The Case of the Presidential Virus

The President of the United States is sick, afflicted with a case of COVID-19.

Or he was sick, if his macho, mask-removin’, chest-thumpin’, helicopter-salutin’ return to the White House on Monday evening is to be believed. He saluted the chopper that dropped him on his well-groomed lawn for almost as long as a now-famous house-fly hung out on Mike Pence’s closely-cropped hair on Wednesday night during the vice-presidential debate.

The fly was a Democratic spy, some have said — sent by operatives to divine what, if anything, was going on in the Vice-President’s head. I doubt that’s true: deploying robotic intelligence-gathering houseflies seems well outside the Dems’ skill-set. Consider that after regarding “devil-incarnate” Trump for years with horror and disgust, the best the Democrats could produce as opposition standard-bearer was the affable but doddering Joe Biden.

The fly, I suspect, in keeping with the tenor of the times (even insects aren’t immune), was simply making a statement: Black Flies Matter.

Perhaps the conspiracy theorists are correct: perhaps Donald Trump was never actually sick — that it was all a diabolical political ploy on the part of the president to stick-handle his way to re-election. Americans, it must be said, are remarkably susceptible to conspiracy theories: 9/11 never happened; the moon landing was a hoax; the earth is actually flat; Elvis is alive and working as a groundskeeper at Graceland; the government dumped toxic chemicals in the drinking water to turn Americans — and all of the frogs — gay (thanks for that one, Alex Jones… anything’s possible, I guess).

“Don’t be afraid of COVID,” the President declared upon leaving Walter Reed National Military Medical Center after a three-night stay. “Don’t let it dominate your life.”

That message surely fell flat with the grieving families of the roughly 210,000 Americans who have died due to COVID this year. The virus didn’t dominate their lives — it took them.

It appears that Mr. Trump is unacquainted with the wise and timeless words of Elie Wiesel: “To forget the dead would be akin to killing them a second time.”

Legions of American voters will vote for Mr. Trump in November despite his many foibles and imperfections, so profoundly worried are they by the prospect of a Biden presidency; but this sort of behavior on the part of the President serves only to swing the door to the Oval Office wider for Joe Biden.

Much was made of Donald Trump’s age and weight when the news broke of his positive test, as if the man already had one foot in the grave. Lost amidst the hysterical reporting was that the chance of surviving a COVID infection in his age group is significantly higher than 80 per cent — particularly now that dexamethasone, the steroid taken by the President, has been shown to have such significant therapeutic effect.

For the President to ascribe his recovery to the unproven monoclonal antibody supplied by Regeneron and proclaim that he will make that “miracle drug” available free to anyone is on par with his previous uninformed musings about hydroxychloroquine. The odds are high that he would have survived without any treatment whatsoever; and the one medicine he received that is proven to make a difference is the steroid, not the monoclonal antibody.

For the sake of this essay, let’s take the news of the President’s illness at face value: that he has — or had — a case of COVID-19. (If indeed he has recovered, he did so — miracle of miracles — without imbibing hydroxychloroquine, bleach, or sunlight.)

The concept of a “case” first penetrated my consciousness when I encountered the daring escapades of Frank and Joe Hardy as a fresh-faced six-year-old. The Ghost at Skeleton Rock. Footprints under the Window. The Mystery at Devil’s Paw. The Clue of the Screeching Owl… fifty-six titles in total, all of which I read multiple times. (I was a bookworm before I was born: those weren’t hiccups or kicks my expectant mother felt — it was me turning pages.)

Every Hardy Boys book revolved around a case to be cracked — clues to be deciphered and villains to be caught. The boys’ batting average was 100 per cent, naturally. Every story ended with the bad guys behind bars: case closed.

The Hardy boys receded into my rear-view mirror as I grew older. I landed in veterinary school at the age of twenty, whereupon I encountered anew the concept of “cases”, this time in the context of animal disease.

