Bad News Thread

It's because of the siloed nature of our education. And so being intelligent doesn't equate to knowing, right? And so unfortunately our education is siloed between clinical management and then another silo, clinical research, and then another silo, basic science research. Very, very few clinicians out there that are practicing medicine have ever spent any significant amount of time in a basic science research lab. That's relegated to the PhDs. And so you got PhDs over here doing this, developing tests like PCR, everything else, learning what that means. You've got a group over here of clinicians that are constantly being told that they have new toolboxes of therapeutics from the pharmaceutical industry, or diagnostics from the radiology industry, or laboratory chemical analysis through Quest laboratories or whatever it is.
 
And so when Quest labs comes along and says, "We have a new PCR test to diagnose Corona virus." There's no question that, we don't have anything in our educational background that would trigger a question of is that valid? If Quest labs, which is our most trusted source of laboratory stuff in my clinic or Lab Corp or any of these big national labs comes along and says, "Hey, we have this new test." The physician automatically assumes, "Well certainly they did their due diligence to show that this test actually is clinically significant or irrelevant to my patient. Who's showing up with a question of whether or not they have this virus in their bloodstream."
 
And so that's the assumption we made not knowing what PCR even means really. So PCR means Polymerase Chain Reaction, is a methodology that was developed in genomics to be able to amplify tiny, tiny little signals or the tiniest presence of genetic information. And so with PCR, it's a very powerful way for us to determine what genetic decisions is a cell making at any given moment. And so in my lab, we can do PCR even for mitochondria that are a little microbes that live inside the human cells, and we can see what genomic decisions and what proteins they're making and all of that based on PCR.
 
And we're talking about tiny micro, micro nano particle strips of nucleotide sequences that you can pick up with PCR. And the way that you do it is you run an assay if it amplifies almost everything in the background there, and then you run it again and amplify everything, you've just amplified. And then you run it again and amplify everything you just amplified twice. And so with PCR, you can run this 150 times, and by the time you've run it a hundred times or whatever, you're finding genetic information that is maybe circulating in your mother's womb. You're down at this trace, trace level of nucleotide sequences, this might've been a bacteria that you breathed in a week ago, that's now filtered out of your system. But in the process, it happened to make some genomic information in the form of RNA that sequenced into your bloodstream for a moment. And you can pick that up by PCR.
 
So when you start to amplify and cycle and cycle PCR, it gives you a completely inaccurate look at what's actually going in your body today. And that's, the danger with starting to say, "This is a diagnostic tool." Is what you can say is, "Yeah, somebody has some symptoms of upper respiratory and stuff," or shows up with chest pain and a heart attack and you run a PCR and it says, "Oh, you have COVID-19." No, all that means is that person may have walked by somebody, their body never expressed the virus in any amount. Their body was in total balance with it, they never got sick from that virus, they're presenting with a true heart attack, but they have enough of that genomic sequence that you're now amplifying that.
 
And it's only in the last week or two that we see some of the States Governors starting to realize that they're being tricked into making emergency decision- making on this fallacy of testing. And they're starting to demand that the labs that are doing these rapid PCR tests publish with the results, how many times did you amplify that before you got a signal of that? And that's what we should have done at the beginning. And we should have set a threshold for relevance. We should have said, "If you need to amplify this more than five times, there's no way this is an active clinical infection." And so we should have set a threshold .......
 
But the fact is it's way less than 25 and 40 times, which is the typical average that you're seeing these labs run when they're doing screening for Corona virus. So the methodology is severely flawed. The reason why doctors are being deployed in masks to do this is because they don't understand the technology. They don't understand because they were never practicing that technology and they were never asked to even understand it. They just said, "The only thing that doctor needs to know is what is the CPT code? What is the insurance code? So that you can order the test and bill it to insurance." That's as far as we go as clinicians in understanding it, we don't understand how we get sodium measured in blood, but we order basic chemistry and get sodium, potassium, all the electrolytes. But none of us think about how the hell did that lab figure it out. That sodium is 135 milligrams per deciliter. We don't know, we don't care. We're data and analysis team, we are not the beta production team.
 
And so that's the danger of something like this being rolled out by something like the WHO or the CDC that says, "Oh, we have this test." And your clinician of course is like, "Well, certainly the CDC is only going to recommend a test that's clinically relevant." If it's not, there's no stop gap. There's no checks and balances in our current public health policy to allow us to make intelligent decisions about those testing.
 
So, an example of the heart attack that we just used. Somebody shows up with chest pain and you're concerned that their oxygen maybe registers at that 93% or 94% slightly below the normal bell curve. And so you're like, "Oh, I wonder if they have Corona virus and therefore they're presenting with a heart attack." And you run a COVID-19 PCR screening test that comes back positive. It totally changes your mindset as a physician. You stop thinking as a clinician, you start reacting to a data set instead of looking at your patient. And so this is a common phenomenon. It's not hard to imagine as a clinician, how we could be so misled to think, "Oh my God, our hospital is full of Corona virus patients." When in fact our hospital's full of some Corona virus patients, some pneumonia patients, some influenza patients, a bunch of heart attack patients, a bunch of cancer patients, but we keep reading it as Corona, Corona, Corona.
 
