Mask refusal in the 1918-1919 influenza pandemic

This is from an article about the history of medicine, about people refusing to wear masks in the 1918-1919 influenza pandemic:

“Adherence is based on three concepts: individualism versus collectivism; trust versus fear; and willingness to obey social distance rules. Jay Van Bavel opines that some countries tend to be more individualistic,16 and therefore more likely to reject rules and ignore attempts by public health authorities to “nudge” behavior change with risk messages or appeals for altruism. In collectivist cultures, people are more likely to do what is deemed best for society. Trust and fear are also significant influences on human behavior.17 In countries with political division, people are less likely to trust advice from one side or the other and are more likely to form pro- and anti- camps. This may also undermine advice issued by public health professionals. The last and most difficult to attain is social distancing. Human beings are social animals with bodies and brains designed and wired for connection. A pandemic, in many ways, goes against our instinct to connect. Behavioral psychologist Michael Sanders argues that if everybody breaks the rules a little bit, the results are not dissimilar to many people not following the rules at all.18

From another article:

“It was the worst pandemic in modern history.

The 1918 influenza virus swept the globe, killing at least 50 million people worldwide.

In the US, the disease devastated cities, forcing law enforcement to ban public meetings, shut down schools, churches, and theaters, and even stop funerals.

In total, 675,000 Americans died from the Spanish flu, named after the disease’s early presence in Spain.”

I read a book on the 1918-1919 influenza. It started in the U.S. The photograph that haunts me is the bodies stacked five deep in the hallways of San Francisco Hospitals.

And in a third article:

“The scenes in Philadelphia appeared to be straight out of the plague-infested Middle Ages. Throughout the day and night, horse-drawn wagons kept a constant parade through the streets of Philadelphia as priests joined the police in collecting corpses draped in sackcloths and blood-stained sheets that were left on porches and sidewalks. The bodies were piled on top of each other in the wagons with limbs protruding from underneath the sheets. The parents of one small boy who succumbed to the flu begged the authorities to allow him the dignity of being buried in a wooden box that had been used to ship macaroni instead of wrapping him a sheet and having him taken away in a patrol wagon.”

A CDC article about the history of the 1918-1919 influenza says this:

“The fully reconstructed 1918 virus was striking in terms of its ability to quickly replicate, i.e., make copies of itself and spread infection in the lungs of infected mice. For example, four days after infection, the amount of 1918 virus found in the lung tissue of infected mice was 39,000 times higher than that produced by one of the comparison recombinant flu viruses.14

Furthermore, the 1918 virus was highly lethal in the mice. Some mice died within three days of infection with the 1918 virus, and the mice lost up to 13% of their body weight within two days of infection with the 1918 virus. The 1918 virus was at least 100 times more lethal than one of the other recombinant viruses tested.14 Experiments indicated that 1918 virus’ HA gene played a large role in its severity. When the HA gene of the 1918 virus was swapped with that of a contemporary human seasonal influenza A (H1N1) flu virus known as “A/Texas/36/91” or Tx/91 for short, and combined with the remaining seven genes of the 1918 virus, the resulting recombinant virus notably did not kill infected mice and did not result in significant weight loss.14

The 1918-1919 influenza virus was sequenced and studied in 2005. We did not have the tools before that. Frozen bodies were exhumed with the permission of Inuit tribes to find the virus.

Later, that same article talks about future pandemics:

“When considering the potential for a modern era high severity pandemic, it is important; however, to reflect on the considerable medical, scientific and societal advancements that have occurred since 1918, while recognizing that there are a number of ways that global preparations for the next pandemic still warrant improvement.”

Let us now travel back to a worse epidemic: the plague in the Middle Ages:

“Did you know? Between 1347 and 1350, a mysterious disease known as the “Black Death” (the bubonic plague) killed some 20 million people in Europe—30 percent of the continent’s population. It was especially deadly in cities, where it was impossible to prevent the transmission of the disease from one person to another.”

I am hoping that people will awaken, get their vaccines, wear their masks and stop Covid-19 in its’ tracks, so that our death rate resembles the 1918-1919 Influenza. Not the Middle Ages plague.

Covid-19: A gentle answer

I went to have a hair cut today and went in three shops since I was downtown anyhow.

