—Ebola update:  Short again.  The WHO is late with a situation report, but as near as I can tell from other sources there appears to be 1 new case in the last week.  Again, low trickle is likely to continue for a bit, and no one will pay attention because coronavirus is all.

Speaking of coronavirus though…

—I’m going to include parts of the update to our lab this week, as Indiana is one of the many states to at least partially re-open (only big difference I have noticed so far is a LOT more trucks on the road):

—Since we went live, and have been on the grind (including both of the closed pork plants and various forms of prevalence and test method studies), we have issued close to if not over 45,000 reports.  At least, that’s how many I know I have reviewed.  That’s about 40% of the total number of tests reported in the state of Indiana, and on any given day, we are 40-50% of the volume.

—Over the last couple weeks, the Tyson pork plant aside, the number of positives have been dropping.  Our current average is 10-15% which is down from a peak of 18-20%.

—Like many states on the downslope, Indiana is starting to re-open.  There will be new cases from this.  I would encourage you all to continue precautions like handwashing, social distancing, even masks when out and about.  I am confident the Ro is below 1 right now; let’s please do our part to keep it that way.  I will expect that some towns/cities/counties/states re-opening will have enough cases in a few weeks to re-impose some type of quarantine again.  Where those will be is impossible to predict right now, although, as you have seen on the news, some of the “hotter” parts of the state have a slightly delayed re-opening schedule (Lake, Marion and Cass counties in particular).  But mini-flares requiring re-quarantine has happened to China, Singapore and Japan at least already, and will come to the US in some form as well.

—The virus will re-ignite those small battles; it is unequivocally losing the war.  

—Will there be a second wave later this fall?

I dunno.  Maybe?  If I could see the future, I wouldn’t buy lottery tickets.

Plural.

I would buy one lottery ticket.  One is all I would need.

Sadly, I cannot see the future like that.  It’s possible that local flare-ups reignite into a broad and significant second wave.  

Arguing against a broad second wave is the SARS outbreak of 2002-2003 and MERS, both coronaviruses, neither of which had a second wave similar to the Spanish flu pandemic that is the most common news media comparison for SARS-CoV-2.  The only follow on outbreaks of SARS were accidental lab releases or late infections that were not recognized quickly enough, but were small and local.

—So brief word on news media comparison of SARS-CoV-2 to Spanish flu.  The Spanish flu hit the US in three waves between 1918-1919.  The first wave hit in approximately March, and was highly contagious but not especially deadly.  The second wave was a mutation of the first wave, and was 10 times more lethal.  There were plenty of patients who got the flu in the first wave who got it again in the second wave, but were less likely to die due to partial immunity.

But, and this is an important but, that was influenza.  Influenza and coronavirus are not the same animal, even though they cause similar symptoms.  The coronavirus RNA genome is large and in one piece.  SARS-CoV-2 is picking up occasional mutations along the way, but is not especially rapidly mutating for an RNA virus.   There is an excellent pre-publication paper here (https://www.sciencedirect.com/science/article/pii/S1567134820301829?via%3Dihub) on the mutations seen thus far in SARS-CoV-2.  Among the more interesting findings is that most cases in the US came in by way of New York, and there is an East Coast and West Coast predominant strain. Hopefully, they do the -right- thing and call one Biggie and the other Pac.  The East Coast strain, when it arrives, quickly dominates infections, but there is no evidence of a clinical difference between the two just yet.  

The Spanish flu, on the other hand, was an influenza A strain.  Influenza A is also an RNA virus, but has its genome in 8 separate segments.

Influenza is one of the most prolifically mutating viruses known to man.  This is why there is a different vaccine for it every year, while most other viruses need only one vaccine shot with an occasional booster however many years later.  Influenza mutates by “shift and drift.”  Shift is where influenza plays mix and match with its segmented genome, similar to genetic recombination in eukaryotes.  The big antigenic leaps this creates cause pandemic flu, and is how Spanish flu was born.  For the second wave, Spanish flu “drifted”—its very error prone replication hit some magic missense mutations, which, coupled with WW1 trench warfare, selected for a really deadly version of itself.

We fear Ebola for the sheer mortality rate.  We worry about SARS-CoV-2 for its hospitalization rate and infectivity.  The most terrifying virus out there, bar none?  Influenza.  Precisely because it is a highly infectious shape shifter.