And it's led to tragic mistakes at the clinical level over and over again. Examples, just in my little sphere, I'm a part-time clinician, now I don't see patients every day, but even in my tiny little patient contact every month, I have examples of tragic mistakes that were made in the hospital systems. For example, a young woman aged 34 or five, she presented with hypoxia, weird changes in her white blood cell count, confusion, neurologic symptoms, was just out of it. And it seemed to come out of the blue. And the labs were bizarre, her white blood cell, red blood cell counts all of this. And so immediately the clinicians were like, "This must be," having never actually seen a case of COVID-19 in their clinic, they said, "This must be COVID-19." Ran a PCR and it was negative and saying, it wasn't even there. And they had heard that maybe there was a 20% false, positive, or false negative rate to the PCRs. They're like, "Well she must still have Corona virus."
 
And so they sent her to the hospital and said, "We suspect clinical, the test is negative, we think this is COVID-19." So the hospital then has to go through ridiculous measures. Everybody has to gown up, treat them like a hazmat patient. This woman now nobody can touch her, nobody can go in the room, nobody is now talking to the woman because they're all thinking COVID-19. So nobody's taking a good clinical history, which is only place you ever make an accurate diagnostic decision to treat is talk to the freaking patient, and talk to them about their last three, six months. Maybe this isn't even an acute issue.
 
Well it hadn't been an acute issue. She had been having stuttering neurologic symptoms for months. By the time she died, two weeks later, they had run 12 COVID-19 screening tests. All of them were negative, but they couldn't break themselves out of the mindset of this is a patient dying from Corona virus because she had what they had heard were the symptoms of hypoxia and weird things in the bloodstream, maybe in liver failure, ultimately kidney failure. And she dies of multi organ failure.
 
The physician was so disturbed that was in charge of her hospital case by what was going on because she had come to believe that it wasn't COVID-19. But by the time she had made that decision, the patient was non-verbal in the ICU intubated. She asked the family, in tears, "I think we have horrifically mismanaged this case, I'm asking an unusual request because the death certificate already says, 'Corona virus COVID-19,' on there. But I really believe you guys would be smart to do an autopsy to see if we've made some grave medical error."
 
dad4 said:
These days, we have enough tests to run daily covid tests for every meat packing plant worker. We also have enough masks to give every meat packing worker an N95 every day. It was an issue over the summer, but there are not enough cold room workers to pose a problem now.

Why is it so hard to visit with friends outside? You keep acting like, if your dinner party gets replaced with Mah Jong at a picnic table, then the secret police have arrived to burn your Vaclev Havel books.

Just meet people outside and show a bit of imagination.
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You’d have to get to a reliable rapid prick or saliva test. There have been lots of outbreaks in meat packing plants despite masks
 
So that is a brave physician who in the care team is saying, "I think I made a mistake." When there was this very societally accepted diagnosis and on autopsy, it turned out she had an acute leukemia that should have easily been caught by any hematologist. Had a hematologist been asked to get involved in the case. No hematologist was ever called because they thought it was an infectious disease, So these are the ways in which the narrative of a public pandemic can really screw up our clinical accuracy and acuity. And these are very smart, caring physicians. These are not people who are lazy. These are not physicians that are careless, but the narrative can be so baked into our experience that we're trying to make the square peg fit in the round hole over and over and over again, because it's the only thing that is top of mind for all of us.
 
And so that's just, I want to paint that public or that human picture of how can we all be complicit in this without being stupid? It's not that, I don't want people to think, "Doctors would have to be stupid to," no. In an intelligent fashion, we can be stuck in this trap. We can be part of the complicit to this narrative that's so inaccurate. So I think your ask was really more around, is the mortality change this year or not? And that is really fascinating because in the end all cause mortality hasn't changed at all for annually across the world, human population is still going up.
 
So this was not a pandemic that threatened human existence that changed our fertility rate that changed our population growth, anything like this, this is not plague, this is not the Spanish flu, this is nothing like that. What we can say is that there was an interesting pattern of respiratory death in some countries. In most countries, they were very predictable. Anytime you would see flu season happen, that's where you saw the increase in mortality in China to Iran, to Northern Italy, et cetera, all these hotspots around the country followed their typical trends.
 
In the United States and Canada and Australia, where we came under one control narrative. We saw some weird aberrant patterns in there because we were using PCR testing at such a high volume. And with so much trust that we painted an unusual picture of mortality from a virus that was, no viruses ever in the respiratory setting, behaved like the Corona virus did in the United States, by the narrative we're telling.
 
Grace T. said:
You’d have to get to a reliable rapid prick or saliva test. There have been lots of outbreaks in meat packing plants despite masks
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Turnaround is about a day or two now. You’ve got options.

You can even go with the full, oversensitive nasal swab PCR that IZ hates.
 
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