Confronted with a stallion with colic, for instance, I was trained to “crack the case” by divining the cause of his equine belly-ache: twisted bowel, worm infestation, food impaction, bleeding ulcer, or simple indigestion. Diagnosis in hand, I’d administer treatment, and in most cases the horse would survive (my batting average got better with practice, I assure you): case closed.

After some years in veterinary practice I wandered off to medical school, where it was more of the same (albeit of the two-legged variety, where the stakes are arguably a bit higher). I learned to tackle cases of all sorts: appendicitis, pneumonia, fractures, meningitis, septic shock, and so on.

A “case” in the medical business, just as in the Hardy boys’ detective work, represents a problem to solve — a disease (“dis-ease”) to be remedied.

Hence the main thrust of this piece: a case is NOT simply a positive test. Which is why it drives me somewhat bonkers to listen to daily recitations of COVID “cases”.

Yesterday’s tally in my province of Alberta, according to Medical Officer of Health Dr. Deena Hinshaw was 277 “new cases”. That means, indisputably, that 277 people who presented for testing tested positive for COVID.

But does it follow that an additional 277 people are significantly unwell from COVID-19? Does it mean they will end up in hospital? Does it mean they will die?

To reiterate: positive tests are not cases.

It’s true that people are more likely present for testing if they have symptoms; but we also know that roughly 40% of those infected with COVID-19 remain free of symptoms, that the majority of the remainder suffer only mild symptoms, and that children in particular are rarely affected at all.

We are gravely informed every day by Medical Officers of Health across the country that “case numbers” are higher than they’ve ever been; that the dreaded “second wave” is upon us.

Shunted aside is the fact that we’re doing far more testing than we did in the spring.

Shunted aside is the fact that it is a far younger cohort of people who are now testing positive — folks who are much less likely to become significantly unwell.

Shunted aside, too, are the significant shortcomings of the PCR test that is most widely used — a test that detects fragments of viral RNA but doesn’t do a very good job of correlating the presence of those fragments with severity of illness or infectious risk.

And God forbid that one should call attention to the average age of those who have died from COVID-19. It’s astonishingly difficult to ferret out that number. A rudimentary Google search can ordinarily and instantly tell you everything you need to know about almost anything. To take a not-quite-random example, Google will tell you that the average lifespan of Canadian beavers is 10–15 years in the wild, but 20 years in captivity (given a choice, I suspect that beavers would unanimously choose to live wild and free, the longevity gains of captivity notwithstanding).

But good luck Google-mining the average age of death from COVID-19 for Canadians: Hardy-Boy-level sleuthing is required. As best as I can deduce, Texas Instrument calculator in hand, the average age of death from COVID in Canada is approximately 81 years of age (whereas the average age of death in this country before the pandemic was just north of 82). Point this out, however, and one risks being accused of the despicable practice of “age-ism”.

With “cases” rising, authorities are threatening to once again lock down vast swathes of the country while imprisoning long-term care residents to prolong their lives at all costs, even if that means upsetting entirely the apple-cart of the economy for generations and crippling the educational, mental and financial well-being of our children, grandchildren, and great-grandchildren. Has anyone interviewed our elders as to whether this is what they want? Do they want to be locked away from their loved ones in the waning months of their lives? Do they want to die utterly alone? Are they comfortable with the future being destroyed for their descendants so they can eke out a few more months on this green planet?

I’m going to go out on a limb and say: “I doubt it.” Like the aforementioned beavers, most would choose instead to be free, I think.

To be clear: I have the deepest respect for my elders. My mother is 90 years old and in a long-term care home. I don’t want her to die. But nor do I want her to spend her last time on earth wholly apart from those whom she loves, or to die completely alone… that, I tell you with passion, would be a crime against humanity.

Also: In no way am I suggesting that we shouldn’t track the number of positive tests. We need to understand how COVID is moving through the population so we can plot strategy and devise counter-measures.

But wouldn’t it be more sensible to lead off the daily COVID accounting with the number of people in hospital? The number in ICU? The number who have died? The average age of those who have died?

Because those are the numbers that matter most.

