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 covidwaco.com (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.

On Masking

I had intended to write this weekend on a variety of topics, including herd immunity, the recent RECOVERY trial using low-dose dexamethasone in critically ill COVID-19 patients, antibody testing, and the question of whether the increase in cases is really just due to increased testing (answer: unfortunately, no). But when I woke up this morning the world seemed suddenly, vehemently, and inexplicably divided on just one subject: wearing masks.

Part of this can be accounted for, at least locally; yesterday the City of Waco issued an order requiring businesses to create and post mask policies for employees and customers. As with anything that has been unnecessarily politicized and sensationalized, I recommend you read for yourself what the order actually does and does not require. This morning I had half a dozen messages asking for my thoughts on whether or not masks are an effective strategy, and several people shared pieces of misinformation they wanted to bring to my attention.

So while I would still like to write about all of the above issues, I think this one will have to take priority today.


Are masks safe and effective?

G.K. Chesterton said that he was most convinced by evidence that is ‘miscellaneous and even scrappy.’

“A man may well be less convinced of a philosophy from four books, than from one book, one battle, one landscape, and one old friend. The very fact that the things are of different kinds increases the importance of the fact that they all point to one conclusion.”

G.K. Chesterton, Orthodoxy

So while we will look at scientific studies, journal articles, and other medical evidence, I want to include data from various kinds of research, including both laboratory conditions and real-world epidemiology, and from both prior to and during the COVID-19 pandemic. I also want us to apply some common sense and a good bit of our own past experiences. This can be dangerous in a field like medicine, where realities are often counter-intuitive, but if undertaken cautiously this common sense approach can serve as an anchor for the more academic information.

With that in mind, I think we can start by thinking about the advice we give to children when they are sick or have seasonal allergies (if your children are like mine, these efforts are ultimately futile, but struggling against that futility is a time honored parenting tradition). We tell children to place their hands over their mouths when they sneeze or cough. If we are particularly savvy (and can get past the occult theme; looking at you anti-Harry Potter friends), we teach them the Vampire Sneeze/Cough, where we cough into the antecubital fossa (the bend of the elbow) instead of our hands.

It does work much better if you wear a cloak at all times.

Why? Because respiratory viruses are spread through respiratory droplets; mucous and saliva from the respiratory track that contains the virus. In this article we will look at the filtering ability of various types of masks and whether they are actually able to catch the microscopic particles that cause illness, but you don’t need a microscope to measure the number of microns between a toddler’s fingers when she almost but not quite entirely fails to cover her mouth for a cough; it’s a lot.

Now it’s true that these etiquette maneuvers do not actually stop or absorb all of the particles; they catch some and merely redirect others into the surrounding environment. But you knew that. If you live with a sick child, the odds of yourself or another family member getting sick is high regardless of how good they are at vampire coughing. The goal isn’t to stop 100% of the droplets, but to modify the spatial distribution; to make it less likely that you will get sick from someone coughing or sneezing a few feet away or across the room. Even in science some things are intuitive; if you can feel the spray of respiratory droplets on your face when someone coughs near you, you know your chances of getting sick are higher.

This is the same principal we are talking about when it comes to masks. Nobody is saying that if someone has COVID-19 they can just wear a mask, N95 or otherwise, and cough and sneeze without getting anyone sick; studies have show that the particles still escape. But if someone coughs across the room from you, their mask or their elbow, or even better both, interrupts the momentum of the droplets (50 mph for a cough, 100 for a sneeze according to a study in the Journal of Fluid Mechanics) and decreases the chances of the droplets reaching you, giving you time to move away or at least cover your own face, blocking a few more particles. These are components of an overall risk mitigation strategy that involves things like social and physical distancing, frequent hand washing, sitting outside instead of inside, contact tracing of COVID-19 patients, and staying home if you are sick.

Masks aren’t perfect, but nobody is claiming they are.

