID-19 is just as incredibly dangerous as the leading causes of death.

But the final and most important issue here, and maybe the one I should have started with, is that these statistics are lies, at least when you are seeing them shared on social media now. That graph above showing COVID-19 deaths compared to cancer and heart disease is from March, when ‘only’ a few thousand people had died from COVID-19 and the US had yet to hit any regional surges. It compares cases at the beginning of the pandemic to deaths from other causes for the entire year. But by the second week in April COVID-19 had become the leading cause of death, in deaths per day, and stayed there throughout all of April and half of May. Since then it has continued to jockey for position with cancer and heart disease (while disproportionately affecting people already battling these diseases), and is now on the rise again.

Also from April 2020

If we want to compare apples to apples, we could wait to compare the number of deaths once COVID-19 had an appreciable impact; the 2nd graph below shows COVID-19 deaths compared to other causes of death today. If we wanted to compare same-sized apples, we could look at deaths from COVID-19 since the first death was reported in the US on February 29th; the 3rd graph below shows deaths from COVID-19 compared to an equivalent time period, 154 days (and for the 2017 flu and 2009 H1N1, the slightly shorter period encompassing their entire flu seasons).

Ask yourself why people are sharing only the top graph on facebook, 4 months and 160,000 deaths later

Looking at the 2nd graph, COVID-19 has already surpassed stroke, drug overdose, and the very deadly Seasonal Flu of 2017-2018, and there is zero chance that it won’t also surpass accidents and chronic respiratory diseases soon. But unlike the flu, COVID-19 did not begin to disappear in the late Spring and early Summer, and we are once again seeing a surge in deaths from the virus as we enter August. If we look at the 3rd graph, there is reason to believe that COVID-19 will settle in as the 3rd leading cause of death in 2020; but it has already dwarfed all other causes except heart disease and cancer. Even this graph undersells the true impact of the virus, since the proportion of deaths occurring in February and March was very low. If we were to look at the number of deaths in the 120 days since COVID-19 deaths began to rise at the end of March, the picture would be even more bleak; but posting more and more alarming graphs by limiting the time frame to the most dangerous months of the pandemic so far, in order to show how dangerous COVID-19 really is, feels a little too much like manipulating the data in the virus’s favor; and COVID-19 doesn’t need or deserve any help from us.

So these comparisons are problematic because they ask us to believe that our society doesn’t already devote enormous resources to these other problems and that they don’t have incredible impacts on the economy, and because they are comparing very different causes of suffering, disease, and death that have to be combatted very differently. And they are deceptive because they are deliberately using old data from early in the pandemic (using old data when you know new data is available is also called lying) and discounting whatever time period of the pandemic doesn’t support their narrative. But I think the most frustrating thing for someone like me who spends hours every day talking about and thinking about diabetes and heart disease, has devoted extra time and effort to gaining proficiency with methods of treating drug dependence and preventing drug overdose, and has spent hundreds of hours working in emergency rooms and treating people following accidents and motor vehicle collisions, is that people often seem to be sharing these comparisons not because they actually care about these other important medical issues, but because they don’t mind using them to reinforce their COVID-19 denialism and conspiracy theories… and then dropping them again once they are no longer useful or convenient. But because I’ve lost my lisinopril bottle again and apparently want to see how high I can get my blood pressure this week, we are going to save that discussion for tomorrow when we talk about the comparisons being made between COVID-19 and Human Trafficking.

America’s Frontline Doctors (I guess I don’t count?)

I have seen this video of Dr. Simone Gold, Dr. Stella Immanuel, and Dr. Dan Erickson, and other physicians in almost every format over the past 24 hours; from a 45 minute long version to just Dr. Immanuel’s comments. My favorite presentation of it, if I’m allowed to pick a favorite, is the headline that I saw first which read, “American Doctors Address COVID 19 Misinformation with SCOTUS Press Conference.” I know it’s the oldest tactic in the book, but something about people spreading misinformation by claiming they are fighting misinformation still really gets to me. I understand this video was viewed over 14 million times before youtube and social media sites began to take it down, and I understand why. The group, America’s Frontline Physicians, present themselves in patriotic themed lab coats (I did not know that was a thing) in front of the US Capitol (or whatever building that is; I was homeschooled), and tell Americans what we have all so desperately wanted to hear for months; there’s nothing to be worried about, your lives can go back to normal now.

Several of these physicians we are already familiar with. Dr. Dan Erickson’s interview with local news stations was perhaps the biggest COVID-19 misinformation viral video until Plandemic came along (a week later), and Dr. Simone Gold has gone viral multiple times; I addressed her “COVID-19 as a Mass Casualty Event” letter on the blog back in May. Though these doctors don’t know me from Adam, to me they are starting to feel like old friends; or at least old frenemies. They are becoming more sophisticated in the posturing they take around misinformation (that sounded ominous; “they are becoming more sophisticated”, like they were killer robots from SkyNet); including in their talk the idea that they are being ‘silenced’ even though tens of millions of Americans have heard their dissenting minority opinions, claiming to speak for ‘thousands of doctors’ (this is probably an accurate number; there are about 1.1 million doctors in the US), and painting a convincing picture of themselves as the front-line doctors ‘actually diagnosing and treating’ COVID-19 and the people ‘silencing’ (read: disagreeing with) them as shadowy powers-that-be, as opposed to just being the vast majority of conscientious front-line doctors who simply hold to higher standards of evidence and have less tolerance for the invasion of political concerns into our care of patients. All of this is lent some credence by the fact that this video is being censored on Youtube and Facebook, of course; but considering the views they share really are dangerous, I have to admit that I don’t know whether censoring the video is the right call or not; I’m glad it’s not my decision to make. My approach has been to analyse and discuss, and I’m thankful for those who have provided me with the transcript and alternative links to the video for me to try to do that.