Those are the numbers that give an accurate picture of the severity of this pandemic.

Those are the numbers upon which we should be basing public policy.

And those are the numbers that increasingly are telling a good news story. As I wrote recently in an essay entitled “The COVID Three Step”:

We’ve come a long way since March… it was eminently reasonable, when we couldn’t properly grasp the scale of what we were facing, to hammer down, close the schools, and make preparations as best we could.

But that was then. This is now.

We know now this isn’t the Black Death. This isn’t smallpox. Nor is it the Spanish flu. We’re not stacking bodies in the streets. Nor is that likely to happen.

Case-fatality-rates have plummeted since the spring due to the twin impacts of better treatments for patients and society’s general adherence to the sensible COVID “cha-cha”: hand-washing, wearing masks in indoor public spaces, and reasonable social distancing.

If we had done that dance from the beginning, and if we had treated patients then as we treat them today, the number of people dead from COVID would be a fraction of the 10,000 lives we have lost in this country. (As I pointed out in The COVID Three Step, the death toll would likely be roughly on par with the number of people who die in traffic accidents in Canada every year; yet we don’t shut down traffic).

Hindsight is 20-20 (pun fully intended) — we know far more now than we did then. But that’s precisely the point: if we apply what we’ve learned, and if we all do the dance, we can co-exist productively with this virus:

We can keep our schools and our businesses open.

We can begin to erase the climate of fear that has had us by the throat for too long.

We can begin to mitigate the horrific impacts of the last six months of upheaval.

President Trump, Grand Pooh-bah of the Disciples of Denial, is not helping the cause, to put it mildly. After three days in hospital he waltzed un-masked back into the White House, like a modern-day Typhoid Mary (except that Typhoid Mary may not have known she was contagious, whilst the President knows full well he is infectious — he just doesn’t seem to care.) The President is playing with this virus like a pyromaniac toys with matches — and everyone around him is getting burned.

I’m surely not the only physician gravely concerned that this man is leading the free world while medicated with high-dose dexamethasone. I administer the drug professionally, but I also know it personally: three times in my life I’ve received high-dose dexamethasone following major surgery. I can attest first-hand to its side effects, to the irritability, the euphoria, the aggressiveness, the borderline psychosis.

That Trump has been allowed to continue to occupy the Oval Office, that he has access to the nuclear “button” in his drug-addled state, that he hasn’t been forced to hand over the reins of power temporarily to his Vice-President, is political malpractice of the highest degree. If that doesn’t keep you awake at night, nothing will.

Mr. Trump’s brash denials aside, and politics aside, this virus is nasty. You DO NOT want to encounter a full dose.

But nor is this the apocalypse — and we owe it to our children to stop treating it like it is. Amidst the COVID outbreak an outbreak of common sense is long overdue.

There is much cause for optimism. The glass is not half-empty. It’s at least 99.7% full. Best estimates of the overall infection fatality rate from COVID are in the range of two to three per thousand — and that number is steadily declining. Which means your overall risk of NOT dying from COVID if infected with the virus is 99.7% — and far lower if you are young.

It can seem, at times, as if the world in 2020 has been flattened by an unrelenting hurricane of trouble. Yet as Brandi Carlile reminds us, you can dance in a hurricane — so long as you’re standing in the eye.

The eye, in the case of this pandemic, is bordered by good old-fashioned common sense.

Stay in the eye, my friends. Do the COVID Three Step. And pray that the steroid-stoked American president keeps it together.

Then this hurricane shall pass, as so many have before. The overwhelming majority of us will survive.

And in the end the human race will be fine.

Case closed.

By dredles

Physician, veterinarian, father of four... the makings of a sturdy soapbox.

2 replies on “The Case of the Presidential Virus”

Enjoyed reading this essay. Loved the “Black flies matter”
I do not understand why our president was not corralled during this phase. His disregard for protecting those around him is mind boggling.
It seems like many folks do not understand the effects of steroids, and believe him, including those physicians managing his case.

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