It’s also important to note that the studies that have shown only very modest benefits of masks, such as the study that produced the graph above, have focused on the spread of droplets through coughing and sneezing; high pressure, high velocity events that force droplets through and around barriers such as masks and sleeves. However, the City of Waco is not asking 100,000 people to wear a mask in case one of those people happens to cough in HEB. We now know that both asymptomatic and presymptomatic COVID-19 transmission do indeed occur, and the mechanism of transmission still seems to be from saliva and respiratory mucous, including respiratory droplets and aerosols, even in the absence of coughing and sneezing. Talking, forcefully exhaling, singing, yawning, spit talking; all of these are lower pressure events where a mask may actually block, rather than redirect, a higher percentage of these small, lower velocity particles. Again, you already believe this intuitively, because you cover your mouth when your breath stinks.

Or you should.

I also think that revisiting our actual real life experience and common sense is particularly important when dealing with medical misinformation, which is often found to be self-contradictory and manifestly illogical within only a few moments consideration and comparison to facts we already know. It rarely takes being a physician or another scientist to figure out that these wild claims on social media aren’t accurate, though I’m sure it helps.


Unmasking Mask Misinformation (sorry)

A friend sent this to me this morning; it was posted on a public forum (“public forum” sounds so much more legitimate than “Facebook comments”) as a response to our city’s new masking policy. I’ve also been sent a longer paragraph format piece that starts “I am OSHA 10&30 certified.” Since they overlap quite a bit, I won’t re-post that one in its entirety, but it’s just full of contradictions (‘surgical masks only filter on the exhale’ yet ‘become useless’ for protecting you if your breath clogs them), false claims (‘N95 masks can’t filter COVID-19’, ‘asymptomatic spread doesn’t occur’), and nonsensical statements (if you wear a mask and get exposed to COVID-19 you become a walking virus dispenser, cloth masks are worse than no barrier at all). It does make one really excellent point though; if you are relying on wearing a mask to fully protect you from getting or spreading COVID-19, that is indeed a false sense of security. We can’t say that often enough; but it just doesn’t follow that masks are worthless or make the problem worse, which is what they repeatedly claim. I’d like to go through the claims above in order, before concluding with some final arguments for masking.


Claims #1 and #2: Masks decrease oxygen intake and increase carbon dioxide retention.

This is something that has been studied extensively, and there is no evidence that simple surgical or cloth face masks will cause hypoxia or any significant decline in oxygen levels. Oxygen molecules are very small and diffuse easily both around and through these types of masks; they are nowhere near the size of viruses, or the much larger respiratory droplets that carry most of the virus that is exhaled. The same is true about Carbon Dioxide, which is only slightly larger.

But you can also consult your own experience here. Many types of people already wear masks for many hours of the day, from surgeons to certain industrial workers, and women in many cultures wear face coverings as a part of their public clothing. Yet we do not consider these persons to be at high risk for either hypoxic (low oxygen) or hypercapnic (high CO2) injury. A big part of the problem is that we have sensationalized the wearing of masks during COVID-19 and have started to treat it like it isn’t a normal part of our experience already, which it absolutely is. Whether it is the above examples, or Halloween or Comic-Con, or my 5 year old spending three weeks straight in his Spider-Man costume and refusing to wear anything else, the wearing of masks is something we all have some degree of experience with and have never really been concerned about until now, when we are suddenly being told they are extremely dangerous, generally by the same people who have been spreading various types of COVID-19 misinformation since mid-March.

But more to the point, you can study this on your own. A battery powered pulse oximeter is very accurate and costs about $12, and you can use one to do a simple experiment that will reassure you, at the very least, that your face mask is not causing your oxygen levels to drop. Check your oxygen level with your mask off, and then wear it for however long you expect to need it when you are out running errands or whatever scenario you are worried about. Then check it again. In general in a healthy adult, readings above 95% are normal and below 90% are concerning. As an example, I’ve been wearing my properly fitting N95 for the last half-hour and my O2 saturation has fallen exactly one percentage point.

I’ll admit, I freaked out for a minute before I realized the labels are upside down.