Since I worked from 8-5 today, including a morning spent in our outdoor tent clinic diagnosing, treating, and counseling patients with COVID-19, and a motorcycle drive in a torrential downpour (it said 10% chance of precipitation!), I’m about 18 hours behind on responding to this video. In interest of making this analysis available to those who have asked for it more quickly, I’m going to take it one doctor at a time, starting with a response to Dr. Stella Immanuel’s comments. The full transcript is below, up to the Q&A which I won’t spend time addressing. My comments are in blue and will be added as I go.

TL;DR: Posting now, editing and adding to later. Reserve the right to wake up at 3 AM and fix spelling erros.

Congressman Norman: (00:00)
… I’ll turn it over.

I have no idea who Congressman Norman is, but it has a very sinister ‘Spider-Man villian’ ring to it, doesn’t it?

Dr. Simone Gold

Dr. Simone Gold: (00:01)
Thank you. Thank you so much congressmen. So we’re here because we feel as though the American people have not heard from all the expertise that’s out there all across our country. We do have some experts speaking, but there’s lots and lots of experts across the country. So some of us decided to get together. We’re America’s Frontline Doctors. We’re here only to help American patients and the American nation heal. We have a lot of information to share. Americans are riveted and captured by fear at the moment. We are not held down by the virus as much as we’re being held down by the spider web of fear. That spiderweb is all around us and it’s constricting us and it’s draining the lifeblood of the American people, American society, and American economy.

America’s Frontline Doctors seems like a new organization, but for COVID-19 Viral Video enthusiasts like myself, seeing them all together in this video feels like the first time we saw all of the The Avengers together in The Avengers after 4 years of build-up. The group’s logo is a caduceus overlaid with an American flag; a perfectly fine image, I suppose, but taken with their political aims it sends a clear message; “we are the only doctors that true American patriots can trust.” Later, when these physicians make claims that other doctors have not been using hydroxychloroquine, have been encouraging people to wear masks, or have been advising caution and social distancing because of political motivations, please remember exactly who has overtly politicized their medical calling and emblazoned it on their lab coats. You know what my lab coat has it on? Germs (that’s what they all have, which is why I don’t wear one).

I think Dr. Gold’s discussion of the fear capturing the American people here is very interesting. Certainly there are many responses to the deadly viral pandemic that America is facing; fear, anxiety, bravado, calloused indifference, defiance. I’ve had all of those responses myself, and that was just this morning. I have seen many people suffer from anxiety about the virus, for the sake of themselves and their loved ones, and have offered a listening ear and counseling (and, when appropriate, anxiety medication); I have also seen people who consider COVID-19 to be a political tool or a hoax and have shown brazen disregard of the very real danger posed by the virus, and a great many of them are going to watch and share this video. There is something fairly calloused and icky about sharing a message that ‘you don’t have to be afraid anymore’ to people you already know aren’t taking a dangerous thing seriously. Nevertheless, I’ve actually repeated Dr. Gold’s main point here, “I don’t want you to be afraid,” at least 100 times in the past week; probably far more. When I counsel patients who likely have COVID-19, or whose loved ones do, I almost always tell them that I don’t want them to be afraid. I also tell them about social distancing and counsel them on isolation precautions, and talk to them about getting in touch with their close contacts to encourage them to quarantine, and I talk with them about reasons they would return to my clinic or go to the ER or even call 911 if their symptoms worsen. Because my desire for them not to be afraid isn’t because there isn’t anything anything to be afraid of, like Dr. Gold claims, but because because fear leads to anger and anger leads to hate, and hate leads to suffering… Because fear is the mind killer, the little-death that brings total obliteration… Because with great power comes great (no wait that isn’t one, sorry)… But really because God has not given us a spirit of fear, and I believe that my patients will thrive best and be most free from fear when they have a healthy respect and understanding of the virus and how to protect others and respond to complications based on the best, most reliable information possible.

Dr. Simone Gold: (00:53)
This does not make sense. COVID-19 is a virus that exists in essentially two phases. There’s the early phase disease, and there’s the late phase disease. In the early phase either before you get the virus or early, when you’ve gotten the virus, if you’ve gotten the virus, there’s treatment. That’s what we’re here to tell you. We’re going to talk about that this afternoon. You can find it on America’s Frontline Doctors, there’s many other sites that are streaming it live on Facebook. But we implore you to hear this because this message has been silenced. There are many thousands of physicians who have been silenced for telling the American people the good news about the situation, that we can manage the virus carefully and intelligently, but we cannot live with this spider web of fear that’s constricting our country.

Dr. Simone Gold: (01:45)
So we’re going to hear now from various positions. Some are going to talk to you about what the lockdown has done to young, to older, to businesses, to the economy, and how we can get ourselves out of the cycle of fear. Dr. Hamilton.

