Blue State Blues

A majority of states have begun loosening social and work restrictions in an effort to “stop the hemorrhaging” of jobs and productivity.  With the loss of jobs states and communities were also losing income and tax revenue.  Many families were turning to food banks and unemployment to survive.  For some individuals it may be the first time in their life that they were unable to provide for their family.  Several states have stubbornly extended “sheltering in place” mandates into the summer and beyond.  New York Governor Cuomo refuses to even speculate as to a possible date when there will be a relaxing of restrictions.  While refusing to relax restrictions, Governor Cuomo is whining about the $8 billion in lost state revenue due to the pandemic.  New York City was hit extremely hard by the virus but the Governor did not deal with the crisis very well.  His classic response was to shut down one of the most vibrant cities on earth.  The longer he keeps the state and NYC closed down, the more businesses and revenue that will be lost.  The COVID-19 Task Force guidance was to shelter in place for several weeks to “flatten the curve” of new infections.  In the early days of the infection the numbers of those infected who required hospitalization was rising dramatically.  Governor Cuomo was rightly concerned that there may not be enough hospital beds and ventilators to care for the increase.  It has been nearly three months now and new infections have dropped throughout the nation except for a few “hot spots.”  New York City has seen a dramatic decrease in infections and the additional medical beds that were rushed to the city’s aid were scarcely used.  The hospital ship USNS Comfort has departed from NYC and the Javits Center is being returned from a makeshift hospital to its original function.  Despite all these good indicators, Cuomo still refuses to begin reducing statewide restrictions.  Infection rates have never been homogenous in states, concentrating primarily in densely populated cities like NYC, Chicago, Detroit, Baltimore and Washington, D.C.  Why should the entire state be treated as if the infection rate was the same as that of the big cities?

As we return to normalcy one message is abundantly clear, red states are moving more quickly than blue states.  Red states tend to be more conservative and have a Republican governor whereas blue states tend to be liberal and run by Democratic governors.  Red states have already seen a rise in employment and revenue and will be much quicker to return to prosperity.  The blue states that have remained locked down will likely lose businesses and citizens to red states.  The “fears” of blue state governors is that there will be a second wave or spike in infections if they allow people to interact again.  California Governor Newsom has hinted that he may keep California shut down until we have a vaccine.  Red states have not seen a significant rise in infections with their stepwise approach of returning to normal.  Florida Governor DeSantis has expressed faith that his residents will act responsibly.  The infection numbers and death totals reflect that confidence was justified.  A recent poll revealed that less than half the population plan receive the vaccine when it is ready.  Does that mean that blue states will forever remain closed?  I believe blue states don’t want an economic recovery so as to hurt President Trump.  The American economy that Trump built was the “greatest show on earth” and the Democrats are out to destroy it by any means.  They don’t realize how this is hurting the working class but then the Democrats are no longer the party of the working class.  They work for George Soros and the billionaire class from Hollywood, Silicon Valley, and the Ivy League.  Donald Trump is the one who represents the interests of average Americans.  He is the one who can rebuild the economy not the tax & regulate Dems who will strangulate the recovery in its infancy.

Mask or Not to Mask

As states resume many of their non-essential activities and businesses the Centers for Disease Control and Prevention (CDC) issued recommendations to all Americans.  Those CDC guidelines are based on updated infection numbers and current knowledge of viral transmission.  During the shelter in place essential businesses and their employees were advised to wear masks, gloves and avoid touching the face.  As more businesses open the CDC is now recommending that EVERYONE who ventures out in public wear some sort of facial covering.  Since viral testing has become more widespread we are discovering that a substantial number of individuals infected with the virus have no symptoms.  These “super spreaders” could be shedding the virus unintentionally.  A cloth or surgical-type mask will help prevent any respiratory or nasal droplets from becoming airborne and potentially infecting others.  A facial covering need not be the “Cadillac” N95 mask that is recommended for frontline healthcare workers.  In fact you could be wearing one type of N95 that does more harm than good.  There are several types of the N95 mask, one is designed for industrial use and another for medical use.  The industrial mask has a one-way valve that serves solely to protect the wearer.  The one-way valve blocks incoming particulates but permits exhalation of respiratory droplets that could be infectious with the virus.  The N95 mask for medical use lacks the one-way valve and protects patient and medical personnel.  The CDC recommends that N95 masks for medical use be reserved ONLY for first responders and hospital personnel in direct contact with infected patients.  The N95 mask must be “fitted” to the individual’s face assuring a good seal thereby preventing air from entering around the mask edges.  The effectiveness of the N95 is accomplished through an inner nonwoven polypropylene fabric mesh that blocks fine particles and viruses.  A simple surgical mask or cloth covering is sufficient for most people provided the surgical mask is changed daily.  If choosing to wear a cloth mask it should be washed regularly.  Facial coverings are still no substitute for frequent handwashing and physical distancing as a method of preventing spread of the virus.