There is one group of people we should mention here, and that’s people with chronic lung disease such as COPD or Asthma. For people with these conditions, the increased heat and moisture of the air within the mask, and the decreased air flow directly to the nose and mouth, really can create both real and perceived difficulty breathing (and in these conditions, these trigger each other so easily that drawing a distinction between the physiologic respiratory distress and the anxiety-provoked sensation of respiratory distress is almost a false dichotomy; not being able to breath is scary). These are also conditions that predict a higher likelihood of severe illness in COVID-19, which complicates matters. For these individuals who should already be taking every precaution possible for their own safety in the midst of this pandemic, the decision of whether and what kind of mask they should wear when they do have to go out should be a discussion between them and their doctor. For the rest of us, especially those of us who personally care about someone with Asthma or COPD, it’s important that we take every precaution we can; it should go without saying that our “what about someone with a chronic respiratory illness” should only ever be a legitimate question on their behalf, not a rhetorical ‘gotcha’ to turn off our intellectual honesty on this issue and dismiss the benefits of everyone else wearing a mask.


Claims #3 and #4: Masks shut down the immune system and reactive your own viruses.

The third claim, that masks shut down your immune system, is just a reiteration of the above two, and there is absolutely no evidence for it. As we’ve already said, doctors, nurses, and other medical professionals, and especially those involved in surgery, wear masks all the time without any fear of their immune systems being shut down or weakened. And while these types of people are often fearless when confronting deadly situations or illnesses in order to care for their patients, as we have seen throughout this pandemic, they tend to otherwise be fairly health conscious. I still remember being shocked during a group discussion in medical school when we were asked what it was we valued most highly. I was trying to honestly wrestle with whether I valued my faith, my wife, or my daughter most, and how it was even possible to separate those things from one another, when my friend answered “my health,” and several others nodded in agreement. I have no judgement for that person, but the whole idea was very alien to me (and maybe that shows something of my privilege in having lived overall a very healthy life, often despite my personal choices). Maybe this friend would risk the thing he valued highest on behalf of a patient (in fact I think he would); but if there was any evidence that his health was imperiled by wearing a mask, he would be leading the charge against masking (just checked facebook; he isn’t), and probably would have been doing so since medical school.

The fourth claim is one that I first came across in the Plandemic “documentary” last month, and based on the wording it seems to be taken directly from there (or they are both taken from a 3rd, unknown source, which I’ll call “Q”)(I’m now being told that “Q” is already taken). The actual claim is that wearing a mask will activate dormant retroviruses that live in your body. Retroviruses are a family of viruses that replicate by inserting viral DNA into host cells and hijacking cellular machinery, and only a few known species causes disease in humans, including HIV and Human T-Lymphotropic Virus, which can cause certain cancers. This claim is very specific and very conspiracy-theory oriented, but I suspect that this distinction between retroviruses and common viral illnesses like cold and flu is not being made by the people spreading this meme.

The long and short of it is that this just isn’t the way the immune system works. You don’t have a host of dormant viruses sitting in your lungs that, if breathed into a cloth or small space and then breathed in again, will suddenly become active and cause an infection. Do you get sick when you sit in a car? What about when you hold your breath? What if you sleep with your face too close to a pillow? Is there evidence that we see more respiratory infections in people that wear masks regularly? Of course not. In someone who has a functioning immune system, once your immune system has seen and defeated a virus, you cannot give that virus to you; you already have an effective immune response to it. There are a small number of exceptions, like getting shingles through varicella zoster reactivation, but coronaviruses aren’t one of them and there is no evidence that wearing a mask or breathing out and then breathing in the ‘same air’ has anything to do with viral reactivation; there isn’t even a physiologic mechanism that would make this possible.


Claim #5: The virus is too small to be trapped by the masks!

This is where both the misinformation and the answer get a bit more technical, and if you want all of the scientific details, the blog First10em has an amazing article on masking, viral transmission, the 6 feet apart rule (which they call the “2 meter” rule, whatever that means), and the transmission patterns and particle sizes of both droplets and aerosols. The question of whether various types of face masks besides N95’s actually do filter the COVID-19 virus itself is still an unanswered question, but the answer seems to be, to some degree, yes. Studies have shown different types of masks to have varying filtering efficacy even down to to very, very small particles in the range of 300 nanometers or less, in fact right in the range of the virus itself (the SARS-CoV-2 virus is roughly 120 nanometers; an earlier version of this article incorrectly reported the size of the measured particles in this study as 40 times smaller than the virus, which was just due to me getting my conversions wrong. Sorry; pay attention in 8th grade algebra, kids), but other studies have shown that the virus is still able to transmit through (or around) masks, at least to a few inches away and if propelled by a cough. Taken together these studies seem to reiterate what we have been saying all along; masks aren’t perfect, but they do decrease the risk, especially in short-term contact with non-cough, non-sneeze related transmissions like we would see in asymptomatic and presymptomatic cases. Indeed, this is confirmed by a Hong Kong study in 2011 that found that the protection offered against respiratory pathogens by all types of face masks decreased with higher velocities and prolonged exposure.