Dr. Bob Hamilton

Dr. Bob Hamilton: (02:03)
My name is Dr. Bob Hamilton. I’m a pediatrician from Santa Monica, California. I’ve been in private practice there for 36 years. And today I have good news for you. The good news is the children as a general rule are taking this virus very, very well. Few are getting infected. Those who are getting infected are being hospitalized in low numbers. And fortunately the mortality rate of children is about one fifth of 1%. So kids are tolerating the infection very frequently, but are actually asymptomatic.

And thank God for that. As a father of 4 young children, I cannot even imagine the anxiety, fear, and paranoia I would experience if we were living through a pandemic like the Spanish Flu, which disproportionately killed young children. I cannot imagine the pandemonium, the incredible amounts of fear, and even the difficulty in staffing clinics and hospitals if exposure to the virus put our children‘s lives at great risk instead of just our own. Though Dr. Stella Immanuel below discusses the panic that her patients commonly present with when they believe they may have COVID-19, I’ve only see this a few times; many patients need reassurance and education, but only a handful have been truly on the verge of a panic attack. But I have seen many, many people very concerned about their children and grandchildren. In fact, when I inform patients that they have been diagnosed with COVID-19, they usually ask “what about my children?” before they ask any other question.

The truth is we don’t know the mortality rate among children, for a lot of the same reasons that it’s so hard to lock-down a true infection fatality rate in general; imperfect testing, asymptomatic cases, minimally symptomatic cases that are never tested, and still being fairly early in the course of the pandemic and not having all of the data we need. But we all agree it’s smaller than for older patients, and Dr. Hamilton’s estimate of 0.2% is within the commonly accepted range based on the data we do have. I would point out that 0.2% is still a very alarming mortality rate for a virus that is as infectious as COVID-19; but a lot of us hope the rate is actually even lower and that children tend to be asymptomatic or minimally symptomatic at a high enough rate that we are simply missing most cases. We hope, but we don’t know. So while I can counsel the patients who anxiously ask me if their children are going to be ok (which would be the very first question on my mind as well) that they are at less risk from COVID-19 than any other age group, I cannot promise them that their children will be unaffected or free from risk, and I still counsel them on what to watch for.

Dr. Bob Hamilton: (02:38)
I also want to say that children are not the drivers of this pandemic. People were worried about, initially, if children were going to actually be the ones to push the infection along. The very opposite is happening. Kids are tolerating it very well, they’re not passing it on to their parents, they’re not passing it onto their teachers. Dr. Mark Woolhouse from Scotland, who is a pediatric infectious disease specialist and epidemiologist said the following. He said, “There has not been one documented case of COVID being transferred from a student to a teacher in the world.” In the world.

I think here Dr. Hamilton is straying into a fairly disingenuous way of looking at these statistics. One of the first and most widely followed mitigation steps early in the pandemic was to transition schools to online learning. More than closing non-essential businesses, more than observing social distancing, more than wearing masks once sufficient evidence to support mask-wearing was amassed, children were compliant with not being in school at very high rates because schools were, physically, closed. I will accept that children have not been the driver of the pandemic; they are also one of the groups that has been kept at home most successfully during it. Saying children have not driven the pandemic is not the same as saying they would not have or might not if these mitigation measures were not followed. The question of whether or not children can or will drive the pandemic once schools reopen in person is nuanced and difficult; I’ll try to address it in the next paragraph and in greater detail in a later article. But it’s important that we don’t fall into the trap of evaluating the course the pandemic has taken so far without taking into account the effects of the precautions and mitigation measures we have taken in response to it.

Dr. Bob Hamilton: (03:19)
I think that is important that all of us who are here today realize that our kids are not really the ones who are driving the infection. It is being driven by older individuals. And yes, we can send the kids back to school I think without fear. And this is the big issue right now, as Congressman Norman alluded to, this is the really important thing we need to do. We need to normalize the lives of our children. How do we do that? We do that by getting them back in the classroom. And the good news is they’re not driving this infection at all. Yes, we can use security measures. Yes, we can be careful. I’m all for that. We all are. But I think the important thing is we need to not act out of fear. We need to act out of science. We need to do it. We need to get it done.

Again, just because children in school have not driven transmission so far, because they have not been in school, doesn’t mean that it isn’t a risk. I don’t know whether or not we should reopen schools normally in a few weeks. There are lots of reasons I haven’t been able to come to anything like a firm conclusion about it. The data is complicated, and it’s such an important question that it really does require a degree of thorough research and critical thinking that I have not been able to give to it yet. Part of that is my own privilege; my wife and I homeschool our four children (and I include “and I” very generously), so it’s a question that doesn’t personally affect us. Homeschooling has always involved some degree of privilege, even though it is also challenging and requires sacrifice, but that’s never been quite so obvious to me as it is now in the midst of this pandemic, when this one big question mark seems to be looming over nearly every family we know but our own. But even though it doesn’t directly affect our own children, there are many teachers and school aged children that we deeply care about (and tons that we sort of care about or middling care about), and the question has been heavy on my mind, especially as more and more close friends have asked me to research and write about it.