It is important to remember that a surgical or cloth mask will NOT protect an individual if you are exposed to a COVID-19 patient.  They are ineffective in filtering viruses and do not maintain an effective seal around the mouth and nose.  Even the N95 masks must be cleaned or “decontaminated” after a given period of use.  Duke University discovered a method of sterilizing masks by exposing them in a room to hydrogen peroxide vapor.  The CDC found ultraviolet irradiation and moist heat were additional promising methods for decontaminating N95 masks.  Masks that become contaminated with body fluids should not be decontaminated and reused regardless of the method.  As with other critical personal protective equipment (PPE), production of N95 masks had previously shifted to foreign nations.  At the onset of the COVID-19 pandemic China controlled 50% of global mask production.  President Trump invoked the Defense Production Act and encouraged 3M to step up their production of N95 masks.  The U.S. was also able to divert a shipment of 200,000 masks from Bangkok to the U.S.  We will not be totally safe in public until there is herd immunity.  That can only be achieved when enough individuals have been vaccinated or infected with the virus and recovered.  It is NOT necessary to wear a mask in your home or car (provided you are only with those you have been in quarantine with).  It is also not necessary (in general) when outdoors unless you are unable to practice social distancing.  Whether you FEEL sick or not, you could still be shedding the virus and a mask is the best way to prevent spread to others.  You are also setting an example of appropriate behavior to those who may believe that a mask isn’t needed.  As responsible Americans we can count on each other to do the right thing!

 

 

The Last Full Measure

A recent report stated that 55% of Americans did not know the true significance of Memorial Day.  Survivors of the “greatest generation” are more likely to understand the true meaning of Memorial Day than are members of GenX.  Very few families weren’t directly or indirectly affected with the personal loss of a loved one in the last “great war” our nation faced.  With fewer Americans in uniform today battlefield deaths are more limited and fewer of today’s generations are members of Gold Star families.  The “Gold Star” designation was initiated in WWI to honor families of service members who died during combat.  In giving his famous Gettysburg Address President Abraham Lincoln used the expression “the last full measure of devotion” as a tribute to the soldiers of both sides who died for their cause.  Members of the armed services sacrifice much of their own personal comfort and freedom to keep us safe and free.  Life itself IS the “last full measure” that someone in uniform can give of themselves to their country.  We should not need a special day in the year to remind us what others have done to secure our freedoms.  The storming of Omaha Beach depicted in the movie “Saving Private Ryan” is a testimonial to the courage and bravery of American soldiers.  This assault was an insurmountable mission yet our men demonstrated courage and bravery in the face of near certain death.  Throughout history our men and women in uniform have demonstrated courage & bravery under fire.  A popular expression today speaks to the bravery of our armed forces, “Land of the free because of the brave.”

The first Memorial Day was celebrated shortly after the Civil War (May 5, 1868) to honor the more than 600,000 troops killed on the battlefield (union & confederate).  It was named Decoration Day at that time after the numerous flowers that were laid on the graves of the fallen.  The official name change to Memorial Day took place in 1967 and it was made a federal holiday in 1971.  It is easy for some to confuse Memorial Day and Veterans Day but this is a day when every living veteran honors his/her fallen brothers and sisters.  The 1% of Americans who serve in the armed forces today understand the risks but willingly accept them.  “Freedom isn’t free,” and taking up arms is the only way to insure that freedom.  Memorial Day is our opportunity to thank those for whom their greatest sacrifice was the “last full measure.”  The COVID-19 pandemic has altered our ability to gather and honor the heroes who died in service to our nation.  We can still fly the flag and/or visit the local veterans cemetery.  It is important to remember that the fundamental principles of Memorial Day are patriotism and sacrifice.  There is no greater gift than to lay down one’s life for another.  We can’t expect to retain our many freedoms without the willingness of dedicated, qualified men and women willing to serve in defense of those freedoms.  Enjoy your holiday but never forget that the freedoms we enjoy were paid for with the blood and the breath of hundreds of thousands of veterans.  That sacrifice will continue to be required if we are to remain safe from enemies both foreign and domestic.