Again, Oxygen molecules are < 0.5 nm

Regarding this piece of misinformation though, we can summarize the two main errors pretty succinctly; the virus isn’t floating through the air by itself, it’s suspended in respiratory droplets and aerosols; and the masks aren’t supposed to block 100% of the particles on the microscopic level (though that would great), just trap most of them and slow the others down. The mosquito through a chain link fence analogy is silly because mosquitos can fly around barriers volitionally, and because it uses the size of the virus instead of the size of the respiratory particles, which are much larger (1-100 microns, mostly, instead of 0.12 microns). But if you want to use the analogy, it’s more like hitting golf balls through a chain link fence; yes, the gaps are bigger than the golfballs, and some will go through if they are hit really hard; but many will be blocked outright and many others will be slowed down and redirected.


Claim #6: There is no evidence to support masks.

We have already looked at some of the various types of evidence that I believe we all find somewhat convincing. We believe as a culture that masks are least helpful in preventing infections in some situations, such as surgery, and believe they are safe when we wear them for cultural or religious reasons, as part of our jobs, or as part of costumes. We engage in barrier maneuvers (some better than others) to block large respiratory droplets when we cough and sneeze. We know the masks redirect and lessen such droplets even in these high-velocity conditions, and we’ve seen the evidence from physics and fluid dynamics studies that they can filter the smaller aerosols under low-velocity conditions. For me, the last remaining piece of the puzzle is, “does it actually work, really?”

I want to look at two more types of evidence; epidemiology evidence from before the COVID-19 pandemic, and emerging epidemiological data from right now. An Australian study in 2009, well before the COVID-19 Pandemic (but you knew that), found that the wearing of face masks did diminish the transmission of upper respiratory illnesses even among household contacts, but that there were fairly low rates of compliance with masking. If masks were worn more, they could help significantly.

“Adherence to mask use was associated with a significantly reduced risk of ILI-associated (Influenza Like Illness) infection. We concluded that household use of masks is associated with low adherence and is ineffective in controlling seasonal ILI. If adherence were greater, mask use might reduce transmission during a severe influenza pandemic.”

This study and others like it, 10 years prior to the COVID-19 pandemic, should at least put to rest any ideas that wearing masks is a novel recommendation or a government ploy to control yet another aspect of our lives. Masks have been recommended, and shown to work, for preventing respiratory virus transmission for decades; any suspicion of them now likely comes more from the current hyper-politicized, conspiracy saturated climate than from anything else. But the COVID-19 virus is new and acts very differently from other respiratory viruses in so many ways, so what’s to say that masks will be effective for COVID-19?

It is too early in this pandemic to have robust and definite conclusions about which measures helped most and which showed modest or negligible benefits. We know that social distancing helps from evidence in places like Sweden and Norway, and we now seem to be living the results of relaxing our own social distancing measures without other robust mitigation strategies in place. When it comes to masks, we could compare the United States, which is (apparently) very resistant to masks becoming a social norm to places like South Korea where wearing a mask has been the norm since early in the pandemic; but this comparison is complicated by vastly different healthcare systems and populations and by a strong difference in adherence to other mitigation efforts as well, which we Americans have also been consistently defiant of.

Population: 328 Million
Population: 52 Million

I do agree in principal with the approach by one writer to the CDC’s journal, Emerging Infectious Diseases, in comparing Taiwan to Singapore; but again this is not a perfect comparison by any means.