All of that to say, I don’t have an answer today; I hope to write about it soon, but I can’t promise I’ll have an answer then either. For now I’ll say this; I think the burden of proof has to be on the side of proving it’s safe, not on the side of proving it’s not safe. I need to review the studies on transmission and shedding in children, but the claim I’ve seen that children are very unlikely to transmit the virus seems very counter-intuitive. Transmitting respiratory viruses is what children do. I’ve got four of these booger goblins at home; the little one gives kisses by putting his entire mouth around your nose, and the 2nd youngest “whispers” to you by blowing spit into your ear and your eyeball. One of the questions we always ask someone with a cold or flu, even pre-COVID-19, is whether they have been around anyone sick. If the answer is “well I have kids” or “well I work in a school” my response is, “say no more.” If there’s one thing we’ve learned about COVID-19, it’s that it’s different. Maybe kids really don’t shed it, maybe they really don’t spread it to each other or to adults; maybe we can reopen schools with sufficient distancing guidelines that it will not endanger the lives of children or or adolescents or their caregivers, teachers, or families. If that’s the case, that’s wonderful; but it has to be very, very clearly demonstrated by real scientific evidence. It isn’t something we can risk on the type or quality of “evidence” that some of the members of America’s Frontline Doctors seem to find sufficient. We’ll try to look at as much of that evidence as we can in an upcoming post.

Dr. Bob Hamilton: (04:07)
Finally, the barrier, and I hate to say this, but the barrier to getting our kids back in school is not going to be the science, it’s going to be the national unions, the teachers union, the National Education Association, other groups who are going to demand money. And listen, I think that it’s fine to give people money for PPE and different things in the classroom. But some of their demands are really ridiculous. They’re talking about, where I’m from in California, the UTLA, which is United Teachers Union of Los Angeles, is demanding that we defund the police. What does that have to do with education? They’re demanding that they stop or they shut all private charter schools, privately funded charter schools. These are the schools that are actually getting the kids educated.

This gets too deep into politics for me. Look at the various teachers unions’ demands (if they have demands) in your area for yourself and see if you think what they are asking for is reasonable. Better still, talk to teachers you know and ask for their opinion on reopening schools, the same way that you would (hopefully) ask me or another physician you know about our views on wearing masks or other medical issues related to the pandemic. I know some teachers, and I know that their greatest desire (besides something called a “smart board”) is to be back in the classroom educating and pouring life into your children. They want the schools to reopen, but they want to know the safest and wisest way for it to happen, because too much of their job already deals with childhood suffering, and seeing anything like an abnormally high number of their students (your children) die from COVID-19 because we re-opened schools in the midst of a surge of cases would break them. No profession is perfect (something I’m hoping to write about soon too, but in the meantime you should go read Harriet Washington’s Medical Apartheid for yourself), but if you don’t think doctors in general want you to be well and thrive, and you don’t think teachers want your children to grown and learn, I’ve got some questions about who you do trust.

Dr. Bob Hamilton: (04:59)
So clearly there are going to be barriers. The barriers will not be science. There will not be barriers for the sake of the children. That’s going to be for the sake of the adults, the teachers, and everybody else, and for the union. So that’s where we need to focus our efforts and fight back. So thank you all for being here and let’s get our kids back in school.

Leave out that there really are some scientific barriers to knowing whether or not fully reopening schools is actually going to be safe for the children, which is probably the single biggest concern among teachers anyway; there’s still something very calloused about calling out teachers for not wanting to re-open schools because of concerns about their own safety.

Dr. Stella Immanuel

Dr. Stella Immanuel: (05:27)
Hello, I’m Dr. Stella Immanuel. I’m a primary care physician in Houston, Texas. I actually went to medical school in West Africa, Nigeria, where I took care of malaria patients, treated them with hydroxychloroquine and stuff like that. So I’m actually used to these medications.

I’ve learned an awful lot from African physicians over the years, though I’ve never been to Nigeria and have not had the privilege to travel to West Africa since before medical school. I do not know the arc of Dr. Immanuel’s career, how long she practiced in Nigeria and how long she has now practiced in the US (I am told she used to live in the same city where I did undergrad). On my most recent short term trips to volunteer in hospitals in South Sudan and Uganda, I went in a teaching role; and while I did have some things to contribute, there is no question that I gained from doctors there more knowledge and insight than I was able to give, which is what I fully expected would happen. And nowhere was this dynamic more clear than in treating patients with “tropical diseases” like yellow fever and malaria. Diagnostic tests, medications, and clinical pictures that I had encountered primarily in textbooks were bread and butter medicine for the physicians I worked with, and I’m sure I must have seemed fairly slow on the uptake, trying to figure out the right chloroquine dose for pediatric malaria patients or recognize the differences in the clinical picture between malaria and dengue fever. While I’ve now also used these medications for malaria, in addition to prescribing them for lupus here in the US, I would completely concede more extensive experience with antimalarial agents to a West African trained doctor like Dr. Immanuel. What I cannot honestly concede is more extensive experience diagnosing and treating COVID-19.

Dr. Stella Immanuel:
I’m here because I have personally treated over 350 patients with COVID. Patients that have diabetes, patients that have high blood pressure, patients that have asthma, old people … I think my oldest patient is 92 … 87 year olds. And the result has been the same. I put them on hydroxychloroquine, I put them on zinc, I put them on Zithromax, and they’re all well.

The best way to study a medication’s efficacy is a double-blinded, randomized, controlled trial. There are studies that have been done and are being done on hydroxychloroquine for COVID-19 that are designed this way, and if done carefully they will provide the absolute highest quality data we will have on this medication. So far the ones we have do not show benefit. It’s worth pointing out here that one large, well-designed study is of much greater value than many small or poorly designed studies, and of infinitely greater value than any one or a few clinicians’ anecdotal experiences. But in a pandemic I do believe in an all-hands-on-deck approach to both clinical treatment and research, and I appreciate all of the doctors for whom research is not a usual interest or activity taking the time and energy to bring their results forward.

