Category Archives: Social issues ( be civil ! )

I hope to Hell I was wrong about China

From the South China Morning Post — 9:52pm, 15 Jan, 2022

“The Chinese capital reported its first community case of the Omicron coronavirus variant on Saturday, with local and imported infections of the strain now detected in about half of the country’s provinces and municipalities.”

https://www.scmp.com/news/china/politics/article/3163525/china-braces-omicron-variant-extends-its-reach-and-lunar-new-

If true, containment, quarantine, lockdowns and isolation are hopeless.  The quote implies that they’ve already failed.

I find this very worrisome for reasons listed in a post 12 December 2021, a copy of which is below.

The short answer is that the mainland Chinese are immunologic virgins to exposure to the variants of the pandemic virus.  Hopefully their vaccines will work better against omicron than those of the west, but there is no reason to think they will.

Is China following a Smokey the Bear policy on the pandemic?

China is following a prevent pandemic virus infection policy, just as Smokey the Bear followed a prevent forrest fires policy.  The latter didn’t work out well, as although fires were prevented for a while. However, when fires did occur, they were much much worse than the smaller ones Smokey prevented.  There was much more tinder and stuff to burn.

Actually Smokey has changed his tune slightly.

https://en.wikipedia.org/wiki/Smokey_Bear  SmokeyBear.com’s current site has a section on “Benefits of Fire” that includes this information: “Fire managers can reintroduce fire into fire-dependent ecosystems with prescribed fire. Under specific, controlled conditions, the beneficial effects of natural fire can be recreated, fuel buildup can be reduced, and we can prevent the catastrophic losses of uncontrolled, unwanted wildfire.”

Revision 14 December 2021 — China’s policy of prevention has resulted in a Chinese population which has been vaccinated using two killed virus vaccines (Sinopharm, Coronavac).  They have not had any natural infections with the virus (aside from the original cases) as far as we know given what China has allowed out.

Infection with the virus itself exposes you to all its proteins, with your immune system responding to all of them.   Western vaccines are just to the spike protein.

It tends to be forgotten that moist cases of pandemic viral infection are asymptomatic.

Given 800K deaths  from COVID19  in the USA, how can I possibly say this is good. Here’s how :>

If you had an infection with the virus, you develop antibodies.  Nowadays, everyone who is vaccinated has antibodies so there is no point in testing for them, but what were things like in the days before vaccines?

The following is from a post July/2020.

https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html–https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html.

New York State  randomly tested 3,000 people at grocery stores and shopping locations across 19 counties in 40 localities to see if they had the antibodies to fight the coronavirus, indicating they have had the virus and recovered from it. With more than 19.4 million people residents, according to U.S. Census data, the preliminary results imply that at least 2.7 million New Yorkers have been infected with Covid-19.They weren’t all hospitalized.

Here’s some work the same month from Queens — https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html

At a clinic in Corona, a working-class neighborhood in Queens, more than 68 percent of people tested positive for antibodies to the new coronavirus. At another clinic in Jackson Heights, Queens, that number was 56 percent. But at a clinic in Cobble Hill, a mostly white and wealthy neighborhood in Brooklyn, only 13 percent of people tested positive for antibodies.

So the disease has already to spread to half the population in some neighborhoods in Queens. If even 10% of them were sick that would have been 140,000 hospitalizations.  They didn’t happen.

OK, so a lot more people were infected than got sick.  Why is this good?

Enter the omicron variant of the pandemic virus.  It can evade the antibodies produced by all the current vaccines (in the West — protection against the Chinese killed viral vaccines CoronaVac and Sinopharm isn’t known yet).   Yet omicron doesn’t appear to produce severe disease. Thus far…

 

The CDC in the past week said of the 40+ omicron cases it knows about (there certainly are more out there, and more to come), there was one hospitalization (for two days) and no deaths.

Here is Dr. Fauci 12 December 2021 — “We’re getting anecdotal information … not necessarily confirmed yet, that the level of severity appears to be maybe a bit less than in the Delta. But there are a lot of confounding issues that it may be due to the underlying protection in the community due to prior infections,”

Source — https://nypost.com/2021/12/12/omicron-appears-to-evade-some-protection-from-covid-vaccines/

So the Chinese population may be sitting ducks for omicron having been given vaccines (Sinopharm, Coronavac) of unknown potency against omicron.  If their statistics are true there has been little or no natural infection with the pandemic virus in the Chinese population (which Fauci has just implicated is protective),.  Given that I have a son, daughter in law and two grandkids living in Hong Kong, I find this extremely disconcerting.

The pandemic of the ‘fully vaccinated’

At the end of 12 January ’22 the state of Massachusetts had 3,180 COVID19 patients in hospital.  484 were in the ICU and 278 were on respirators.  Of those 3,180, some 1,005 were ‘fully vaccinated’.  — https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-interactive-data-dashboard-

Addendum 15 Jan: Thanks to MStriker for picking up the error.  1,005 above should be 1505, giving 49%.

That’s nearly 50% of the hospitalized.  This,  in Massachusetts where we believe in Science.  We’re not talking about the toothless peasantry of West Virginia.  The fully vaccinated are serious and important people; news anchors, members of congress, white house staff, not the unvaccinated riffraff we’ve heard about.  What are the faithful believers in Science of Massachusetts to do? ,

If this sounds like Schadenfreude it is.  I’ve listened and read plenty of it in the press in the past two years, with much gloating over the deaths of the unvaccinated.   .  These people died and snarkery (such as the above) is inappropriate and cruel. So let those who formerly thought they were safe worry a little (including me) and realize that science is never settled.

What can be done to restore the faith?  It would certainly be of interest to know the percentage of the fully vaccinated in the ICU or on respirators.  This might actually be evidence of some protective effect of the vaccines.

This data is certainly known to the department of health.

Also, the definition of fully vaccinated can be found (with some difficulty) on their website.  It is clearly outdated e.g. two shorts of Pfizer or the other vaccine longer than 14 days ago.  There is nothing in the definition about boosters.  The definition goes back to September 2021.

I’m sure that in the charts of all 3,180 hospitalized COVID19 patients, the presence and time of  booster administration is noted.  So the State Department has in hand evidence for the efficacy/nonefficacy of boosters, to prevent hospitalization, and when in hospital to prevent serious complications of COVID19.  This should be released immediately.

Who is Gabriel Leung and why you should very much care what he says

From today’s (5 Jan) South China Morning Post (SCMP)

“Fellow government adviser Professor Gabriel Leung, dean of the University of Hong Kong’s faculty of medicine, told a radio programme there were “probably five to 10 invisible transmission chains in the community. It’s a very alarming situation”.

