Never Again

We must never again allow unaccountable public health officials and government officials to hijack the people and economy of the United States in the name of safety and "saving even one life."

“And if everything we do saves even just one life, I will be happy.
New York Governor Andrew Cuomo, March 2020

I wrote and published the essay below in April 29, 2020  A recent essay in The Free Press led me to look it up and I was surprised to see how closely I predicted what happened because of the abysmal mismanagement of the Covid Pandemic. I was not prescient or clairvoyant. I was not particularly knowledgeable regarding pandemics or public health. I was simply a physician with a solid fund of medical knowledge and some common sense. I believe that many people, including those without a medical background, could have written something like this.

Here is my essay. I have inserted a few retrospective comments in parentheses.

April 29, 2020- This is my imperfect attempt to put into words my thoughts and feelings regarding this entire Covid-19 situation. Today, after more than five weeks of sheltering-in-place, social distancing, and being prohibited by the powers that be from practicing my profession, I thought I would be delighted at the news that the Governor has given to go ahead to resume elective surgery on May 4. Instead, I find myself angry and sick at heart. I have no appropriate outlet for my anger- going into a quiet corner somewhere and shouting obscenities at nobody doesn’t seem productive- so I am sitting here writing down some thoughts. I will go over this later and see if any of it is worth sharing otherwise it will never see the light of day.

I see a world I no longer recognize. It is a world in which there appears to be a deliberate campaign of disinformation and misinformation the purpose of which, more than anything else, seems to be to instill and maintain an atmosphere of unreasonable fear. The underlying purpose of this is still unclear. One result, however, is that the American people have accepted almost without question a degree of government encroachment of their personal liberties which would have been impossible without the fear factor. We have permitted the Federal, state, and even local city governments to tell us we cannot leave our homes, we cannot keep our businesses open, and we cannot gather in other than tiny groups. A population of 300 million people has allowed itself to be quarantined and a trillion-dollar economy has been shut down, without a timetable or any inkling of the possible repercussions, for the first time in our history. All this because of fear. Fear of a virus about which we admittedly do not know everything, which is not to say that we do not know a lot about it.  

In the beginning, there may have been some justification for taking more extreme measures. SARS-Cov-2 was regarded as a novel bug and its behavior uncertain. We fell back on our experience with SARS 1 and MERS viruses. The experts and our government officials adopted the premise that extreme measures were necessary to slow the spread of the virus and allow for more targeted measures to replace these. At no time was there anyone claiming that this virus could be stopped- the Chinese communist government had insured that by their disinformation and outright lies, to their own people, the WHO, and the world at large. (serologic studies published in May clearly showed that the virus would not be stopped regardless of what measures were taken. ) The plan was to “flatten the curve”. The problem was that flattening the curve, for the purpose of preventing a sudden, massive influx of ill people that would overwhelm our medical resources, would guarantee that the viral epidemic would extend out many more weeks and months than if it had been allowed to run its course, as we do every year for seasonal flu. Combined with the extreme social distancing recommendations and shutdown of all but those businesses deemed essential, this also assured the U.S. of an incredibly long social disruption never before experienced and incalculable damage to the U.S. economy.

Never before have we dealt with a viral pandemic by quarantining the entire population rather than those who are actually ill or at special risk. Never have we quarantined all healthy people on the premise that they might spread a virus unknowingly. Despite having data almost from the first that SARS-Cov-2 was unusually benign to children and healthy adults under 60 years of age, we have persisted in behaving as though everyone is equally at risk. Instead of taking rational measures to isolate and protect the most vulnerable, we have confined a nation to their homes except for necessities- which, as a matter of course, violate strict quarantine guidelines in and of themselves. Instead of allocating resources according to where they are most needed, we have emptied hospitals everywhere, even in communities that have hardly been affected by the virus on the premise that there would be a “surge” of cases at some yet to be determined time in the future. (The Great Barrington Declaration, published in October 2020 proposed a reasonable plan of focused protection of the most vulnerable. Its authors were three eminent epidemiologists. They were vilified by Anthony Fauci and Francis Collins. Hindsight has shown that the GBD was correct.) Necessary surgery has been postponed because it was not deemed an emergency, healthcare workers have been furloughed, and medical practices shutdown. We have no clue how many people may have suffered worse outcomes or died because of delays in treatment. Again, fear has played a huge role in that many people have been afraid to leave their homes for needed medical care. My own hospital has been essentially deserted, awaiting a surge that never came and, with each passing day, is less likely to (my hospital did experience a surge of cases during the Delta spike, but was never overwhelmed, and flu does this every year in any event).

With each passing week, as more and more data has been accumulated, we now know that the models and formulas used to calculate the progression of the pandemic and the potential numbers of sick and dead were seriously flawed and inaccurate to the point of absurdity. Projections of millions dead have been scaled back by orders of magnitude (Even today, the number of deaths due to Covid versus those who died with a positive Covid test of unrelated causes remains controversial). As I write this, SARS-Cov-2 looks like it will be little more than a particularly vicious strain of flu, in its impact on those infected (I think it is safe to say that this ultimately proved to be pretty close to accurate). In all of this we have basically ignored the fact that we deal with flu annually, with numbers of dead also in the tens of thousands, and somehow seem to do this without suspending the constitution, or our economy. We also seem to believe that dying from Covid-19 is somehow worse than dying from the flu, or any of a dozen other potentially preventable causes of death that annually exceed any number Covid-19 might generate.  