But we would not be wise to digest these results without understanding their significance. When Dr. Immanuel says she has treated 350 patients for COVID-19, that feels like a fairly large number; especially compared to the dozen that Dr. Bartlett had treated to support his claims for budesonide or the 50 that Dr. Procter had treated in a recent viral facebook post. But we still need more information, like how her patient population’s demographics compare to the population in general, which she only hints at, telling us the age of her oldest patient but not providing a median age or other demographics factors or data on comorbidities or high-risk conditions. Depending on their risk factors and their ages, zero deaths out of 350 might be exactly what we would expect. Even if Dr. Immanuel’s population perfectly represented the general population (and we have good reasons to suspect this is not the case, as we will discuss below), where we believe the infection fatality rate is somewhere in the still-very dangerous- range of 0.4% to 1.3%, this would only be 1-4 fewer deaths than expected; wonderful, well worth celebrating, but not miraculous, and certainly not proof of a cure. But aside from the simple numbers, there are bigger issues we need to be honest about here.

Dr. Stella Immanuel: (06:12)
For the past few months, after taking care of over 350 patients, we’ve not lost one. Not a diabetic, not a somebody with high blood pressure, not somebody who asthma, not an old person. We’ve not lost one patient.

As I’ve done for every doctor making claims of perfect efficacy for unproven medications over the past few months, I’d like to look at Dr. Immanuel’s claims in the context of her treatment setting; namely, outpatient Family Medicine in Houston, Texas. Here is the graph of positive cases in Houston.

If this looks familiar to my fellow Wacoans, maybe it’s because it looks almost identical to the trend in cases in Waco, and really in most places around Texas. Here is our trend from April to July from the health department’s tracker at (based on positive test results).

You’ll note these charts are not to the same scale; Waco does not (yet) have a population of 2.3 million people. But there are only so many patients a doctor can see in a day, and both Waco and Houston have had plenty of COVID-19 cases, and people being evaluated for possible cases, to keep more than one doctor very busy, and it’s pretty hard for me to imagine that Dr. Immanuel has seen many more patients for evaluation of COVID-19 symptoms than I have over the past couple of months. But if we look at these trends it strongly implies that the vast majority of her patients who actually had COVID-19 would have been in the past 6 weeks, just like mine have been; before that the infection rates in Houston and in Waco were too low for either of us to have extensive experience with patients who actually had the virus, regardless of how many people we were evaluating and testing (important work still, since none of us knew when our surge would start). She doesn’t tell us how many of her 350+ patients were in March, April, and May and how many have been since mid-June, just that she has treated that many patients with hydroxychloroquine over the past several months. If we assume that the majority of these patients have been in the last 42 (great number) days since cases began to climb in Houston, it means that a lot of her patients are not out of the woods yet. There is a lag time from the development of early symptoms of COVID-19 to the development of severe complications, and a further lag time from this to death, while patients fight for their lives in the hospital and doctors and nurses do everything in their power to help them. Finding an exact number is difficult because there are so many factors and so many different ways that people are affected by the virus; but the total lag from onset of symptoms to death seems to be around 18 days. Even this is likely an underestimate, however, since any such data would exclude people experiencing a prolonged battle with the virus who are still fighting it at the time the data is collected, but ultimately pass away from it later. This gives us a mere 24 days during which we can say Dr. Immanuel has had time to see a significant number of patients with COVID-19 and feel confident in saying that those patients have fully recovered and are no longer in danger.

I am playing a bit fast and loose with these numbers here, because I don’t actually think Dr. Immanuel means that the majority of her 350 “COVID patients” have been within the past 6 weeks. The point is this; when doctors claim to have been treating COVID-19 a certain way for months, you need to look and see how many months there have actually been COVID patients in their area. Because if the length of time they have been ‘treating COVID’ successfully and the length of time that SARS-CoV-2 has been endemic in their region don’t line up, we have to ask an important question that runs deeper even than the demographics and risk factors of their patients; did the patients they treated even have COVID-19 at all?

You see, over and over when we have heard from physicians like Dr. Irene Lozano and Dr. Brian Procter that they have a 100% cure rate with hydroxychloroquine or another regimen, it turns out that their definition of ‘having COVID-19’ is extremely liberal. One admits to treating patients with minimal symptoms and questionable exposures; the other says he doesn’t even believe in testing for COVID-19. This is the most basic concept of epidemiology imaginable, but you can’t die from a disease you don’t have. If a doctor says they have successfully treated a condition x number of times, but their diagnosis of the condition doesn’t conform to accepted standards of certainty or rely on any evidence other than a hunch or their desire or ideological commitment to ‘diagnose’ and treat the condition, their results are less than useless; they don’t even count as anecdotal evidence.

I don’t know if this is the case for Dr. Immanuel; she doesn’t say that she doesn’t believe in testing, she doesn’t tell us what test her clinic uses or its sensitivity and specificity, or how many of her hydroxychloroquine patients were treated during Houston’s pre-surge months, or if she uses the accepted clinical diagnostic criteria in lieu of a positive test. I cannot say definitively that Dr. Immanuel has done what so many doctors in these videos have done and artificially inflated her COVID-19 patient series by treating people who did not meet any accepted diagnostic criteria but were merely worried they might have the virus. But this is absolutely key to understanding the significance of her success rates, and I do think she gives us a few important clues in that direction.