Here is what Dr. Leung had to say almost two years ago to the day in the SCMP of 27 Jan 2020.

“As of a few days ago the virus had been found in 29/31 Chinese provinces. ” and “research shows self-sustaining human-to-human transmission is already happening in all major mainland cities.”

Clearly he was right 2 years ago, and widely ignored in the west.   I thought the US government had people watching China.

There were 38 cases of COVID19 in Hong Kong today.  Some of them have the omicron variant (if not all).

This is very scary as despite immunization with Sinopharm and Coronavac, the Chinese are basically immunologic virgins as they have had little exposure to the pandemic virus (Wuhan excepted).  Hopefully it will work better than the Western vaccines.  As of 4 January 2022 Massachusetts had 2,426 hospitalized cases of COVID19 of which 973 were ‘fully vaccinated’ e.g. 40% of cases– not sure if this means 2 shots or 2 shots plus a booster.  On 21 December we had 1621 cases in hospital and the fully vaccinated accounted for only 29%.  So it’s getting worse here.

For an elaboration of why I think the Chinese are particularly vulnerable to omicron see yesterdays post — https://luysii.wordpress.com/2022/01/04/were-about-to-find-out-just-how-good-the-chinese-vaccines-are-against-omicron/

Addendum 7 January 2022

As of 6 Jan Massachusetts had 2,637 COVID19 cases of which 42% are described as ‘fully vaccinated’.

It looks like Dr. Leung was right (again).  From today’s SCMP

“At least 18 locally transmitted cases have been reported in Hong Kong in recent days and the city is reimposing some of its toughest Covid-19 social-distancing measures.”

https://www.scmp.com/news/china/science/article/3162526/shenzhen-covid-19-cases-lower-hopes-hong-kong-border-reopening?module=perpetual_scroll_1&pgtype=article&campaign=3162526

We’re about to find out just how good the Chinese Vaccines are against omicron

A very disturbing article in the South China Morning Post (SCMP) today — https://www.scmp.com/news/hong-kong/health-environment/article/3162088/coronavirus-hong-kong-reports-first-untraceable?module=storypackage&pgtype=homepage.

First: some background. There has been an outbreak of COVID19 traced to the Moon Palace restaurant  in Kowloon recently.   It began with an aircrew member from Cathay Pacific Airways Ltd., who was subsequently found to be infected with omicron.  He ate lunch there 27 December with his family. . Five other customers later tested positive. Yesterday’s paper said that transmission occurred between the first known case and others not sitting close to each other.  I can’t find that particular article, so this is from memory.

Today’s news is particularly bad, because the current case was acquired within the community (with no obvious contact to an infected person, or time at the restaurant), His virus has two of the mutations typical of omicron (further testing is in progress).

Given how infectious omicron is and the population density of Hong Kong (mask or no mask) omicron is likely to spread widely in Hong Kong (and likely China itself).

You won’t find any schadenfreude here.  I have a son, daughter-in-law and two grandkids living there.  This is why I was able to see that a pandemic was in store 2 years ago –https://luysii.wordpress.com/2020/01/27/what-to-do-about-the-wuhan-flu/

It seems quaint now, but I the reason I was reading the SCMP regularly in 2019 – 2020 was the Hong Kong riots in the summer of 2019 their possible effects on my family.

So why am I concerned presently?  Due to the Chinese attempts at tight control, the majority of the Chinese population  have had no infectious experience with the pandemic virus (aside from Wuhan of course). This is unlike Western populations which have been exposed and symptomatically/asymptomatically infected with various strains of the pandemic virus for nearly two years.  So the Chinese are immunologic virgins as far as omicron is concerned.  We are about to see how protective the vaccines they’ve received (Sinopharm, Coronavac) are against omicron.

 

Hopefully, the Chinese are better protected than we have been by the Pfizer, Moderna, etc. etc vaccines.  As of yesterday,  37% of the 2000 or so COVID19 patients in Massachusetts hospitals are said to be ‘fully vaccinated’ (I’m not sure if this means 3 shots or the original 2).

Addendum 5 Jan ’22 — If you want to see how tenaciously the Chinese are tracing cases in the outbreak in Hong Kong — look at today’s SCMP — https://www.scmp.com/news/hong-kong/health-environment/article/3162190/coronavirus-hong-kongs-fifth-wave-has-already?module=lead_hero_story&pgtype=homepage.

Particularly fascinating is a diagram of the diners and seating arrangements in  the Moon Palace restaurant in Kowloon, the source of one outbreak — they have each confirmed case — the table they were sitting at, the times they were there.  Particularly scary is the 20 meter distance between the index case (an airline stewardess) and one of the infected.

Even scarier is the pronouncement of Gabriel Leung — he’s the MD who said the pandemic was in 31 Chinese cities  in 27 Jan ’21, so anything he says must be taken seriously.  See the link to my post  — https://luysii.wordpress.com/2020/01/27/what-to-do-about-the-wuhan-flu/

“Fellow government adviser Professor Gabriel Leung, dean of the University of Hong Kong’s faculty of medicine, told a radio programme there were “probably five to 10 invisible transmission chains in the community. It’s a very alarming situation”.

Stay tuned.   The article said that there 38 COVID19 cases in Hong Kong — it isn’t clear how many are the omicron variant.

So here’s a repeat of a post written 12 December ’21

Is China following a Smokey the Bear policy on the pandemic?

China is following a prevent pandemic virus infection policy, just as Smokey the Bear followed a prevent forrest fires policy.  The latter didn’t work out well, as although fires were prevented for a while. However, when fires did occur, they were much much worse than the smaller ones Smokey prevented.  There was much more tinder and stuff to burn.

Actually Smokey has changed his tune slightly.

https://en.wikipedia.org/wiki/Smokey_Bear  SmokeyBear.com’s current site has a section on “Benefits of Fire” that includes this information: “Fire managers can reintroduce fire into fire-dependent ecosystems with prescribed fire. Under specific, controlled conditions, the beneficial effects of natural fire can be recreated, fuel buildup can be reduced, and we can prevent the catastrophic losses of uncontrolled, unwanted wildfire.”

Revision 14 December 2021 — China’s policy of prevention has resulted in a Chinese population which has been vaccinated using two killed virus vaccines (Sinopharm, Coronavac).  They have not had any natural infections with the virus (aside from the original cases) as far as we know given what China has allowed out.