 

Plantation Joe

The Democrats have been able to rely on the support of black voters for decades.  It probably began with Franklin D. Roosevelt and his New Deal and was solidified by Lyndon Johnson’s Great Society and War on Poverty.  Republican presidential candidates have historically limited their efforts in courting the black vote in the belief that those efforts would be a waste of time.  Candidate Trump made more of an effort than his predecessors and was rewarded with a greater percentage of the black vote in 2016 than previous Republican candidates for president.  As the 2020 election approached the feeling was that perhaps President Trump could improve on that number.  The Trump economy had created the highest employment numbers among blacks, Hispanics and women in at least fifty years.  That has changed with the COVID-19 pandemic and the apparent selection of Joe Biden as the Democratic nominee for president.  Joe Biden appears to believe he has the black vote to himself.  He chief claim to black voter loyalty is the fact he served as vice-president to Barack Obama for 8 years.  Joe seems to think he is one of the “bros” but his numerous slips of the tongue would tell a different story.  He has referred to President Obama as being “articulate, bright and clean” as if that is unusual in a black man.  In a recent interview on “The Breakfast Club” radio show Biden commented to his black host, “If you have a problem figuring out whether you’re for me or Trump, then you ain’t black.”  This should create outrage in the black community since Biden’s tone was condescending.  Biden’s plantation mentality is treating black voters like children who “owe” him their vote.  If black voters are looking for a degree of prosperity, they may want to reconsider their vote.  The large gains in jobs and wages that had taken place prior to the pandemic will likely return if Trump is re-elected.  Biden and the Democrats promise a return to higher taxes (personal & corporate) and return to over-regulation.  Taxes and regulations led to job losses as companies fled to foreign nations with lower corporate tax bases.  Democratic policies will take us back to fewer jobs and higher unemployment.

After his controversial statement Biden appealed to the Breakfast Club audience by saying, “Common man, look at my record.”  Let’s take a look at the Biden congressional record.  In 1975 Biden introduced a bill that effectively blocked the federal government from forced busing of inner-city students to suburban schools.  Next Biden adopted a tough stance on crime and drugs and co-sponsored two bills with Strom Thurmond that were particularly destructive to black communities.  The 1984 Comprehensive Crime Control Act and 1986 Anti-Drug Abuse Act necessitated mandatory sentences for drug possession and abolished parole for federal prisoners.  He encouraged the Clinton administration to espouse a tough stance on crime and helped push through the 1994 Violent Crime Control & Law Enforcement Act that resulted in the mass incarceration of black men and disintegration of numerous black families.  Although Biden has since expressed some regret for his past actions on crime, he never made any movement in the area of criminal justice reform.  Ironically the only criminal justice reform to take place in the past 20 years was done during the first years of the Trump presidency.  I’m not sure why Barack Obama picked Joe Biden as his running mate, but it certainly was not on his race record.