Dr. Stella Immanuel:
And on top of that, I’ve put myself, my staff, and many doctors that I know on hydroxychloroquine for prevention, because by the very mechanism of action, it works early and as a prophylaxis. We see patients, 10 to 15 COVID patients, everyday. We give them breathing treatments. We only wear surgical mask. None of us has gotten sick. It works.

This is clue number one, and it’s a big one. I sometimes use a phrase I’m pretty sure I’ve coined; “we aren’t keeping the secret medicines for doctors hidden in the back.” I say this, when I think it’s appropriate to the patient, to help dispel the idea that I am holding out some sort of secret treatment that I only prescribe to other doctors and their families, which is something that my patients sometimes believe (and that some of them have very good historical reasons for believing). A compassionate, conscientious physician is going to treat your condition the same whether you have an MD or PhD or have very little education, whether you are rich or poor, and even whether or not they like you or you are mean to them; we don’t keep secret medicines in the back that you don’t unless you are ‘in the club.’ And because I believe that Dr. Immanuel is a compassionate physician, I don’t believe that she would be willing to give herself, her staff, and other doctors and medical personnel hydroxychloroquine as prophylaxis if she were unwilling to do the same for others. If she really believes it works in this clinical setting, it would be consistent of her to offer hydroxychloroquine for patients who have been around others with COVID-19, or thought they might have been, or who work in other high risk environments like nursing homes, food service, and grocery stores. And because she has more extensive experience with hydroxychloroquine for malaria treatment and prophylaxis than most US trained physicians, it would be reasonable to expect her to be somewhat more liberal in prescribing it for this purpose without the same degree of anxiety a doctor might feel who has only used it for lupus.

In claiming that she has successfully treated over 350 patients with COVID-19 with hydroxychloroquine, is Dr. Immanuel including the patients she has treated merely for prophylaxis, who have not been diagnosed with an infection at all? I don’t know, but considering the national stage and the passion she feels on this issue, I would feel a great degree of temptation to include those patients and bolster my treatment numbers, and if I wasn’t including them I would want to be explicit on that point.

Dr. Stella Immanuel: (06:46)
So right now, I came here to Washington DC to say, America, nobody needs to die. The study that made me start using hydroxychloroquine was a study that they did under the NIH in 2005 that say it works. Recently, I was doing some research about a patient that had hiccups and I found out that they even did a recent study in the NIH, which is our National Institute … that is the National … NIH, what? National Institute of Health. They actually had a study and go look it up. Type hiccups and COVID, you will see it. They treated a patient that had hiccups with hydroxychloroquine and it proved that hiccups is a symptom of COVID. So if the NIH knows that treating the patient would hydroxychloroquine proves that hiccup is a symptom of COVID, then they definitely know the hydroxychloroquine works.

Dr. Immanuel is referring to a case report from April of one patient, a 62 year old man who presented to the ER with hiccups; he was found to have diffuse groundglass opacities on CT scan of his lungs and tested positive for COVID-19. The case study mentions that he was treated with hydroxychloroquine exactly once (twice if you count the abstract); it was standard treatment at the time this man was admitted, as it was in most places around the country before more evidence emerged that it wasn’t efficacious. The study draws absolutely no conclusions that his COVID-19 was cured by hydroxychloroquine, but rather was published to emphasize that “physicians should keep COVID-19 infection on their differential as more cases are discovered through atypical presentations.” The idea that this case study somehow proves that the NIH “knows the hydroxychloroquine works” is a complete non-sequitur and betrays either intentional or accidental misunderstanding of the case study. Also, I love it when people google things and then post viral videos telling other people to google those things; it creates fascinating Google Trends graphs:

Dr. Stella Immanuel: (07:42)
I’m upset. Why I’m upset is that I see people that cannot breathe. I see parents walk in, I see diabetic sit in my office knowing that this is a death sentence and they can’t breathe. And I hug them and I tell them, “It’s going to be okay. You’re going to live.” And we treat them and they leave. None has died.

This is clue number two. You see, Dr. Immanuel has fallen into the trap that so many other doctors whose claims we have looked at on this site have fallen into; they are actually treating the virus as though it were even more dangerous than it already is. Most doctors I know would accept a death rate for COVID-19 somewhere between 0.4 and 1.3% based on the best data we currently have available; incredibly dangerous, but not a death sentence. The diabetic patient with COVID-19 is most likely to recover without treatment, but if unchecked the virus could easily kills hundreds of thousands or even millions. That’s what happens in most dangerous, contagious illnesses; if unmitigated, it will kill far too many people, but any particular person is still statistically unlikely to die. In fact, I spend a lot of my time saying to my patients I am testing for COVID-19 almost what Dr. Immanuel is saying. I don’t hug them, but I do offer a therapeutic hand on the arm and say, “I think you’re going to be ok. Most people recover from this and never have to be in the hospital. Let’s talk about what to watch out for and how you can feel a little better while your body fights this.” By believing that this virus is almost universally deadly for certain people, she is ensuring that her evaluation of her treatment numbers is biased, because she then cannot objectively compare her survival rates to the real death rates. Each case proves the drug was the key, miraculous cure, because she’s convinced that each patient she treats would have died without it.