Infection with the virus itself exposes you to all its proteins, with your immune system responding to all of them.   Western vaccines are just to the spike protein.

It tends to be forgotten that moist cases of pandemic viral infection are asymptomatic.

Given 800K deaths  from COVID19  in the USA, how can I possibly say this is good. Here’s how :>

If you had an infection with the virus, you develop antibodies.  Nowadays, everyone who is vaccinated has antibodies so there is no point in testing for them, but what were things like in the days before vaccines?

The following is from a post July/2020.

https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html–https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html.

New York State  randomly tested 3,000 people at grocery stores and shopping locations across 19 counties in 40 localities to see if they had the antibodies to fight the coronavirus, indicating they have had the virus and recovered from it. With more than 19.4 million people residents, according to U.S. Census data, the preliminary results imply that at least 2.7 million New Yorkers have been infected with Covid-19.They weren’t all hospitalized.

Here’s some work the same month from Queens — https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html

At a clinic in Corona, a working-class neighborhood in Queens, more than 68 percent of people tested positive for antibodies to the new coronavirus. At another clinic in Jackson Heights, Queens, that number was 56 percent. But at a clinic in Cobble Hill, a mostly white and wealthy neighborhood in Brooklyn, only 13 percent of people tested positive for antibodies.

So the disease has already to spread to half the population in some neighborhoods in Queens. If even 10% of them were sick that would have been 140,000 hospitalizations.  They didn’t happen.

OK, so a lot more people were infected than got sick.  Why is this good?

Enter the omicron variant of the pandemic virus.  It can evade the antibodies produced by all the current vaccines (in the West — protection against the Chinese killed viral vaccines CoronaVac and Sinopharm isn’t known yet).   Yet omicron doesn’t appear to produce severe disease. Thus far…

The CDC in the past week said of the 40+ omicron cases it knows about (there certainly are more out there, and more to come), there was one hospitalization (for two days) and no deaths.

Here is Dr. Fauci 12 December 2021 — “We’re getting anecdotal information … not necessarily confirmed yet, that the level of severity appears to be maybe a bit less than in the Delta. But there are a lot of confounding issues that it may be due to the underlying protection in the community due to prior infections,”

Source — https://nypost.com/2021/12/12/omicron-appears-to-evade-some-protection-from-covid-vaccines/

So the Chinese population may be sitting ducks for omicron having been given vaccines (Sinopharm, Coronavac) of unknown potency against omicron.  If their statistics are true there has been little or no natural infection with the pandemic virus in the Chinese population (which Fauci has just implicated is protective),.  Given that I have a son, daughter in law and two grandkids living in Hong Kong, I find this extremely disconcerting.

The pandemic isn’t ending by a long shot

There’s nothing like data to change your mind.  Just 6 days ago I posted a rather optimistic take on the pandemic which I updated daily (a copy of the most recent  update 31 December ’21 is to be found after the ****

It began like this

I hope I’m not doing what I’ve seen many times, a devoted family hovering over a brain dead patient seeing signs of life when none exists because they desperately want to. Who can blame them?  They’re human beings not rational automatons.  Nonetheless, there are two signs that the pandemic is actually ending.

Well, I was doing exactly that.

The media endlessly  trumpets a surge in ‘casesm but remember a case is defined as finding the virus (in the form of a viral protein or the viral genome) in your respiratory passages.  It does NOT mean you are sick.

Example — a few days it was mentioned that 800 kids were being admitted to the hospital each day in the USA with COVID19.  However every hospital admission gets tested for the virus, and it turns out the kids were being admitted for other childhood problems — fractures, appendicitis etc. etc.  They weren’t sick with COVID19.

So I was encouraged, that despite the surge in ‘cases’ people sick with COVID19 weren’t filling the hospitals.  Hospitalizations and death are the numbers you need to know.

Here is some data from my home state of Massachusetts

Date stands for the date of the report, and includes all data up to and including the previous day — Total cases is really total cases of COVID19 in hospital.

Date       Total cases   Fully vaccinated   % fully vaccinated

21 Dec      1,621            470                       29%

22 Dec     1,632            500                      31%

23 Dec     1,595           503                       31%

So I was pretty optimistic that the pandemic could be peaking when I wrote the post on December 26.

Data proved me wrong

27 Dec       1,636         509                       31%  — essentially the same

28 Dec      1,707           529                       31%

29 Dec       1,711           572                       33%

30 Dec       1,817          631                       35%

31 Dec         1,954        686                       35%

If you’d like to follow the Massachusetts data yourself — here’s a link — https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-interactive-data-dashboard-

It is updated each day (except on weekends) after 5 PM

Ditto for Florida. Here’s where I got the data — https://www.nytimes.com/interactive/2021/us/florida-covid-cases.html

Look at the Florida data carefully.  There are 4 graphs, a big one on the top of ‘cases’ from March 2020 to the present.  You can click on it at any point and see how many new ‘cases’ there were that day.

Now  below this there are 3 more graphs (but each is shrunk down to 1/3 the size of the top one to fit).  They are from left — number of tests, number hospitalized, and number of deaths.

Note the left most — the number of tests increases in December about the same way the number of cases does  — so although there is a surge, it may be due (in part) to increased testing.

Note the two right most graphs — hospitalizations and deaths.

A comparison with Massachusetts is instructive –Florida with a population of 20 million or so had only 2,005 COVID19 patients in hospital on Christmas day, while Massachusetts withs 6.7 million had 1,505.  So what has Florida done that we’re not doing up here?

Addendum 27 December — the number of COVID19 cases in hospital in Florida 26 December was 2129 a 6% increase from 25 December.

Date                     COVID cases (Florida)  Deaths

26 December           2129                               22

27 December           2228                               18

28 December           2560                              16

29  December         2963                               16

30  December          3376                              19

Given the greater than 50% increase in hospitalized cases in a few days, I think that daily deaths will similarly increase (with a 1 – 2 week time lag as is usually the case).

Then there are curve balls about the data itself

On 28 December the CDC said that it had overestimated the prevalence of omicron — According to agency data, omicron accounted for about 59 percent of all U.S. infections as of Dec. 25. Previously, the CDC said the omicron variant comprised 73 percent of all cases for the week ending Dec. 18. But that number has now been revised to 22.5 percent of all cases.– https://covid.cdc.gov/covid-data-tracker/#variant-proportions

So that means that omicron deaths won’t be as large as the initial prevalences given by the CDC implied. Revisions of data are common and unavoidable in a fluid situation like this.