Cheap Shot

The media pounced on a study published in the British Journal Lancet on 96,000 hospitalized patients with COVID-19 who were treated with either chloroquine or hydroxychloroquine.  This was a retrospective, non-controlled analysis of patient medical records but caught the media’s attention due to its negative findings.  The drugs that President Trump suggested could be “game changers” were found to increase mortality over patients who were given neither of the two drugs.  One of the chief risks of these drugs is a delayed repolarization of the heart (referred to a prolonged QTc interval).  When combined with azithromycin or other antibiotics in a class known as macrolides that risk is even greater.  This delayed repolarization can lead to an irregular (and potentially fatal) heart rhythm.  The study noted that in patients who were given hydroxychloroquine, there was a 34% greater risk of death and a 137% greater risk of a serious arrhythmia.  When a macrolide antibiotic was added there was a 45% greater risk of death and a 411% greater risk of serious arrhythmia.  In patients who were given chloroquine the numbers were 37% greater risk of death and a 256% greater risk of a serious arrhythmia.  When the macrolide was added to chloroquine the risk of death remained at 37% but the risk of a serious arrhythmia rose to 301%.  Some cardiologists are declaring that the drugs fail to demonstrate benefit and have distinct potential for harm.  I don’t know if the data obtained can be considered reliable since it was not gathered from a controlled study where patients are randomly assigned to different treatment groups.  Despite the President’s faith in the efficacy of the medications in question, the Trump Administration has warned against the use of the drug outside of hospital settings or clinical trials.  Hydroxychloroquine remains part of the treatment protocol for many medical centers and has been used successfully in China and Europe.  The drug is generic and may be taken by mouth therefore some clinics are treating outpatients with the medication.  There are currently multiple legitimate studies underway that should give us some answers as to the role (if any) of hydroxychloroquine in the treatment and prophylaxis of COVID-19.

Today’s brief national news conference consisted of Dr. Birx from the President’s COVID-19 Task Force providing the most positive news since the pandemic hit the U.S.  There has been a consistent decrease in the number of new infections and deaths throughout the nation.  Dr. Birx stated that the remaining “hot spots” were in Maryland, the District of Columbia and Northern Virginia.  Dr. Birx answered several questions and one press corps member specifically asked her to address the negative findings with respect to hydroxychloroquine reported in the Lancet study.  Dr. Birx pointed out that many of the patients who had arrhythmias or died during treatment had multiple co-morbidities.  One chief co-morbidity was pre-existing heart disease.  Diseased hearts (such as one with coronary artery disease) will already be oxygen-deprived  and primed for disaster.  We have evidence that the virus attacks the heart itself and it is a known fact that fatal arrhythmias are more likely to occur in a diseased-weakened heart.  Researchers would have no way of knowing what led to the death in a patient with multiple co-morbidities.  They may have died even if placed on a drug other than hydroxychloroquine. This was a flawed study and NO conclusions can be drawn from it.  It is just another opportunity to take a cheap shot at the President.  Hydroxychloroquine seems to have helped some pts; at this point we don’t yet have anything with proven 100% efficacy.

 

Latest COVID-19 News

In the initial weeks and months of the COVID-19 pandemic the media terrorized the public into thinking this virus was the next “black plague” and a threat to humanity.  The Centers for Disease Control and Prevention (CDC) was itself giving mixed messages as to the dangers of the virus and how to best deal with it.  We were initially advised to wipe down all surfaces, including the outside of groceries, packages and metal surfaces.  We were led to believe that the virus could live for days on metal surfaces and to be especially careful with the gas pump handle when filing our vehicles at gas stations.  As a medical person this advice did not make sense to me but who am I to question the authorities at the CDC?  Viruses are bits of DNA or RNA, pieces of genetic material that can not survive outside a living cell for an extended period.  Bacteria are a different story since they possess everything they need to survive for prolonged periods of time.  So now the CDC is informing that we don’t need to take precautions with wiping down our groceries or packages from UPS or FedEx.  That gas pump may be safe from the virus but then you should still wash your hands or use hand sanitizer because there could still be bacteria on that handle from dirty hands touching it before you!  We have received different messages at various times regarding wearing a mask and with the need for testing.  It is confusing to the average person, but keep in mind that the mortality rate from an infection is LESS than 1%.  Most people who are infected have “cold-like” symptoms and recover.  The elderly and those with chronic medical conditions and obesity are at risk of a more serious illness.  We were also told that we could be re-infected once we were “cured” of an acute infection with the virus.  There is good news on that front as well since South Korea released a report on this very topic.  A May 19 report by the Korean Centers for Disease Control and Prevention found an inability to isolate infectious virus from 108 “cured” patients who retested positive for the virus.  They believe this indicates that samples from “re-infected” patients are picking up on genetic material from noninfectious or dead viruses. The absence of infectious virus suggests these individuals are not re-infected nor contagious.