To the best of my knowledge, and the currently available data, coronavirus does NOT mutate the way influenza mutates.  So there are arguments against a possible second wave.

On the other hand, neither SARS nor MERS ever got out as far and as fast as SARS-CoV-2.  We are a little off the edge of the map, and here there could be a monster.

So, prudently, we will keep the testing capacity ready just in case and not get too complacent with hand washing and other infection control measures into the fall.  In the meantime, when watching or reading the news, remember that flu is not coronavirus and coronavirus is not the flu.

—Lastly, and this will be a somewhat involved section, apparently “Shark Week” is off the table and we’ve moved into “Conspiracy Theory Week”.

It’s a fun week, don’t get me wrong.  

Between my phone blowing up last evening from friends and family and a few of the scientists and technicians at work who grabbed me the moment I walked in the door to ask if I have seen “Plandemic”, or at least the 25 minute interview portion with Dr. Judy Mikovitz, it’s clear I should probably take a few minutes to address it.

Lunch today was the first time I have seen the 25 minute section in question.  I will go in approximate order of that video as things strike me, with a 5 minute Google search limit for anything I can find for or against claims made in the video.  I’m not going to link the video because YouTube keeps yanking copies of it (will cover that at the end).  Again, all opinions are my own.

First, the video is very professionally produced.  Good spliced YouTube videos and news clips, ominous music in the right places.  Dr. Judy Mikovitz is calm, collected, and matter of fact throughout, which is important, because she sounds credible. Despite a name like “Plandemic” this isn’t obviously:

So if you don’t have the background in what she’s talking about, yeah, I can totally see how she’s convincing.

Fortunately, I’ve got a bit of a background here.

As we begin, Dr. Mikovitz gets my attention when the interviewer immediately starts out by addressing the “character questions”—an apparent elephant in the room.   Dr. Mikovitz claims this was a conspiracy against her over much of her career, culminating in an arrest for “fleeing prosecution.”

You can find contemporary reports from these incidents in 2011 with a quick Google search (the Chicago Tribune in particular covered with a few articles).  Dr. Mikovitz was charged in 2011 by the state of Nevada for stealing lab notebooks, computers and data from her employer at the time, WPI.  Specifically, the charges in the issued arrest warrant were NOT “fleeing prosecution” but felony possession of stolen property and essentially felony theft of the same.  She states at a point a few minutes later in the video that the officers who came to her house searched it “without a warrant.”  One minute of Google search later, since the state of Nevada had an arrest warrant already, “search incident to arrest” is absolutely legal and does not run afoul of the fourth amendment (but please check with an attorney; I am not one).  Since they were arresting her in her house, and for possession of stolen property, they have a right to search the house and anything “in plain sight” that is stolen property is legally discoverable and admissible, even without a separate search warrant.  The same Google search that found the actual charges against Dr. Mikovitz also turn up that WPI won the civil case against her, and that is where the gag order she mentions comes from.  That was in summary judgment, when she never showed up to court with her “90+ witnesses.”  WPI also expressed its disappointment that the state of Nevada dropped charges against Dr. Mikovitz, after a lab assistant admitted to removing the materials to a relative’s house at Dr. Mikovitz’s direction.

This is somewhat contrary to Dr. Mikovitz’s claims in the video that the police planted stolen material in her house to frame her.

Dr. Mikovitz and the interviewer allude that this persecution of Dr. Mikovitz relates to a “controversial” paper she published in Science that, according to their statements in the video, showed “viruses were responsible for a lot of chronic inflammatory diseases.”

The controversial paper is, indeed, controversial.  Dr. Mikovitz et al. claimed that XMRV virus was the cause of chronic fatigue syndrome (CFS), a constellation of symptoms linked by debilitating chronic fatigue (no, you probably don’t have it, even if you feel tired a lot—it’s very rare.  But of course talk to your medical professional if you have a concern, especially if you Dr. Google it).  Note this is one virus, causing one disorder, now believed to be an autoimmune disease.  And not multiple viruses causing lots of chronic inflammatory diseases, which is what the Plandemic interview stated.