There are lots of tourists and visitors walking around without masks.

In one shop the owner asks if I am Dr. O, and it turns out her daughter babysat for my children 19-20 years ago. We had a nice discussion about our offspring. We are both wearing masks.

In a mineral store somehow the covid-19 subject comes up. I say that I am wearing a mask because I am on oxygen and vulnerable, and even though I am vaccinated, if I get covid-19, it might kill me.

The two owners are not wearing masks. The woman says, “We are both vaccinated, but I am just really confused about what to do.”

I say, “Well, I am a Family Physician. Let’s take chicken pox. If someone is exposed, it can take 21 days for them to break out in the rash. They will be contagious for 1-2 days before they have symptoms. The problem is that it can be ANY of those 21 days. After they break out in the rash, they are contagious until every pox is crusted over. So it can be six weeks that they are possibly or certainly contagious. With Covid-19, the Delta Variant is so infectious and again people may not have symptoms yet, so I am wearing a mask any time I am around strangers.”

The woman says, “Thank you for telling me about it. It’s helpful to hear from a professional.”

“You’re welcome.” I say, gathering my bag to go.

“Look,” she says, “I am putting on my mask now!”

I look and she is.

Covid-19 Delta Variant

This article: The CDC warns that the delta variant is as contagious as chicken pox and can make people sicker than the original Covid-19

Chicken pox has up to 21 days before you break out after exposure. It is really really contagious. And it is infectious until every pustule has scabbed over. And it can kill people, especially adults. It can also cause some pretty awful birth defects, which is why we ask every patient who is pregnant if they have had chicken pox or the vaccine. If not, we check antibodies. If they have no antibodies and are exposed, they are to get VZIG within 48-72 hours, an antibody to the virus to try to stop the birth defect. In my small town, it’s flown in by the health department.

So as contagious as chickepox is really bad. Chickenpox is worse than influenza. Tuberculosis is a very small bacteria and can be airborne as well.

The delta variant kills people who are unvaccinated at a higher rate than the original Covid-19. The 30-50 year olds are dying.

The delta variant can infect vaccinated people though rarely. The vaccinated people are way less likely to be hospitalized and die. However, someone walking around with delta (vaccinated or unvaccinated) apparently sheds 1000 times more virus than the original Covid-19. This means that we all need to put our masks back on unless we are in our homes with the very small groups we should stick with. If we do not do that, we may have more deaths this winter than last winter.

I double masked on the plane, one flight from Chicago to Seattle, two days ago. I kept the mask on in the taxi and waiting for the ferry. I felt most exposed waiting for the ferry because fully half the people were ignoring all of the mask signs. Ah well. I was going to travel in late August again but the prediction is for a big Covid-19 wave starting to peak in 4-6 weeks. Seems like a bad time to go anywhere, much less on oxygen.

Gather up whatever you need to get through the winter and get ready. Enjoy the August sun, but store up things for this winter. I think it is still going to be a hard one.


There is lots of detail on the CDC website.
will the unvaccinated change their minds in time?

Welcome home

Two friends texted welcome home and a third picked me up. I was in the east, visiting a friend who has known me since birth. I had a good trip. She is twenty years older than me.

It was very much an adventure traveling on oxygen, but it worked. It’s like having a cell phone that weighs ten pounds, plugs into your nose, the batteries are the size of my hand, my carry on weighs 50 pounds (batteries, oxygen concentrator, camera, flute, laptop and phone) (also a book, I’m retro) AND you still have your phone AND you can’t breathe if you leave part of it at home….. So why can’t I have ONE wire to charge all of these stupid electronics instead of a cord for the phone and a cord for the oxygen concentrators and a car charger and a cord for the laptop and a cord and charger for the camera. Hello Electronic Hell.

Anyhow, made it there and back, double masked on the plane and taxi and ferry and…. the number of people who were ignoring the “you must wear a mask” on the ferry was impressive. About half. Well, fifty percent of people are dumber than the other 49%, right? Right now I can pick them out in a crowd really easily. Hey, I am on oxygen, I really do not want covid-19 or strep A or flu or whatever else you are coughing into the air.

Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

covid 19 two

From November 20th, 2020:

My ex called Saturday. Early, which unusual. I thought he was calling to say his mother died.