In the realm of treatment, researchers at the Johns Hopkins Kimmel Cancer Center have found a common drug (prazosin), when given early, can lower the risk of death in patients infected with the COVID-19 virus.  Prazosin is a non-selective alpha-blocking drug that has been used to lower blood pressure and treat enlarged prostates.  Blocking alpha receptors dilates blood vessels and relaxes the sphincter at the junction of the bladder & prostate.  The chief side effect of the drug is orthostatic hypotension.  This was not a controlled study but the researchers believe that when given early the drug seems to prevent the overactive inflammatory process referred to as “cytokine storm.”  It is this cytokine storm that leads to acute respiratory distress syndrome (ARDS) and the diffuse hypercoagulable state.  The researchers emphasized that once the inflammatory process had begun the drug would likely be ineffective.  In mice studies prazosin was found to block catecholamines (epinephrine, nor-epinephrine) and reduce levels of cytokines.  It is inexpensive and may be given by mouth but blood pressure should be monitored.  Inhaled nitric oxide gas has also been granted emergency approval by the FDA in the treatment of COVID-19.  It is a known bronchodilator and vasodilator and has improved oxygenation in hypoxemic patients.  It did not decrease mortality when used in patients with ARDS but has not yet been clinically studied in COVID-19 patients.  Treatment continues to evolve, but there is hope that the majority of Americans need not be afraid to resume some form of normalcy.

Stealth Voter

The results of the latest Quinnipiac University poll of 1,323 self-identified registered voters gave Joe Biden a 50% to 39% lead over President Trump.  These same voters gave the President a 56% negative rating on how he was handling the COVID-19 crisis.  The poll was a phone survey and the primary question asked voters whether they would vote for Joe Biden or President Trump in November.  If you recall none of the polls taken in the 2016 election ever had Donald Trump in the lead yet our current president won all but the most liberal of states.  I don’t know who these polls contact, but they have never called me or any of my acquaintances.  I’m sure there is a liberal sampling error to all these polls because the results always lean in a liberal direction.  The media is no help with at least 96% of their reporting on the President is negative.  Despite the non-stop media criticism and the negative polls since Donald Trump first stepped on the political scene, I actually predicted (albeit quietly) that Donald Trump would win in 2016.  To me the answer was obvious; Donald Trump was speaking the language of the average American and voiced the concerns of everyone in my social circle.  Trump was calling out the dangers of China’s trade imbalance, of illegal immigration, of a defunded and disarmed military and an over-regulated business community.  Perhaps the Hollywood elitists, Silicon Valley geeks and the Ivy League snobs were happy with the status quo but working class Americans were getting the short end of the stick.  The last election brought an end to predictability thanks to the appearance of “stealth voters.”  The stealth voter will tell friends and pollsters that they will vote for whomever is running against candidate Trump.  In truth they like what Trump stands for and voted for him in 2016 and plans to vote for him again.  They won’t make their true feelings known publicly with the understanding they will suffer harassment and potential violence from those who hate Trump.  The voters who despise Donald Trump likewise despise anyone who supports our President.  Conservative voters can have friends with different points of view, but liberal voters believe conservatives (especially if you support Trump) are evil people and should be unfriended.  Even during a health crisis the Left continues to politicize every response at the federal level hoping that will increase the chances of a Democratic win in the 2020 presidential election.  The incompetence appears to have been at the state level.  The greatest number of illnesses and deaths tended to take place in “blue” states with Democratic governors.

Joe Biden is a seriously flawed candidate and even if I was a diehard Democrat I could not vote for him.  He does not have the mental capacity to handle the many domestic and foreign crises that a modern-day president faces.  Joe Biden is so fragile that he is afraid to leave his basement while our President travels around the country.  Trump is seen thanking and encouraging front line workers while Biden is sheltering in place.  That is a blessing for the Democrats because Biden is not making public gaffs and being confused as to his whereabouts.  Joe Biden can’t complete a thought without a major blunder; can you imagine him negotiating with Putin or other world leaders?  Our economy would never recover if the Democrats take over the White House and Congress.  In my view the stealth voters must come forward and save our nation from the disaster that would take place in a Biden administration.   I don’t believe in polls since Donald Trump entered onto the political stage.  Barring some disaster I fell that President Trump will be elected to a second term.