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Give Me the Fences

A virus is not a living organism in the traditional sense of the word. To use the term ‘live” regarding viruses is inexact but probably the best word to use. A virus is an entity because of what it does rather than a description of its molecular integrity. Apart from their detrimental effect on humans and other living organisms, they don’t do anything. Viruses cannot “live” (maintain their molecular integrity) independently for very long, cannot reproduce, and have no energy requirements. In the traditional sense, “living organisms” require energy to maintain their molecular integrity and reproduce. Because viruses have no machinery to preserve their molecular integrity or survive the elements, they do not last long out there on their own.

Viruses are bits of genetic material. They are surrounded by protein. That’s it. When they “infect” us, they enter our bodies, get into our cells, and “use” our cellular machinery to create duplicates of themselves. They duplicate themselves in large numbers; some exit our bodies and disintegrate once exposed to UV light and air. Except for the few that enter the next body, and so on.

Our body responds to the virus by developing a fever. The elevation in body temperature is an outmoded and relatively ineffective attempt at making an inhospitable environment for the little buggars. We also mount in “immune response. In this response, we create antibodies to the proteins that coat the virus. Not the genetic material. That would be impossible. Your body would end up attacking your genetic material. Thank goodness that doesn’t happen. Once your body has an idea of the existence of this protein, it can now much more quickly mount a response to the virus. You will no longer get sick when exposed to this virus. We call this “immunity.”

Vaccination is when you introduce a protein to your body that is not associated with an infectious agent. Your body doesn’t know anything except to do what it does any time a foreign protein presents within your body. It creates an immune response. If exposed to an infectious agent with that same protein, your body can mount a much faster and more robust immune response, so you do not feel sick. This quick response does not preclude you from having the virus in your body and does not preclude you from passing the virus on to the next person. Although, it does reduce the duration of time for which you are ‘infectious.”

This reduced infectious time cuts down on the spread of the disease.

Masks are effective barriers to the spread of airborne viruses. Someone who was “anti-mask” compared surgical masks to shooting a .45 caliber bullet through chicken wire. Here’s what the chicken wire would look like; A standard .45 bullet is 11.5 mm in diameter, roughly. A pore in a surgical mask is 200 to 800 times larger than a virus (they vary). The fiber in a surgical mask is 260 times larger than the virus. So if we extrapolate that to a .45 bullet, the holes in the chicken wire are 4.6 meters in diameter, and the “wires” are 3 meters in diameter.

If you had your choice, would you instead face a random shooter behind two fences or no fences? I will take the fences.

But let’s extrapolate this to reality. The virus will not “live “long outside of a body and does not travel in a straight line. Also, it is surrounded by a droplet as it flies through the air. This makes it much larger than the size of the virus alone. Likewise, it has no “intentions” like a shooter might. Yes, you can still get a virus when you are both wearing a mask, but you reduce the risk just as you reduce the risk of being hit by a stray .45 bullet when behind two 3-meter diameter chicken wire fences.

To say, “You can still get COVID while wearing a mask,” is a true statement. There is no opposing argument to that in existence. The opposing view (you can never get COVID when wearing a mask) is implied by the propagandist. A scientist telling you the truth will tell you that you reduce your risk of catching and spreading COVID when you wear a mask. The propagandist wants you not to wear masks and believe them ineffective. You only need to question, “What’s in it for them?” Who is behind it?

Three sources come to mind. One is when you follow the money trail; who profits when we don’t protect ourselves from COVID? For one, the vaccine manufacturers. Let’s face it, as long as we keep spreading COVID; they are not going out of business. Compare this to smallpox vaccine makers. They are out of business.

Another “trail” would be political. Our enemies would not mind if we all died, were too sick, or were mired in too much propaganda to fight.

How about just good old, “I want to be right at all costs?” The anti-vaxxers that have been around since before COVID don’t want to be proven wrong.

We “dumb” doctors wear masks to protect ourselves and our patients, and we have done so before COVID and will do so after COVID. We don’t fall prey to propagandists because we know what questions to ask. Nobody had to explain the pore size to me to understand how masks work. The “pore size” experts came out of the woodwork during COVID faster than the “how hot jet fuel burns and the melting properties of industrial steel” experts after 9/11.

Coronavirus: Don’t Worry About the Test

A word about medical tests. In light of the coronavirus pandemic, you have probably seen me on Facebook telling people not to worry about getting the test. Clearly, I must be mad. Clearly this must be some kind of evil plan to capitalize off of sick people. Let me explain myself.

It is not uncommon for the lay public to think a medical test will have one of two outcomes; the patient has the disease and the test indicates they have the disease or the patient does not have the disease and the test indicates that the patient does not have the disease. In an ideal world, all medical tests would be that good. But guess what? There’s not a single medical test on the planet that does this. Not a single one.

In fact, a medical test is going to have one of four outcomes not two. Here are the four possible outcomes: Either

1)  The person has the disease and the test indicates that the person has the disease.

2) The patient has the disease, but the test indicates that they do not. This is a false negative.

3) The patient does not have the disease and the test indicates that the patient does not have the disease. Or,

4)  The patient does not have the disease, but the test indicates that the patient does. This is a false positive.