I am beginning to suspect they are prone to hyperbole.  We’ll see how that develops…

Anyways, what was controversial was that independent research groups could not replicate Dr. Mikovitz’s findings.  They did find contamination of some plasmids used in her studies with XMRV though.  When it was shown that Dr. Mikovitz’s lab could not reliably detect XMRV in blood samples as was the original basis for her Science paper, the journal retracted the article.  You can find more detail here, but because of the viral video we are discussing, this website keeps getting crashed by everyone looking up the retraction of this study:  www.retractionwatch.com/category/by-author/judy_mikovits

Per contemporary reporting, WPI and Dr. Mikovitz were wrangling over IP around XMRV and CFS up to that point.  That inconvenient fact appears to be a cutting room casualty of Plandemic, as it is not mentioned in the interview—even when she will shortly turn to making IP allegations about other doctors in the news.  Per news reports, WPI ultimately fired her for concerns about the integrity of her work (and alleged theft), and she has since gone on to be an author of a book on viruses and vaccines.

So now Dr. Mikovitz turns to allege that powers that be, including Dr. Anthony Fauci, suppressed a key paper on HIV that she was writing decades ago.  Honestly, who knows?  That’s he said/she said at this point as to who was first to submit to a journal.  But she alleges that Dr. Redfield and Dr. Fauci, among others, conspired to present the HIV epidemic in a way that would favor patents they were authoring on it.

Again, 5 minutes on Google and the USPTO web site, and Dr. Redfield’s only HIV patent is a therapeutic method of use that is owned by the University of Maryland filed in 2000 that does not, to me, seem to be especially commercially valuable for the treatment of HIV.  Regardless, 2000 is well after the events Dr. Mikovitz is alleging.  Dr. Fauci does indeed hold patents for IL-2 as a supplement to several named treatments that comprise HAART, the mainstay of anti-HIV treatment.  All are controlled by the Department of Health and Human Services, and the earliest was filed in 1995.  Dr. Fauci did not publish on the use of IL-2 with HAART until 1999.  However, the effectiveness of HAART had been recognized as early as 1996 as the major driver for the reduction in HIV mortality, and was not in any way delayed by anything Dr. Fauci was doing with IL-2 (https://www.ncbi.nlm.nih.gov/pubmed/?term=9516219 if you want the 1996 effectiveness of HAART paper). 

My understanding is that HIV jumped to humans from the closely related SIV that affects great apes—in Africa.  It is unclear how, as Dr. Mikovitz alleges in the video, earlier publication of its identification in French saliva samples would have spared Africa of its spread in the early 80s.  Or what the HIV related patents of Drs. Fauci and Redfield, filed decades later, have to do with that either.

For what it’s worth, Drs. Redfield and Fauci have never been listed as inventors on the same patent anywhere that I can find.  I may have been looking in the wrong place though.

But NOW we get some pretty impressive claims from this Plandemic video:

“There is no effective vaccine against a RNA virus.”
–Dr. Judy Mikovitz, viral disease expert for “Plandemic”

I’ll bite!  First four RNA viruses off the top of my head with a vaccine against them.  Oooo… It’s like playing “Family Feud”…  Alright…. Show me Hepatitis A!

Good answer!  Good answer!  But not the top answer….  Alright, I’ll go with…. Mumps!  (also an RNA virus)

“Before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year, but the actual number of cases was likely much higher due to underreporting. Since the two-MMR dose vaccination program was introduced in 1989, U.S. mumps cases decreased more than 99%, with only a few hundred cases reported most years.” 
–Centers for Disease Control Data

Not even a cool chart or map for mumps?  That’s gotta just barely ding onto the list above Steve Harvey.   Okay… how about… rubella (german measles) (also an RNA virus—first vaccinated in 1971)!  Is rubella on the list?!?!?!

Good answer!  Good answer! Cool charts again.  Okay, one more try here.  Show me…..  Measles! (that’s right—all three parts of the MMR vaccine, measles,  mumps and rubella, are RNA viruses)

Looks like a clean sweep.  Those are pretty big differences in case burden from those RNA viruses before and after vaccination.  In fact, with the measles chart, you can even see the black bars go down as the blue line (% of the world vaccinated) goes up.

I’m going to agree to disagree with Dr. Mikovitz that “no effective vaccines” to RNA viruses exist.

