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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Hygiene Theory

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

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

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

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

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

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

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

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

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

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

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

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

Memes for Dr. Shiva Ayyadurai

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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