Every single test that we have at our disposal in medicine has false negatives and false positives. As a practitioner of medicine I have to know the characteristics of the test that I am using. But let’s back up a second. How would I know the test for disease is giving false results? I  need a second “More accurate” test to determine that the disease is actually present in those for whom my test is falsely negative. This second test acts as a gold standard to which the first is compared.

Here’s an example. Let’s talk about pneumonia. If you come in to see me and you tell me that you’re coughing, you have a fever, and you’re getting green mucus. Then, I listen to your lungs and I hear abnormal sounds in one area of your lungs. I could diagnose you with pneumonia. But, “wait a second” you’re saying. “Don’t I need a chest x-ray?” Well the answer to that is “no”…unless I think that there is an alternative diagnosis that has to be ruled in or out. Or maybe I just want to be extra sure because of the implications of the treatment that I will be prescribing. So let’s say you do get that x-ray and it shows pneumonia in the place where I already knew you had pneumonia. That would be the gold standard for pneumonia. I don’t need to apply the gold standard to everybody with pneumonia because literally millions of such X-Rays have confirmed this clinical presentation time and time again.

With that in mind let’s move forward. So we use a gold standard to determine what we called the sensitivity and the specificity of a test. Sometimes that gold standard is something as simple as a chest x-ray… Historically the gold standard was the autopsy. Now the autopsy won’t always tell you what somebody had but it will definitely always give you the prognosis 100% of the time. In fact, the autopsy is the only test in medicine that has 100% of anything and that is its prognostic value. After an autopsy no matter what I find… Your prognosis is that you’re dead. That you were dead was generally an assumption, within acceptable accuracy standards, made before the autopsy…but is without a doubt 100% certain afterwards.

But I digress. So any test is going to have true positives true negatives false positives and false negatives. And we will determine this by measuring against a gold standard.  Sensitivity is the measure of how well the test detects the disease in the presence of the disease. Specificity is how well it detects the absence of disease in the true absence of disease.   Us medical people go to school a long time to understand this concept and its application to all the tests we do in medicine. See…we’re not just people who wear white coats and don’t do what you want.

The coronavirus test has about a 30% false negative rate. What that means is if you get a coronavirus test that comes back negative there’s still a 30% chance that you have coronavirus. Needless to say, that’s pretty useless information isn’t it? If you have a positive coronavirus test, then you most definitely have the disease. So if you get a coronavirus test that has a 30% false negative, what can you do with the results? If it comes back positive you can quarantine yourself. If it comes back negative… You’re going to quarantine yourself. If you don’t get a test at all… You’re going to quarantine yourself. So clearly for patients who do not need mechanical ventilation, there’s truly no benefit to the test.

Now, what about the people who do need to be hospitalized with coronavirus. Same situation; if I do the test and  its positive, then you definitely have coronavirus. If I do the test and it’s negative, there is still a 30% chance that you have coronavirus. The treatment will not change one bit. You’re still going to get mechanical ventilation. You still might get hydroxychloroquine and azithromycin. But the test is completely unnecessary in this scenario…and, quite frankly, takes too much time to be relied upon to decide to initiate any therapy.

Now the forthcoming antibody test? That I think has tremendous value for you as an individual. If you test positive for antibodies to coronavirus you are definitely safer out there in the world than you were if you don’t have antibodies to coronavirus. That’s an actual useful test that will have impact on you.

The coronavirus test itself is not that useful for you as an individual. It’s incredibly useful as a surveillance tool and epidemiological tool. I’ve heard friends tell me that they’ve been exposed to somebody and their work won’t allow them to come back until that person’s test comes back negative. This employer doesn’t understand the test. My assumption would be that they’re trying to prevent the spread of coronavirus but their methodology is horribly flawed and is going to ultimately yield the opposite result. So if they have restrictions on who can come to work they need to base it on something else. Most places base it on whether or not you’re symptomatic. Now of course we all know that that’s not perfect, that plenty of asymptomatic people have the disease and can spread it. But there’s literally no way other than shutting down completely to prevent that. And guess what most businesses are doing… They’re shutting down.

In summation… Don’t worry about the coronavirus test. it’s not going to change much for you if anything.  When the antibody test is available, get it.  Stay home, stay safe. Protect your healthcare workers by staying home.  Come to the ER if you have an emergency situation, but simple cold symptoms (cough, fever, aches) can all be taken care of at home the exact same way we will take care of it in the ER: Tylenol, fluids, rest.  Try a tele-medicine service. This is as good a time as any to try this out.

Disclaimer: The opinions stated herein are my own and not representative of any organizations to which I belong.

The Franklin Effect

I have discovered an interesting phenomenon.  when asked, most health care professionals state they have a desire to have something important named after them.  I have named this, “The Franklin Effect.”  It is quite prevalent.  I had been in the process of claiming the secondary name for a Mobitz II arrhythmia, with Wenkebach having claimed the Mobitz I.  What I found was that many others had also lobbied for the naming rights.  It turns out, many had even offered up money.  Let’s just say that it was too rich for my pocketbook, but it gave me the idea that apparently I wasn’t the first to try to get so cheaply recognized for something I had nothing to do with.  It was this idea that led me to the work that ultimately revealed that the Franklin Effect is quite real and quite prevalent amongst many whom have never discovered anything important.

I have now also decided to name my short educational videos after this.  I will be launching periodical (period defined by how much free time I have) videos on core content and special topics and posting them under the Franklin Effect title.  I felt it important to remind you all of what the Franklin Effect actually is.