  • Update: It has been pointed out to me that there are now several recently published studies, conducted during the COVID-19 pandemic itself, that have looked at the issue of mask wearing to determine if the benefit is significant. You can find two of them here and here (with thanks to Baylor Epidemiologist Dr. Emily Smith, PhD, who has written an excellent summary of the current evidence for masks). I’m sure many more studies are ongoing. Of course none of these are going to be able to perfectly measure the effectiveness of masking under real life pandemic conditions; if you can imagine a scientific experiment that could, it would probably be unethical and immoral (and logistically impossible), such as taking members of a population and randomizing them to wearing or not wearing masks and then measuring how many become sick from each group. Those types of study designs are entirely off the table, so we analyze epidemiological data; looking at what happened in countries, regions, and cities where masks were adopted early, and what happened in other places after they were adopted later on. It isn’t possible to know how well the mask policies were followed from such data, or to perfectly tease out confounding factors like social distancing measures, the success of contact tracing, and the robustness of testing programs; it wouldn’t be possible to say masks are the most important thing if they are always or nearly always used in conjunction with other mitigation strategies, which is exactly how they should be used. But these studies do conclude that implementing mask policies (and following them!) makes a significant difference in the trajectory of this pandemic, and taken as just one important kind of the multiple kinds of evidence we have looked at, I do think they contribute to a convincing case for wearing masks.

Ultimately, once this turns the corner, we will never be able to say with certainty what the real answer was; whether it was wearing masks that helped the most or the heightened caution in other areas when cases began to climb, whether reopening resulted in a surge here in Texas or if it was our bucking of social distancing all along, whether each of our mitigation measures individually made a difference or not. What we can say for certain is that the American method so far has not been working. By denying the disease’s existence and danger, producing conspiracy theory after conspiracy theory, claiming we beat it prematurely, and fighting tooth and nail against every reasonable recommendation and rule meant to protect ourselves and our neighbors, we have taken a global pandemic and made it largely into an American pandemic, with the highest number of cases and deaths in the world.

There is plenty of evidence that masks are safe, and that they stand a fair chance of helping, especially against asymptomatic and presymptomatic spread. If you are sick, get tested, stay home, and isolate; make sure you get the medical care you need. If you are well and can physically distance yourself from others, then distance yourself from others while finding ways to still care for your community and your own mental and physical health. If you cannot distance because of strong religious or moral convictions or the realities of your job, or due to strong personal preferences, then please wear a mask and wash your hands frequently.

This is just one of the ways we can do better during the rest of this pandemic; myself included.

The Paradoxes of PlanDemic


Final Thoughts

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

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


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

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


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

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

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

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


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

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


The Minions of Big Pharma (O0:38)

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

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

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

Though there are beautiful exceptions.

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

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

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

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

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

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

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


Minute 1 to Minute 10

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

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

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

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

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

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

Dr. Judy Mikovits: “Oh absolutely not!”

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

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

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


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

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

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

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

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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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

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


What about Italy? (15:35)

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

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

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

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

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

Glad I got that flu shot

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

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


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

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


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

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

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

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

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

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

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

Another Doctor Webb

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

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

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

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

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

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

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

Even if it makes you look silly

Healing microbes in the Ocean.

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


COVID-19 Deaths from the day PlanDemic was released:

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

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

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

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

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

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

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


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

0:22 Kern County California.


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

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


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


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


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

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

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


1:44 See above. 


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

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


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


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

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

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


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


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

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

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

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


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

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

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

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

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


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

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

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

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

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

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

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

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

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

Dr. Erickson

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

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

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

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


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

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

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


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

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


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

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


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


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


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

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


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

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

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

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

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

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

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

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


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

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

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


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

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

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


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

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


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

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

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

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

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


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


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

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


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

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

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

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

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

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

These lost lives are not insignificant; statistically or otherwise.


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

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


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

The Church and Medical Misinformation During COVID-19

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

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


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

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

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

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

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

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

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


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

1. Understand your source.

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

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

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

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

2. Do your research.

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

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

3. Be honest with yourself about your political leanings.

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

4. Beware of easy answers.

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

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

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

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

  • Germs are good for you.

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

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

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

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

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

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

  • The doctors want you to stay sick.

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

  • The doctors are being controlled by big pharma.

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

  • The doctors mean well but have been tricked.

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

5. Ask your brothers and sisters in Christ.

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

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

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

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

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

6. Repent (or at least, redact).

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

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

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


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