The sudden shifts in data and information (sometimes incorrect, sometimes conflicting) is so typical of the early days of a new disease.  It so reminds of the early days of AIDs in the 80s when I was in practice.

In medicine, you never have the data you really want.  But you do not have the luxury of waiting for it.  You have to advise patients and families with the information you do have.  It’s difficult and frustrating, but very fit work for your intelligence.  And it’s important in a way that few things are.

Now here is the old post with all its twists and turns. You may find it interesting

********

This post is updated daily with new data — today’s is 31 December.

Addendum 30 December — nothing like new data to make you change your mind. Going from 2005 hospitalized COVID19 cases 25 Dec to 2,963 on 29 December in FLorida is a significant surge.  The fat lady hasn’t sung in Massachusetts, New York or Florida.  The pandemic is surging where it counts — hospitalized COVID19 patients.

 

I hope I’m not doing what I’ve seen many times, a devoted family hovering over a brain dead patient seeing signs of life when none exists because they desperately want to. Who can blame them?  They’re human beings not rational automatons.  Nonetheless, there are two signs that the pandemic is actually ending.

First, some background.  The media endlessly trumpets surges in ‘cases’.   Here’s the latest from Massachusetts — https://www.wwlp.com/news/health/coronavirus/covid-19-surge-in-mass-continues-to-cancel-news-years-eve-celebrations/.

Remember a case is defined as finding the virus (in the form of a viral protein or the viral genome) in your respiratory passages.  It does NOT mean you are sick

Nonetheless, there are two signs that the pandemic is actually ending.

First from Massachusetts, where ‘we believe’ in science and the adults in the room are in charge.  There is no question that the number of cases has dramatically increased in the past month — follow the following link to an excellent site which allows you to click and explore

https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-interactive-data-dashboard-

If you click on various points of the curve you’ll see that a month ago the state had 750 people in the hospital with COVID19. On 23 December there were 1,595 — surge enough for anyone.

As someone well over 60 and being fully vaccinated (Pfizer) with a booster 9/21 I’me very interested in how many breakthrough infections in fully vaccinated people there are — it was 503/1595 on 23 December 31.5% hardly trivial.They don’t give an age distribution of breakthroughs at various ages, but based on past experience, it’s likely to be highest in the Medicare set.

I’ve been watching the site for the past few days and here are the numbers.  Date stands for the date of the report, and includes all data up to and including the previous day — Total cases is really total cases of COVID19 in hospital.

Date       Total cases   Fully vaccinated   % fully vaccinated

21 Dec      1,621            470                       29%

22 Dec     1,632            500                      31%

23 Dec     1,595           503                       31%

Addendum 27 Dec

27 Dec       1,636         509                       31%  — essentially the same

Addendum 28 Dec

28 Dec      1,707         529                          31%

Addendum 29 Dec

29 Dec       1,711         572                          33%

Addendum 30 Dec

30 Dec       1,817       631                            35%

Addendum 31 Dec

31 Dec         1,954     686                           35%

Not stable or decreasing — 1817 is 14% increase from a week ago 23 Dec.  Note that the percentage of the fully vaccinated is increasing.  Certainly no longer the pandemic of the unvaccinated. Florida jumped 10% today (see below) which shows why you’ve got to get figures each day and look at trends

I plan on daily updates for the rest of the week.  Things look quite stable in Massachusetts — not so much in Florida

Addendum 29 Dec — the statistics in New York State are nowhere as good — https://coronavirus.health.ny.gov/daily-hospitalization-summary

On 21 Dec there were 4200 or so COVID cases in hospital in New York State — as of the 28th there are around 6600.

Now both New York State and Florida both have about 20 million people, yet Florida’s case load today of 2560 is only 38% that of New York ! !  A smart friend thinks this is due to the far greater population density in NY (particularly in New York City).  Perhaps, but there has been a huge amount of criticism in the New York Times and other elements of the mainstream press of Florida and its Governor for they way they’ve been lax about masking, school closures, and social distancing.

Addendum 30 Dec

Comparing Florida and New York again.  Florida has a population of 21,480,00 and 62.390 deaths.  New York has a population of 19,450,00 and 58,560 deaths.   So Florida has 2% more death per capita.  Much closer than I had been led to believe by the press which basically called Governor DeSantis a murderer due to his unmasking policy.  Well, maybe he is, but then so is former Governor Cuomo for sending recovered COVID19 nursing home patients back to the nursing to infect the vulnerable

The numbers in Massachusetts are pretty stable and large enough to be significant. Now maybe this is seeing signs of life where none exist due to lags in reporting due to the Christmas holiday etc. etc.   But if it isn’t, it is good news.  I await next week’s numbers with great interest.

Addendum 30 Dec — Well it was wishful thinking.

Second — the data from Florida as of 26 December– according to the New York Times — https://www.nytimes.com/interactive/2021/us/florida-covid-cases.html

There are 4 graphs, a big one on the top of ‘cases’ from March 2020 to the present.  You can click on it at any point and see how many new ‘cases’ there were that day.

In case you can’t, here are a few numbers.

Date                 new cases

24 December  31,683

23 November   1,605

Certainly, surge enough for anyone.

Now  below this there are 3 more graphs (but each is shrunk down to 1/3 the size of the top one to fit).  They are from left — number of tests, number hospitalized, and number of deaths.

Note the left most — the number of tests increases in December about the same way the number of cases does  — so although there is a surge, it may be due (in part) to increased testing.

Note the two right most graphs — hospitalizations and deaths.  They don’t really budge in December.

In particular the deaths appear to have declined.  Again a caveat about the reporting accuracy over the Christmas holiday.

Also note that Florida with a population of 20 million or so had only 2,005 COVID19 patients in hospital on Christmas day, while Massachusetts withs 6.7 million had 1,505.  So what has Florida done that we’re not doing up here?

Addendum 27 December — the number of COVID19 cases in hospital in Florida 26 December was 2129 a 6% increase from 25 December.

Addendum 28 December — the number of COVID19 cases in hospital in Florida 27 Dec  2228 another 5% increase

Addendum 29 December — the number of COVID19 cases in hospital in Florida 28 Dec 2,560 — a big increase

Addendum 30 December — the number of COVID19 cases in hospital in Florida 29 December is 2,963 — another big increase

Addendum  31 December — the number of COVID19 cases in hospital in Florida 30 December is 3,376

I should have reported the number of deaths earlier, but didn’t, but I will start now.  It is given daily by the NYT, but the graph of deaths isn’t interactive and you can’t pick these numbers from it

There were 22 COVID19 deaths in Florida on the 26th.