Dr. Mikovitz claims that there is enormous amounts of money in vaccines.  Merck makes the MMR vaccine (and many others).  And indeed, per their 2019 annual filing, they do really good business with vaccines.  But their top two products by revenue are Keytruda (oncology) and Januvia (diabetes).  Keytruda alone outsells Merck’s entire vaccine portfolio.  And MMR isn’t Merck’s top seller.  Gardasil, the HPV vaccine, does 50% more by revenue.  Again, that’s three minutes of Google to the Merck investor relations site and a scan of their annual report.

“It would take 800 years.”–Dr. Mikovitz, on possibility of natural evolution of SARS-CoV-2 from other closely related coronaviruses

As we mentioned in an earlier update, SARS (spontaneously evolved from animal coronaviruses) led to MERS about 10 years later, and about 10 years after that we have SARS-CoV-2.  Does not appear to take 800 years, and in fact, a natural cycle of around 10 looks like it may be establishing a pattern.  In addition, Dr. Mikovitz is going to later make a claim about how ubiquitous various coronaviruses are in all kinds of animals.  Each of those is a chance for independent evolution towards that host, and all of that variation is a very fertile ground for natural selection and emergence of other cousins like SARS-CoV-2.  Remember this paper from up above (https://www.biorxiv.org/content/10.1101/2020.04.29.069054v1) that shows SARS-CoV-2 is adapting at a typical pace for an RNA virus and already has East Coast/West Coast Biggie/Pac strains a few dominant strains.  That paper also clearly shows genetic evidence for origin in China, where less overall diversity is present—contrary to a later unsubstantiated claim Dr. Mikovitz is going to make about coronaviruses in one particular quadrivalent flu vaccine sent to Italy as the “reason Italy got hit by coronavirus.”

“Ebola couldn’t infect human cells until we took it into the lab and taught it.”
–Dr. Mikovitz, viral disease expert for Plandemic, describing her work in 1999 at USAMRIID, essentially claiming that she was part of a program that turned Ebola into a human pathogen.

The first time Ebola was identified and speciated was an outbreak of its associated hemorrhagic fever in humans in Zaire. 

In 1976.

Guess her interviewer didn’t know that to push back a bit there?

Apparently, Dr. Mikovitz not only made Ebola able to infect human cells in 1999, she was part of a program that made the virus able to travel across time and space to cause significant human disease outbreaks 23 years before she “taught” it to infect human cells.

Remarkable. 

For the record, since then, every Ebola outbreak has been traced effectively to exposure to known virus reservoirs of bushmeat or migratory fruit bats.  There are also two vaccines for Ebola being deployed against the current ongoing outbreak in the Democratic Republic of the Congo.

“Doctors are being pressured to put COVID on a death certificate.”–Dr. Mikovitz

Speaking as a pathologist, and having filled out many death certificates because of the autopsies us pathologists do, let me give you a brief primer on how to fill out a death certificate.  The immediate cause of death is that which most proximally killed the patient.  There are a few lines between that and the underlying cause of death, which is what started the entire process.  So, for example, if you get shot and paralyzed by the bullet, but live for another ten years, only to develop a bed sore that gets infected, and you go septic and die from septic shock, here is what your death certificate looks like: 

Immediate Cause of Death:  Sepsis
Due to:  Bed sore
Due to:  Paralysis
(due to) Underlying Cause of Death:  Gunshot wound

For the record, the manner of death in that circumstance is homicide (unless you shot yourself) and the police can and absolutely will find the guy who shot you to charge him with your murder now.  There’s no statute of limitations.

So how might this look with SARS-CoV-2 in a patient with diabetes (a high risk category) who caught SARS-CoV-2, and developed diabetic ketoacidosis (DKA, which can be triggered by infection in diabetics)?

Immediate Cause of Death:  Diabetic ketoacidosis

Due to:  COVID-19
(due to) Underlying Cause of Death:  Diabetes

There is also typically a section for “contributory” conditions, and you can arguably write that same death certificate this way:

Immediate cause of death:  DKA
Underlying cause of death:  Diabetes
Contributing conditions:  COVID-19

Does that count as a probable or possible death due to COVID-19?  I wouldn’t argue if the epidemiologists did that.  The virus was there and at least possibly responsible for triggering the fatal DKA.  Do I get paid as a pathologist for putting that?