Dr. Stella Immanuel:
So if some fake science, some person sponsored by all these fake pharma companies comes out say, “We’ve done studies and they found out that it doesn’t work.” I can tell you categorically it’s fixed science. I want to know who is sponsoring that study. I want to know who is behind it because there is no way I can treat 350 patients and counting and nobody is dead and they all did better.

Two things on this. Most of the COVID-19 and hydroxychloroquine studies that have come out have not been sponsored by any pharmaceutical company (I can’t think of any that have off the top of my head), and this is the first time I’ve ever seen someone accuse drug companies of fixing data to prove that there was no specific drug therapy available. (yes, yes, I know; they are just setting us all up for a vaccine).

But more importantly, there absolutely is a way that she could treat 350 patients with no deaths and it not be due to hydroxychloroquine, because many doctors around the country have exactly these same types of numbers without using it. In fact, this is almost exactly what my numbers look like. I don’t feel at liberty to disclose the numbers or any details from my clinic without authorization from those patients; but I have been treating at least 20-30 patients for COVID-19 symptoms and exposure daily for weeks, and evaluating a significant number for the symptoms of COVID-19 in the months leading up to the beginning of our surge 6-7 weeks ago. I have treated well over 350 patients for suspected COVID-19, and many have been positive for the virus. None of them have died, praise God. Would I be justified in attributing this to something I am doing? Is it my particular form of counseling and reassurance? Is one of the symptomatic/supportive treatments I am recommending, like tylenol for body aches or hot tea with honey for sore throat, secretly an anti-COVID-19 miracle drug? Does my breath inhibit COVID-19? Of course not. The difference is that none of these have a theoretical mechanism of action against COVID-19 (although my breath may encourage social distancing), and many medications like hydroxychloroquine and budesonide do. I am extremely hopeful that studies will prove some clinical setting or scenario where these really are useful for COVID-19; but using before then because of unreliable anecdotal evidence is irresponsible.

We would be better served looking at my patients, if we could. Some were only recently diagnosed and, as we’ve already stated, aren’t out of the woods yet. If you don’t think I’m deeply concerned about some of these patients getting sick in the next week or two, you haven’t been reading my blog. Many were exposed but did not develop the virus. Many had only a mild clinical course and few risk factors, including age. Many had symptoms that meant they would screen positive for further evaluation for COVID-19, but were actually ultimately due to something else; a bacterial pneumonia, a COVID-19 unrelated COPD exacerbation, migraine headaches, pregnancy. Do I get to count all of them in my ‘COVID-19 treatment’ numbers since I saw them for suspected COVID-19 based on their presenting symptoms? More importantly, these patients self-selected to my clinic by not being ill enough to need to call 911 or present straight to the ER, or by not being elderly enough or having enough medical complications to already live in certain very high-risk settings, like a long term skilled nursing facility, where they would be evaluated by another doctor entirely. If I had placed all of these hundreds of patients on hydroxychloroquine, zinc, and azithromycin, (and if none had adverse events or serious reactions to these medications), their outcomes would have been exactly the same. The only difference would be that they would have purchased and taken unnecessary medications and I would be convinced that I have locked-on to the miracle cure. After that, if any of my patients did die from COVID-19, I would probably be convinced I was still beating the odds.

Dr. Stella Immanuel: (08:21)
I know you’re going to tell me that you treated 20 people, 40 people, and it didn’t work. I’m a true testimony. So I came here to Washington DC to tell America nobody needs to get sick. This virus has a cure. It is called hydroxychloroquine, zinc, and Zithromax. I know you people want to talk about a mask. Hello? You don’t need mask. There is a cure. I know they don’t want to open schools. No, you don’t need people to be locked down. There is prevention and there is a cure.

Do not trust anybody with your medical care who tells you don’t need prevention because you can just do treatment. Please wear a mask.

Dr. Stella Immanuel: (08:48)
And let me tell you something, all you fake doctors out there that tell me, “Yeah. I want a double blinded study.” I just tell you, quit sounding like a computer, double blinded, double blinded. I don’t know whether your chips are malfunctioning, but I’m a real doctor. I have radiologists, we have plastic surgeons, we have neurosurgeons, like Sanjay Gupta saying, “Yeah, it doesn’t work and it causes heart disease.”

I’m a real doctor too and I believe in evidence based medicine. Also, take that all of you radiologists, would-be-plastic-surgeons, and neurosurgeons who did better than me on your boards (you know who you are. Miss you guys); I’m a real doctor!

Dr. Stella Immanuel:
Let me ask you Dr. Sanjay Gupta. Hear me. Have you ever seen a COVID patient? Have you ever treated anybody with hydroxychloroquine and they died from heart disease? When you do, come and talk to me because I sit down in my clinic every day and I see these patients walk in everyday scared to death. I see people driving two, three hours to my clinic because some ER doctor is scared of the Texas board or they’re scared of something, and they will not prescribe medication to these people.

This is clue number three. Just like Dr. Lozano and Dr. Procter, Dr. Immanuel has patients driving across the state to see her because they know she will prescribe these hot-button medications for them even when other doctors wouldn’t. If you don’t understand why this is problematic or how this distorts her treatment numbers, please see my prior posts on those doctors’ claims.