The main stream media has seemed to delight in playing up the worst case scenarios, further fueling the fear. Social media exchanges have deteriorated to senseless arguments about who we are to believe. The White House corps of correspondents has distinguished itself as a group more interested in scoring points against an embattled president , than in providing helpful, objective information. The blatant misinterpretation of the president’s naïve question regarding use of disinfectants, twisting this into a recommendation to drink or inject such materials, and then using this to show his unsuitability to lead is just one case in point. The media has always been influential, hence its designation as the fourth estate. Yellow journalism has always been with us as well as abuse of the power of the press- which today would have to include television and the internet- but never on this scale. No one knows who to believe anymore. The media has repeatedly shown that its reporting is no longer confined to objective facts and, hence the universal acceptance of the reality of #fakenews by everyone. We believe the media only when it reports what we already think is true. The media has a unique power to destroy, without oversight or accountability. The media is like the classic, tongue-in-cheek description of the typical surgeon: sometimes wrong, but never in doubt. One thing the media never does, or does so rarely that it is noteworthy, is to acknowledge its mistakes. I think many of the extreme measures taken so far in this pandemic are done as much for fear of the media as anything else.

Elected officials and medical personnel are vilified no matter what they do. There is a difference in the degree, however. If our leaders respond early and are shown to have overreached, they are criticized, but if they respond late or inadequately, they are crucified. So, they err on the side of draconian measures versus a more limited response. This has, without a doubt, played into the overreach displayed so far as well as the timid and tentative steps being taken to open up our country and restore the economy. Politicians and medical consultants know they will be raked across the coals at the first upward bump in cases and mortality due to Covid-19 once the shelter-in-place is lifted and businesses reopen, as though this was not to be expected (This happened to Governor Desantis when he opened up Florida earlier than any other state).

The “nanny state” has never been more in evidence than during this crisis, a crisis that is as much of our own making as it is directly due to the medical impact of this virus. I have viewed with ambivalence the response of the American people. On the one hand I admire that they, by and large, have tried hard to comply with a seemingly contradictory stream of recommendations and directives. We have accepted social isolation, financial effects ranging from hardship to devastation of any financial future, and an unprecedented curtailment of basic personal freedoms, largely without complaint. The crisis has brought out the good in many people and provided some unforeseen benefits- time for reflection, an appreciation for the little pleasures, imaginative means of maintaining vital social connections. Everywhere I look, I see honest attempts to comply with multiple, incompatible recommendations, some of which have resulted in ludicrous actions, again, out of fear: masks of questionable effectiveness worn incorrectly or for so long that they are more likely contaminated than not, use of gloves as though these cannot themselves carry the virus, and futile efforts to sterilize the entire environment, which has led to a huge rise in accidental poisonings from disinfectants. On the other hand, I view this complacency and compliance on the part of the public with alarm, knowing tha,t if history has taught us anything, it is that power, once acquired, is rarely given up voluntarily. We will have to fight- by this I do not mean actual armed, physical struggle, but rather via legislative means and legal means- to restore those freedoms we have voluntarily relinquished during this crisis. Mark my words.

As a doctor for over forty years, having a sufficient background to look at our response to this virus very differently than a non-medical person, I have been dismayed at the absence of any adherence to sound medical and epidemiological principles and practice that has characterized our national response. At first, I hesitated to speak up, for the reasons mentioned above, not wanting to come across as contrarian, raising doubts about those leading us, or placing anyone needlessly at risk. As the weeks have passed and there has been no meaningful modification of the initial extreme response in the face of more and more data, I find that I cannot stay silent. I can say, from my conversations with colleagues and other educated individuals around me that there is now a ground swell of opinion from the medical community that is saying “enough is enough”. Let’s deal with this pandemic rationally and get everyone back to their lives and work.

We are still not out of the woods. I am sure that fear will play into an agonizingly slow and stepwise opening of the economy and return to normal social behavior that will prove to be unwarranted. On what is this based? Fear, of course. The rationale for this is suspect and poorly defended. What will we do when we see a rise in Covid-19 cases, as we are almost certain to do once our citizenry is once again able to move about freely? What will we do in the fall or winter when SARS-Cov-2 may return on the scene? Will this be the new default, to lockdown the country every time the virus returns to our shores?

I have long decried the profligate spending of our tax dollars by the government and now it is throwing stimulus and bailout money around like there is no limit to it. This in order to counteract the fallout from an irrational economic shut down. Where is that going to come from? Our government is broke, yet we act as though as all we have to do is churn out more money from our printers and all will be well (Our national debt is now up to $34 trillion with an annual budget deficit of more than $1 trillion. These are incomprehensible numbers.) I am more than a physician. I am a father of three and a grandfather of four. I worry about the brave new world that we have created and what it will mean for them. They were never really in danger from SARS-Cov-2 but have paid a price, and will continue to do so, probably well past the day when I am gone.

We have engaged in a social experiment on a massive scale, with no idea of what the outcome may be. Perhaps my biggest fear- there is that word again- is that we have established a precedent for responding to future such pandemics that is not only futile but actually counterproductive and will just further erode our freedoms. I fear this has not been our finest hour.

In closing, I would like to say that Life is dangerous and death is always around the corner for each us. None of us knows the hour or the way in which we will leave this life. We seem to view SARS-Cov-2 as an apocalyptic event but I am sure those who lived through the revolutionary war, civil war, WWI and II, the Holocaust, the purges of Russia, China, and Cambodia, the Spanish flu, or any of a myriad other cataclysmic events felt much the same. I do not put my faith in the President, Congress, Dr. Fauci or Birx, the media, science, or any other earthly agent for my future. I know it is secure in the hands of a benevolent creator and author of all that is good in life. He is in control and, even when things look especially bleak, I trust that there is a plan and a future for mankind. As a Christian, I am directed to do all within my power to love and serve my neighbor but, at the same time, to accept that the world has been, is, and always will be a mess and in a state of continual decay.

(Remember, all of this was written 5 weeks into the pandemic in the U.S.)

Richard T. Bosshardt, MD, FACS