Nope!  Autopsy reimburses the same no matter the cause.

Now, did Medicare make an adjustment to pay up $13,000 for an uncomplicated hospitalization of COVID-19 patient? 

Yes!  As a matter of fact, Medicare did.  You can read about it here: https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

Couple important things to note.  That goes to the facility (not the doctor!) as a lump sum.  That’s all the hospital is getting from Medicare for the patient, and the cost of providing care comes out of that.  It’s not a bonus on top of the regular bill.  The reason for the up reimbursement was because SARS-CoV-2 patients are staying in the hospital and on vents longer than usual for the “regular” pneumonia lump sum code this replaces, and thus costing more.  That was, no joke, causing hospitals to nearly close:  https://www.fiercehealthcare.com/hospitals-health-systems/fah-warns-hospital-closures-loom-if-feds-don-t-distribute-more-cash-to  It’s also to make up for all of the other health care, like elective surgery, that is NOT going on while the hospital has so many COVID-19 cases.

If there is a conspiracy to bribe us MDs to go against our Hippocratic oath (as Dr. Mikovitz alleges), and part of that is these fantastic cash money COVID bonuses, a huge chunk of us are clearly doing it wrong:
https://www.businessinsider.com/doctors-see-furloughs-pay-cuts-coronavirus-hospitals-survey-2020-4

Anecdotally, I know pathologists who have burned through all their PTO for the year as elective surgery heavy facilities they cover were shut down and they were basically furloughed. I know other doctors in other specialties who have taken similar hits.

Plandemic, at least in this interview, makes no suggestion of how the rest of the world is being bribed to inflate the cases of SARS-CoV-2 (seeing as Medicare doesn’t pay anyone in China, or Japan, or Singapore, or Italy or etc.).

“Italy got hit hard by COVID . . . because they received an untested quadrivalent flu vaccine grown in dogs, and dogs have lots of coronaviruses.”
–Dr. Mikovitz, viral disease expert, Plandemic

The quadrivalent flu vaccine grown in cultured dog cells is the Flucelvax vaccine.  52 lots were also approved for use by the FDA this past fall, and distributed in the US.  If you have a severe egg allergy, and you got the flu shot, this is what you got.  Of course it covered the H1N1 pandemic flu A—because we didn’t want a flu pandemic, Dr. Mikovitz!  This was the third most common flu vaccine in the US by number of lots approved by the FDA.  Setting aside easily answered questions about Flucelvax manufacturing quality control, I guess all those cruise ship passengers had just gotten their egg-free flu vaccine when they came down with SARS-CoV-2?  Not sure why, if a contaminated flu vaccine was the cause, the genetic data in the paper I linked above doesn’t appear to show that, but instead shows a clear spread from China which we all saw pretty much real time starting this past December?

I’m going to agree to disagree with Dr. Mikovitz on this one too.

Then Dr. Mikovitz starts talking about hydroxychloroquine. 

Hydroxychloroquine has been effective in stopping coronavirus replication in vitro.  Studies in humans through the outbreak have been generally small and of mixed results.  Frankly, I don’t know if it works or not.  I know there are some who swear by it.  I know some of the larger studies have shown no significant effect.  Regardless, contrary to Dr. Mikovitz’s shocking claim, the AMA is NOT threatening to pull my license if I were to prescribe hydroxychloroquine.  The AMA is NOT a licensing body, and has no authority over my medical license whatsoever.   I am not a member of the AMA—it’s a lobbying organization.

I, like every physician, am licensed by the state(s) in which I practice.

Next, contrary to Dr. Mikovitz’s claims, just because a drug is generic doesn’t mean you can’t make serious bank off it.  Teva Pharmaceuticals is the major generic producer of hydroxychloroquine.  Shares of Teva finished up 10% today on a beat on revenue.  Their CEO stated in the earnings call that this was due to “greater demand in our major markets for generic and OTC products and respiratory products.”  I know at least one big pharmaceutical company pulling real hard for hydroxychloroquine to prove it in the clinic…

Then Dr. Mikovitz alleges that a DoD study published last year shows that the flu vaccine “makes you more susceptible to coronaviruses.”  Here’s the study in question:

This is a study of vaccine interference.  Specifically, the authors wanted to see if the flu vaccine was also inhibiting infection with other viruses.  As you can see from that table above, the influenza vaccine reduces the chance of catching any influenza (warm up the Nobel Prize committee, I know).  It does nothing to prevent infection by any of the other viruses listed (except -maybe- parainfluenza and RSV).  But I doubt they adjusted p-values for multiplicity of testing.  And yes, patients who got the vaccine got a coronavirus more frequently.  But this study is not designed to, and cannot, prove a claim that the flu vaccine increases susceptibility to other viruses.  You have too many confounders.  For example, people who got the flu vaccine are going to include people who, for one reason or another, believe themselves at higher risk for respiratory infection.  Turns out, some of them might be right!  Or are exposed to more respiratory viruses in general.  For example, nurses and doctors are often required to get flu vaccines every year to avoid spreading flu to patients they are treating.  They are exposed to more viruses in general, and if the flu vaccine was not cross protective, you would expect a higher rate of infection among health care workers versus people who don’t get exposed as often and didn’t get the vaccine.  Dr. Mikovitz is extrapolating way too much from this study, and is not challenged on that by her interviewer.

“If you are wearing a mask . . . you are getting sick from your own virus, and reactivated expressions of coronavirus.”
­–Dr. Mikovitz, viral disease expert, Plandemic

I say this as someone who is not wearing a mask when they don’t make me—extraordinary claims require extraordinary proof.  And that, Dr. Mikovitz, is an extraordinary claim.

Masks have been proven in clinical studies (mostly on the flu and in health care settings) to reduce the risk of contracting and transmitting respiratory infection, most commonly in health care settings.  The next time you get surgery, do you want your surgeon to be wearing a mask during the procedure?

Now, I know that Dr. Mikovitz makes a very heartfelt appeal for me to forgive myself as a physician for learning wrong things, and being taught incorrect facts because truth tellers like her have been suppressed by the Man, but, and this is going to sound a little crazy…

…I’m just not convinced by this video that I need to.  Do I know where COVID is going?  No.  Do I think it is the second coming of the Black Death?  Not even close.  Can it cause a big problem by taking up way more beds than available at hospitals?  Absolutely.  And that’s why we are doing what we are doing.  I don’t know where CFR will ultimately fall.  We don’t have a good sense of prevalence and really, a great antibody test is the best hope for that.  But my God, was this risible.

In summary, and purely my opinion, here’s my response to this Plandemic interview:
https://www.youtube.com/watch?v=5hfYJsQAhl0

But Youtube is pulling this Plandemic video down left and right!  They’re suppressing the truth man!

YouTube shouldn’t—but not because this is anything CLOSE to truth.  You don’t stop dumb speech by censoring it.  You stop it with better ideas.  It’s like a lot of these social media platforms have never heard of the Streisand Effect, and how censorship only draws attention. 

Sure, a lie can make it all the way around the world before truth gets its boots on, as the old saying goes.  But call me a hopeless romantic, the truth is still obligated to run the race.  And in the end, truth will make itself known.

Alright, real quick, the other conspiracy theory du jour was the computational biologist in Pittsburgh working on coronavirus who died in a murder suicide this week.  First, I’m not sure what big breakthrough they were near on coronavirus that would cause someone to put a hit out.  Second, most hits are not murder-suicides.  Maybe a murder that looks like a suicide, but it’s a rare hitman who turns around and immediately offs themselves too as happened in Pittsburgh.  So, I say this as someone who, based on the forensic autopsy evidence available in the public record, is 99% convinced Jeffrey Epstein did not kill himself, that some combination of drugs, money and/or sex are much more likely than this computational biologist getting clipped as a man who knows too much.  Let the investigation play out a bit.

But if you want something wild that appears to be true, here’s an interview with the very accomplished Navy pilot involved in one of three videos that the Pentagon quietly declassified and verified as true while everyone was watching coronavirus:
https://www.youtube.com/watch?v=Eco2s3-0zsQ

He’ll walk you through all three so you know exactly what was going on and exactly what is on those videos.  That one is absolutely worth the time.
Your chances of catching Ebola are equivalent to the odds it traveled through space and time to infect Zaire in 1976 after learning to infect human cells in 1999.

Your chances of catching coronavirus are:

<Paladin>