Dr. Stella Immanuel: (09:35)
I tell all of you doctors that are sitting down and watching Americans die. You’re like the good Nazi … the good one, the good Germans that watched Jews get killed and you did not speak up. If they come after me, they threaten me. They’ve threatened to … I mean, I’ve gotten all kinds of threats. Or they’re going to report me to the bots. I say, you know what? I don’t care. I’m not going to let Americans die. And if this is the hill where I get nailed on, I will get nailed on it. I don’t care. You can report me to the bots, you can kill me, you can do whatever, but I’m not going to let Americans die.

I’m choosing to leave this one alone for the most part. Dr. Immanuel has been widely lambasted on social media for holding a number of medical and non-medical beliefs far outside of the norm, some of which are heterodox religious ideas, some of which are conspiracy theories, and some of which are just plain strange. I think her comparison of doctors like myself to Nazi scientists and doctors because we aren’t willing to use unproven medicines and some of the other references in this paragraph hint at that. While I do think that this line of conversation sadly does have some value- it is important to understand if the people we choose to give credence to are reliable sources of truth- I feel that my calling here is to speak to Dr. Immanuel’s arguments, statistics, and scientific interpretations alone.

Dr. Stella Immanuel: (10:09)
And today I’m here to say it, that America, there is a cure for COVID. All this foolishness does not need to happen. There is a cure for COVID. There is a cure for COVID is called hydroxychloroquine. It’s called zinc. It’s called Zithromax. And it is time for the grassroots to wake up and say, “No, we’re not going to take this any longer. We’re not going to die.” Because let me tell you something, when somebody is dead, they are dead. They’re not coming back tomorrow to have an argument. They are not come back tomorrow to discuss the double blinded study and the data. All of you doctors that are waiting for data, if six months down the line you actually found out that this data shows that this medication works, how about your patients that have died? You want a double blinded study where people are dying? It’s unethical. So guys, we don’t need to die. There is a cure for COVID.

This is painful, because she’s absolutely right; dead is dead (although some of us believe that’s not true at all). And if in 6 months I have lost COVID-19 patients and a large, well-controlled, double-blinded placebo controlled study does overturn all the best evidence we have so far and proves that hydroxychloroquine would have saved those patients if I had just given it to everybody who thought they might have the virus or who had certain risk factors or a certain constellation of symptoms, I will be sad that I didn’t use it. I’ll write about it on this blog, and my agony over it will probably come through pretty clearly because I’m not great at hiding that kind of thing. But what I won’t be able to say is “it turns out Dr. Immanuel was right” or “it turns out Dr. Procter was right.” Because recommending a medication that later turns out to be useful based on bad data, misunderstanding statistics, shifting the goalposts of what it means to diagnosis an infection or what constitutes valid evidence, and indiscriminate prescribing designed to bolster my own confirmation bias is still wrong. What’s that saying, something about a blind squirrel is still right twice a day, and we shouldn’t… be blind squirrels… leading the blind? Being right for the wrong reasons is called being lucky (or in the absolute best case scenario, deeply intuitive), and it’s great for you and your patients; it isn’t something anyone can reasonably or ethically follow you in.

How many medications do you take? There are over 20,000 prescription drugs approved by the FDA; unless you take that many, there are probably some out there that might help a symptom or a condition you have; maybe even some that might save your life. We could put you on chemotherapy because you might have cancer. We could put you on daily antibiotics because it might prevent your next urinary tract infection. More to the point, we could treat you with chronic opioids because they have a mechanism for helping your pain, even if your pain is unlikely to have any long-term improvement from them and you run the risk of opioid dependence, a condition I treat every day and have seen ruin lives in ways you wouldn’t believe. We could treat every child who might have an ear infection with antibiotics, regardless of diagnostic standards and the very real risks of antibiotic resistant bacteria (not to mention diarrhea diapers). We could put every flu patient on tamiflu even though it can be a harsh medication and has only limited efficacy in limited clinical scenarios.

No Dr. Immanuel, it is not unethical to refrain from using a medication in a clinical scenario where it has no proven efficacy. This is the philosophy that led to the opioid epidemic and every day leads to polypharmacy, another very real killer of the elderly. We took oaths to first do no harm, and sometimes that means sitting in the tension and anxiety of an unknown future with our patients and admitting, regardless of our own hubris, that we don’t have anything special or prescribable to offer other than our sound advice, sincere compassion, and reliable information. In fact, this is actually a pretty big part of our jobs already.

If 6 months from now (or hopefully sooner) some reliable evidence shows that hydroxychloroquine has a use in specific scenario to treat COVID-19, I will be the first one to prescribe it. Until then, the anecdotal evidence isn’t strong enough, the mechanism of action not surefire enough, and the scientific evidence not promising enough to justify the type of widespread everyone-gets-a-dose treatment these doctors are espousing; and unfortunately, despite her passion and her compassion for her patients, Dr. Immanuel’s clinical evidence, at least as she has shared it here, adds to that data not even at all.

From this point the press conference continued for another half hour. America’s Frontline Doctors is prolific; since this video they have also released additional hour and even three hour long videos. Although I think there are many points from the remainder of the video that could be analyzed, including quite a few I agree with, some that need clarification or explanation, and some that deserve to be debunked, I have to accept my limitations and accept that at this point analyzing the remaining claims is not the most pressing use of my time.

My apologies to anyone who might have been waiting for me to address a specific point in the remainder of the press conference; please do not hesitate to get in contact with me with specific questions, which I may be able to integrate into future posts.

I have deleted the remainder of the transcript since I do not have plans to address the remaining points, but it can be found here and the video can still be found in various places across the internet.