There were 18 COVID19 deaths in Florida on the 27th

There were 16 COVID19 death in Florida on the 28th — increase sure to follow the increase in COVID19 cases in hospital

There were 16 COVID19 deaths in Florida on the 29th — increases sure to follow

There were 19 COVID19 deaths in Florida on the 30th  — increases sure to follow

I plan on daily updates for the rest of the week, so you’ll be able to draw your own conclusions.  Look at the third graph in the second line, it doesn’t look like deaths are surging.

But if accurate, the conclusion is inescapable — the currently extant virus variant (omicron) simply is NOT putting people in the hospital the way the earlier surges did.  Again have a look at the preceding 3 bumps in hospitalization for COVID19 since March 2020, and note how they parallel the number of cases.

Addendum 30 December — nothing like new data to make you change your mind. Going from 2005 hospitalized COVID19 cases 25 Dec to 2,963 on 29 December in FLorida is a significant surge.  The fat lady hasn’t sung in Massachusetts, New York or Florida.  The pandemic is surging where it counts — hospitalized COVID19 patients.

It is thought that the omicron variant accounts for over 50% of new infections no matter where you are, and over 90% in the NY metropolitan area.  So the surge in the new variant may actually be a good thing in that it is replacing delta (the previous dominant variant), a more virulent form of the virus, by a more innocuous one,.

Stay tuned and relax a bit.

Yet another Addendum 29 December (if you can stand it)— yesterday the CDC said that it had overestimated the prevalence of omicron — According to agency data, omicron accounted for about 59 percent of all U.S. infections as of Dec. 25. Previously, the CDC said the omicron variant comprised 73 percent of all cases for the week ending Dec. 18. But that number has now been revised to 22.5 percent of all cases.– https://covid.cdc.gov/covid-data-tracker/#variant-proportions

So that means that omicron deaths won’t be as large as the initial prevalences given by the CDC implied. Revisions of data are common and unavoidable in a fluid situation like this.

Reasoning about data as it comes in is exactly what scientists do.  I love doing this. Any guesses as to what tomorrow will bring?

Is the pandemic ending?

This post is updated daily with new data — today’s is 31 December.

Addendum 30 December — nothing like new data to make you change your mind. Going from 2005 hospitalized COVID19 cases 25 Dec to 2,963 on 29 December in FLorida is a significant surge.  The fat lady hasn’t sung in Massachusetts, New York or Florida.  The pandemic is surging where it counts — hospitalized COVID19 patients.

 

I hope I’m not doing what I’ve seen many times, a devoted family hovering over a brain dead patient seeing signs of life when none exists because they desperately want to. Who can blame them?  They’re human beings not rational automatons.  Nonetheless, there are two signs that the pandemic is actually ending.

First, some background.  The media endlessly trumpets surges in ‘cases’.   Here’s the latest from Massachusetts — https://www.wwlp.com/news/health/coronavirus/covid-19-surge-in-mass-continues-to-cancel-news-years-eve-celebrations/.

Remember a case is defined as finding the virus (in the form of a viral protein or the viral genome) in your respiratory passages.  It does NOT mean you are sick

Nonetheless, there are two signs that the pandemic is actually ending.

First from Massachusetts, where ‘we believe’ in science and the adults in the room are in charge.  There is no question that the number of cases has dramatically increased in the past month — follow the following link to an excellent site which allows you to click and explore

https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-interactive-data-dashboard-

If you click on various points of the curve you’ll see that a month ago the state had 750 people in the hospital with COVID19. On 23 December there were 1,595 — surge enough for anyone.

As someone well over 60 and being fully vaccinated (Pfizer) with a booster 9/21 I’me very interested in how many breakthrough infections in fully vaccinated people there are — it was 503/1595 on 23 December 31.5% hardly trivial.They don’t give an age distribution of breakthroughs at various ages, but based on past experience, it’s likely to be highest in the Medicare set.

I’ve been watching the site for the past few days and here are the numbers.  Date stands for the date of the report, and includes all data up to and including the previous day — Total cases is really total cases of COVID19 in hospital.

Date       Total cases   Fully vaccinated   % fully vaccinated

21 Dec      1,621            470                       29%

22 Dec     1,632            500                      31%

23 Dec     1,595           503                       31%

Addendum 27 Dec

27 Dec       1,636         509                       31%  — essentially the same

Addendum 28 Dec

28 Dec      1,707         529                          31%

Addendum 29 Dec

29 Dec       1,711         572                          33%

Addendum 30 Dec

30 Dec       1,817       631                            35%

Addendum 31 Dec

31 Dec         1,954     686                           35%

Not stable or decreasing — 1817 is 14% increase from a week ago 23 Dec.  Note that the percentage of the fully vaccinated is increasing.  Certainly no longer the pandemic of the unvaccinated. Florida jumped 10% today (see below) which shows why you’ve got to get figures each day and look at trends

I plan on daily updates for the rest of the week.  Things look quite stable in Massachusetts — not so much in Florida

Addendum 29 Dec — the statistics in New York State are nowhere as good — https://coronavirus.health.ny.gov/daily-hospitalization-summary

On 21 Dec there were 4200 or so COVID cases in hospital in New York State — as of the 28th there are around 6600.

Now both New York State and Florida both have about 20 million people, yet Florida’s case load today of 2560 is only 38% that of Florida ! !  A smart friend thinks this is due to the far greater population density in NY (particularly in New York City).  Perhaps, but there has been a huge amount of criticism in the New York Times and other elements of the mainstream press of Florida and its Governor for they way they’ve been lax about masking, school closures, and social distancing.

Addendum 30 Dec

Comparing Florida and New York again.  Florida has a population of 21,480,00 and 62.390 deaths.  New York has a population of 19,450,00 and 58,560 deaths.   So Florida has 2% more death per capita.  Much closer than I had been led to believe by the press which basically called Governor DeSantis a murderer due to his unmasking policy.  Well, maybe he is, but then so is former Governor Cuomo for sending recovered COVID19 nursing home patients back to the nursing to infect the vulnerable

The numbers in Massachusetts are pretty stable and large enough to be significant. Now maybe this is seeing signs of life where none exist due to lags in reporting due to the Christmas holiday etc. etc.   But if it isn’t, it is good news.  I await next week’s numbers with great interest.

Addendum 30 Dec — Well it was wishful thinking.