Nope.

He is an RN at a nursing home. “We’ve gone from one Covid 19 patient to 55 in the nursing home in one week. And they installed a new computer program on Tuesday that makes everything take twice as long. I quit.”

Actually he gave two weeks notice.

He called our kids yesterday. He has Covid 19. However, they are so short of staff that he is working. On the Covid 19 ward of the nursing home.

____________________

In my clinic, we are struggling with watching people travel for Thanksgiving. We have decided. If someone travels or has Thanksgiving with other households, we will offer a zoom visit or a reschedule in two weeks. We do not want them to expose others in clinic. And if we get it or are exposed, we are closed for a minimum of two weeks.

____________________

He called me. Today 60 out of the 70 nursing home patients have it. All of the staff have it. The staff are working anyhow because there is no one else.

On covid-19

I am going to post a series of short essays I wrote on another site at the end of 2020. Because we have to work together and these are relevant. I will post one every day or two.

From Tuesday November 24, 2020:

I have just had a call asking for a Covid-19 test.

Not for symptoms.

Nope. Traveled from Washington to California with a buddy and “My sister thinks I should be tested.”

Me: “Oh, does your sister want you tested before you come to Thanksgiving?”

Patient: “Uh, I think so.”

Me: “First of all, the priority is for people who have symptoms or have been exposed. Secondly I am not ordering a test for someone who has no symptoms, chose to travel and then thinks it’s ok to go to a Thanksgiving dinner in another household if they get a negative. It’s not ok. You can test negative one day and be shedding virus the next. The quarantine after exposure is 14 days. The medical advice from the CDC, from the surgeon general and from me is STAY HOME.”

Others are asking for antibody tests. We don’t know if the antibodies mean you aren’t infectious. We don’t know how long they last. Typically with other covid viruses they don’t last long. In contrast, chicken pox virus gives lifelong immunity. We don’t know if a person can get Covid-19 again, though there have already been some cases. No, I won’t do an antibody test because the person “Just wants to know.”

STAY HOME STAY HOME STAY HOME.

Vaccine Adverse Event Reporting System (VAERS)

Anyone can report to the VAERS system.

Doctors may be a bit nervous about reporting covid-19 reactions. Doesn’t matter. You can report on your own.

That being said, I don’t recommend reporting if you feel like crap for a couple of days after the second shot. If it is severe, you need an ambulance or it goes on for more than say, five days, report.

The first shot is about 80% effective. So, 4 out of 5 people are protected, and 1 in 5 doesn’t take. After the second shot, about 95% are protected. That means 1:20 is not.

So if you responded to the first shot, you will have an antibody response to the second shot. I ran a fever of 102 for an hours and cancelled my day of work and the next day. You could have fever, chills, muscle aches, joint aches, whatever. Take a hot bath or sauna or hot tube, because you can sweat the antibodies out.

I would report reactions that last more than two days or are severe. You can fill the form out yourself online and send it to the CDC.

For the folks refusing the vaccine: Hello. Are you going to have covid-19 parties to infect each other? If you do and you get covid-19, I can tell you that I am glad I am not your doctor. Also I don’t want you in my house. I don’t want to be around you at the Farmer’s Market either. And I think that once everyone has had the opportunity to get the vaccine, if you refuse and get covid, you might have to pay your own doctor and hospital bill. Yeah, that is what I think. And if it bankrupts you: well, you had the opportunity to get the vaccine. Why should insurance have to pay? Or you might die. Death rate for world is holding at 2 out of 100. In the US it’s “only” 1.78 out of 100. That is a fungkload. It’s a lot of people. Choose not to get your vaccine and you could be one of them. I just found out this week that a friend from medical school died in November: age 59. Do not tell me it’s all 80 year old “who would have died anyway”. Each of us will die anyway and I don’t want to die of covid-19.

I took the photograph in medical school: it’s my fellow doctor who was found to have covid-19 after he died suddenly, age 59.

patience

The Ragtag Daily Prompt today is patience. We still have some fog. We hope for clear sailing. We hope the fog bank will shrink. Right now we can see what is under it and avoid it. Patience, patience. Mask and immunize, please, please, push back the fog.