Second — the data from Florida as of 26 December– according to the New York Times — https://www.nytimes.com/interactive/2021/us/florida-covid-cases.html

There are 4 graphs, a big one on the top of ‘cases’ from March 2020 to the present.  You can click on it at any point and see how many new ‘cases’ there were that day.

In case you can’t, here are a few numbers.

Date                 new cases

24 December  31,683

23 November   1,605

Certainly, surge enough for anyone.

Now  below this there are 3 more graphs (but each is shrunk down to 1/3 the size of the top one to fit).  They are from left — number of tests, number hospitalized, and number of deaths.

Note the left most — the number of tests increases in December about the same way the number of cases does  — so although there is a surge, it may be due (in part) to increased testing.

Note the two right most graphs — hospitalizations and deaths.  They don’t really budge in December.

In particular the deaths appear to have declined.  Again a caveat about the reporting accuracy over the Christmas holiday.

Also note that Florida with a population of 20 million or so had only 2,005 COVID19 patients in hospital on Christmas day, while Massachusetts withs 6.7 million had 1,505.  So what has Florida done that we’re not doing up here?

Addendum 27 December — the number of COVID19 cases in hospital in Florida 26 December was 2129 a 6% increase from 25 December.

Addendum 28 December — the number of COVID19 cases in hospital in Florida 27 Dec  2228 another 5% increase

Addendum 29 December — the number of COVID19 cases in hospital in Florida 28 Dec 2,560 — a big increase

Addendum 30 December — the number of COVID19 cases in hospital in Florida 29 December is 2,963 — another big increase

Addendum  31 December — the number of COVID19 cases in hospital in Florida 30 December is 3,376

I should have reported the number of deaths earlier, but didn’t, but I will start now.  It is given daily by the NYT, but the graph of deaths isn’t interactive and you can’t pick these numbers from it

There were 22 COVID19 deaths in Florida on the 26th.

There were 18 COVID19 deaths in Florida on the 27th

There were 16 COVID19 death in Florida on the 28th — increase sure to follow the increase in COVID19 cases in hospital

There were 16 COVID19 deaths in Florida on the 29th — increases sure to follow

There were 19 COVID19 deaths in Florida on the 30th  — increases sure to follow

I plan on daily updates for the rest of the week, so you’ll be able to draw your own conclusions.  Look at the third graph in the second line, it doesn’t look like deaths are surging.

But if accurate, the conclusion is inescapable — the currently extant virus variant (omicron) simply is NOT putting people in the hospital the way the earlier surges did.  Again have a look at the preceding 3 bumps in hospitalization for COVID19 since March 2020, and note how they parallel the number of cases.

Addendum 30 December — nothing like new data to make you change your mind. Going from 2005 hospitalized COVID19 cases 25 Dec to 2,963 on 29 December in FLorida is a significant surge.  The fat lady hasn’t sung in Massachusetts, New York or Florida.  The pandemic is surging where it counts — hospitalized COVID19 patients.

It is thought that the omicron variant accounts for over 50% of new infections no matter where you are, and over 90% in the NY metropolitan area.  So the surge in the new variant may actually be a good thing in that it is replacing delta (the previous dominant variant), a more virulent form of the virus, by a more innocuous one,.

Stay tuned and relax a bit.

Yet another Addendum 29 December (if you can stand it)— yesterday the CDC said that it had overestimated the prevalence of omicron — According to agency data, omicron accounted for about 59 percent of all U.S. infections as of Dec. 25. Previously, the CDC said the omicron variant comprised 73 percent of all cases for the week ending Dec. 18. But that number has now been revised to 22.5 percent of all cases.– https://covid.cdc.gov/covid-data-tracker/#variant-proportions

So that means that omicron deaths won’t be as large as the initial prevalences given by the CDC implied. Revisions of data are common and unavoidable in a fluid situation like this.

Reasoning about data as it comes in is exactly what scientists do.  I love doing this. Any guesses as to what tomorrow will bring?

Is China following a Smokey the Bear policy on the pandemic?

China is following a prevent pandemic virus infection policy, just as Smokey the Bear followed a prevent forrest fires policy.  The latter didn’t work out well, as although fires were prevented for a while. However, when fires did occur, they were much much worse than the smaller ones Smokey prevented.  There was much more tinder and stuff to burn.

Actually Smokey has changed his tune slightly.

https://en.wikipedia.org/wiki/Smokey_Bear  SmokeyBear.com’s current site has a section on “Benefits of Fire” that includes this information: “Fire managers can reintroduce fire into fire-dependent ecosystems with prescribed fire. Under specific, controlled conditions, the beneficial effects of natural fire can be recreated, fuel buildup can be reduced, and we can prevent the catastrophic losses of uncontrolled, unwanted wildfire.”

Revision 14 December 2021 — China’s policy of prevention has resulted in a Chinese population which has been vaccinated using two killed virus vaccines (Sinopharm, Coronavac).  They have not had any natural infections with the virus (aside from the original cases) as far as we know given what China has allowed out.

Infection with the virus itself exposes you to all its proteins, with your immune system responding to all of them.   Western vaccines are just to the spike protein.

It tends to be forgotten that moist cases of pandemic viral infection are asymptomatic.

Given 800K deaths  from COVID19  in the USA, how can I possibly say this is good. Here’s how :>

If you had an infection with the virus, you develop antibodies.  Nowadays, everyone who is vaccinated has antibodies so there is no point in testing for them, but what were things like in the days before vaccines?

The following is from a post July/2020.

https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html–https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html.

New York State  randomly tested 3,000 people at grocery stores and shopping locations across 19 counties in 40 localities to see if they had the antibodies to fight the coronavirus, indicating they have had the virus and recovered from it. With more than 19.4 million people residents, according to U.S. Census data, the preliminary results imply that at least 2.7 million New Yorkers have been infected with Covid-19.They weren’t all hospitalized.

Here’s some work the same month from Queens — https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html

At a clinic in Corona, a working-class neighborhood in Queens, more than 68 percent of people tested positive for antibodies to the new coronavirus. At another clinic in Jackson Heights, Queens, that number was 56 percent. But at a clinic in Cobble Hill, a mostly white and wealthy neighborhood in Brooklyn, only 13 percent of people tested positive for antibodies.

So the disease has already to spread to half the population in some neighborhoods in Queens. If even 10% of them were sick that would have been 140,000 hospitalizations.  They didn’t happen.

OK, so a lot more people were infected than got sick.  Why is this good?

Enter the omicron variant of the pandemic virus.  It can evade the antibodies produced by all the current vaccines (in the West — protection against the Chinese killed viral vaccines CoronaVac and Sinopharm isn’t known yet).   Yet omicron doesn’t appear to produce severe disease. Thus far…

 

The CDC in the past week said of the 40+ omicron cases it knows about (there certainly are more out there, and more to come), there was one hospitalization (for two days) and no deaths.

Here is Dr. Fauci 12 December 2021 — “We’re getting anecdotal information … not necessarily confirmed yet, that the level of severity appears to be maybe a bit less than in the Delta. But there are a lot of confounding issues that it may be due to the underlying protection in the community due to prior infections,”

Source — https://nypost.com/2021/12/12/omicron-appears-to-evade-some-protection-from-covid-vaccines/

So the Chinese population may be sitting ducks for omicron having been given vaccines (Sinopharm, Coronavac) of unknown potency against omicron.  If their statistics are true there has been little or no natural infection with the pandemic virus in the Chinese population (which Fauci has just implicated is protective),.  Given that I have a son, daughter in law and two grandkids living in Hong Kong, I find this extremely disconcerting.

Next up omicron itself and how it came to be.  The possibilities are even more disconcerting.

What is a case of COVID-19?

If you are the medical equivalent of Joe Six Pack, not having the benefit of education in a health field, a case of COVID-19 is not what you think it is.

Doubtless you are worried about the latest variant (omicron aka B.1.1.529) and reading what you can about it.

A normal person like yourself, thinks of a case of something as an illness where you don’t feel well.  Not so with COVID-19.  If they find the virus in your mouth or nose, you’re a case, even if you’re perfectly well, and only had the test so you could visit a friend in the hospital.   We know very well that some people can carry the virus without being sick.

Also remember the number of ‘cases’ depends on how many people get tested, just as the number of fish caught depends on how many people fish.  The number of cases is certain to go up now that we’re all scared (as we should be).

So what are you to do (aside from wearing a mask and getting vaccinated or a booster?)  Watch two things

l. The daily number of people in the hospital with COVID-19 (averaged over a few days)

2. The daily number of deaths from COVID-19 (averaged over a few days, as reporting is always lousy over the weekend.

The news about omicron changes hourly.  Since this morning, Colorado has reported a case, and the New York City area has 5.

On the positive side, none of these people has been hospitalized.  We should know how bad omicron is in a week or two, as it’s clearly all over the world.  Interestingly cases had spread to Europe before the South Africans discovered the virus 24 November (based on what we know now)l

One far out but positive note.  None of the (very few) cases reported today (2 December 2021) have been hospitalized.  It is even possible that this is all omicron will do, and because it appears to be far more infectious than the delta variant it is replacing, it may immunize our population not by vaccination but by infection.

Sadly, the following post (19 May 2021)  had no effect whatsoever.

Anti-vaxers, what is it that you know that we don’t ?

32 members of the University of Pennsylvania Medical School class of 1966 held a 55th reunion by Zoom a week ago.  All 32 have been (voluntarily) vaccinated.

Among the attendees were

l. Mike Brown — Nobel Laureate whose work led to the statins — https://en.wikipedia.org/wiki/Michael_Stuart_Brown

2. Jerry Gardner — All American Basketball Player Kansas ’62  — https://kuathletics.com/roster/jerry-gardner/ — but far from a dumb jock — established a GastroIntestinal program at the National Institutes of Health

3. An (emeritus) professor of neurology at the University of Rochester Medical School

4. The (emeritus) director of the radiology residency program at Yale Medical School

5. An (emeritus)  professor of medicine at Albert Einstein Medical school

6. A (retired) Rear Admiral in the US Navy

There are several more deans and professors among the 32, but you get the idea.

All classmates who spent their careers taking care of the sick (such as yours truly) were board certified in their specialties.  Some were even board examiners for certification in their specialties (such as yrs trly).

Don’t do as I do, do as I say never works.  Anyone who’s raised kids knows that.  The Penn Med class of 1966 has put its money where its mouth is.

So what is it that you know about vaccines that we don’t?  Please get vaccinated.  The new strain (B.1.1.7) is 50% more lethal and much more infectious than the original pandemic virus  [ Nature vol. 593 pp. 270 – 274 ’21 ].

Addendum 20 May:  I thought the following comment and my response were worth placing in the body of the post.

From DH :The one thing everyone in your sample has in common is old age and thus relatively high risk of death if infected with COVID. A lot of the people I argue with online are not absolute anti-vaxxers, but claim that for healthy people under 30, the risk-reward calculus favors not getting vaccinated (e.g., because the vaccines were “rushed”).

I disagree with them, but to be fair to them, your class of 1966 example is not an argument that addresses their claim.

Response:  DH — thanks for commenting: I quite agree with what you say, but there are larger issues. My sample is small but I know several antiVaxers in their 70s. The proportion of unvaccinated minorities is larger than their proportion in the population. Many of them live in multigenerational households so an infected 30 year old could kill granny. Just look at what’s going on in India.

Even worse is the fact that the newer mutations may be more virulent as well as more infectious. This has now been shown to be the case for B.1.1.7 [ Nature vol. 593 pp. 270 – 274 ’21 ]. Even if the vaccines aren’t quite as effective (in vitro) against the new strains, they still offer protection. We will inevitably continue to see new mutants. A vaccinated population is our best hope.

These are the people who ‘believe in Science’

It certainly passeth my understanding why the travel ban on flights from Africa to the USA is to begin 2 days from (27 November)  now on Monday (29 November) rather than immediately.   This is from the ‘adults in the room’ running our country who supposedly ‘believe in science’.

Sixty-one people who arrived in Amsterdam on two flights from South Africa have tested positive for Covid-19, Dutch officials say.

They have been placed in isolation at a hotel near Schiphol airport.

They were among some 600 passengers held for several hours after arrival while they were tested for the virus.”  — source — https://www.bbc.com/news/world-europe-59442149.

The new bug (omicron variant to avoid using nu for confusion with new and xi for confusion with you know who (these were the next letters in the Greek alphabet)) is clearly incredibly infectious, based on 10% of the passengers in two flights being positive for a coronavirus.

The time to ban flights from southern Africa is now, not two days from now as have the European Union and many other countries have done.   Perhaps the President didn’t want to be accused of racism, the way he accused President Trump when he did the same thing in 2020.

Now a bit abut the omicron virus itself and why it is of such concern.  The protein of the virus which gloms on to our cells is the spike protein which is large (over 1,000 amino acids).  300 of them are involved is actually binding to a receptor (ACE2) on our cells.

Omicron has changed (mutated) some 30 of them, many more mutations than most viral variants contain.  Remember it just took one mutation of one amino acid  of beta globin to cause Sickle Cell Anemia.  Some of these mutations have been found in other SARS-CoV-2 variants, and these were associated with (1) increased infectivity (2) ability to evade existing antibodies to the virus.   So far there is no evidence that the omicron variant is associated with more lethal disease, but absence of evidence is not evidence of absence.

It is important to remember that all information about omicron does not come from peer – reviewed journal articles — it’s just too early, as the first mention of the virus was 14 November, so all of this may change.  Reports from the battlefield are always fragmentary and inaccurate.

 

 

President Biden possibly has Occult Hydrocephalus (Normal Pressure Hydrocephalus)

President Biden possibly has Occult Hydrocephalus (Normal Pressure Hydrocephalus).  That’s quite a mouthful. Here are  three levels of explanation, short, medium and long depending on what you already know.

The short explanation — justification for each statement later  – “Extraordinary claims require extraordinary evidence.”  ― Carl Sagan

l. President Biden had a subarachnoid hemorrhage due to an aneurysm in his head years ago.

2. President Biden is in early dementia

3. President Biden is having changes in his walking, one of the reasons leading to his recent medical evaluation

Subarachnoid hemorrhage is one of the most common causes of Occult Hydrocephalus (Normal Pressure Hydrocephalus { NPH } )

Symptoms of NPH are progressive dementia and gait disturbance. So he fits the pattern.

A brief primer on hydrocephalus.  We all have water on the brain (e.g. cerebrospinal fluid  {CSF } ).  We make about two pints a day in the ventricular system of the brain which lies deep in the brain — https://en.wikipedia.org/wiki/Ventricular_system.  It flows out of the ventricles to the surface of the brain where it flows over the surface and is absorbed.   You can imagine what happens if there is a problem absorbing CSF.  Secretion doesn’t stop and the ventricles get bigger  (the origin of the term hydrocephalus), and pressure rises usually along with headache and serious neurologic problems.

It is thought that after subarachnoid hemorrhage, scarring occurs impeding CSF flow, just enough to enlarge the ventricles, but not enough to raise pressure in the head.  Amazingly this can occur years after the bleed and is called normal pressure hydrocephalus (NPH) or occult hydrocephalus (occult because it doesn’t present in the usual way with headache etc. etc.)

NPH was discovered in the late 60s when I just entered neurology.  It was tremendously exciting for patients and docs, because it represented a treatable cause of dementia.  The treatment is placement of a shunt (hollow pipeline) from the ventricular system to the surface of the brain (or elsewhere).

It is extraordinarily easy to diagnose hydrocephalus these days. Just do an MRI or a CT scan and see how big the ventricles actually are.  It is important to note that President Biden should never have an MRI.  High magnetic fields are used, and if the clip placed on his aneurysm by the neurosurgeon contained any magnetic material, the clip would be ripped off the artery causing a fatal hemorrhage. This has actually happened to a few unfortunate patients in the early days of MRI and Biden’s aneurysm surgery was 1988 in the early days of MRI.

The medium explanation

l. Biden’s cerebral aneurysm — I have a whole post on the subject — https://luysii.wordpress.com/2020/12/08/bidens-cerebral-aneurysm/ which is reproduced below the ***

Interestingly, I knew the neurosurgeon who operated on him (Neal Cassell), back in the day when I was a neurology resident and he was a Penn undergraduate, already very interested in neurosurgery.

The post concludes with “I think the chances of occult hydrocephalus developing 32 years after the aneurysm are remote. If it were going to happen it would have already. In the meantime, watch him start to walk.”  Well that was written 8 December ’20, and he’s having trouble walking now.

2. Biden is in early dementia — certainly the most controversial statement in the post.  It’s based on years of clinical experience trying to taking care of demented patients.  Don’t take my work for it  please look at the following post — it contains lots of clips of him speaking (C-SPAN etc. etc.)– just look at them and make up your own mind if he is functioning normally during them.  Remember the symptoms of early dementia are always intermittent.  Here’s the link Vhttps://luysii.wordpress.com/2021/08/20/biden-is-in-early-dementia-yet-more-evidence/. The entire post is reproduced below the &&&&

3. Biden is having changes in his walking — this is the easiest — https://www.whitehouse.gov/wp-content/uploads/2021/11/President-Biden-Current-Health-Summary-November-2021.pdf.  It is incredibly detailed and thorough, I’m not going to reproduce it, but here are a few quotes “The president’s gait is perceptibly stiffer and less fluid than it was a year ago.”

 

 

They put down his gait disturbance to a mild peripheral neuropathy, old foot fracture, spinal arthritis, but they didn’t consider NPH.
I think he should have a CT scan of his head (never an MRI for the reasons above).  It might reveal a treatable cause of his early dementia.
The long explanations 
***

Biden’s cerebral aneurysm

A friend sent me a semi-hysterical rant from a neurosurgeron about the dangers of President Biden’s cerebral aneurysm. Not to worry. This happened in 1988 and was successfully clipped although it ruptured during surgery. The only possible complication at this point is normal pressure hydrocephalus (occult hydrocephalus). That’s a medical mouthful so here’s some background to put it all into context.

If you’ve ever seen a blister on an inner tube, that’s what a cerebral aneurysm looks like. They usually look like a round ball on the side of an artery in the brain. They look nothing like an aneurysm of the aorta. To treat them, one puts a clip around the neck of the aneurysm, so to prevent the pressure in the adjacent artery from bursting it. As Dr. Tom Langfitt, the neurosurgeon who taught medical students, interns and residents at Penn Med in the 60’s said “they’ll stare you down every time”. To put a clip around the neck of the aneurysm you have to jiggle and move it, which may cause it to break. This happened during surgery on President Biden in 1988.

Remarkably, Neal Kassell, the neurosurgeon operating on President Biden was an undergraduate at Penn when I was a neurology resident there in ’67 – ’68. Even before med school (graduating Penn Med in’72) he was vitally interested in neurosurgery and hung around the hospital and would observe Langfitt in action in the OR.

What is there to worry about? Relatively little. It is possible that Biden is developing another aneurysm. One well known complication of a ruptured intracranial aneurysm is something called occult hydrocephalus (or normal pressure hydrocephalus). Blood is extremely inflammatory, and the inflammation can resolve causing scarring (fibrosis) of the linings of the brain. This can impede the flow of spinal fluid.

What are the symptoms? Cognitive decline for one, something that’s been endlessly discussed by pundits, politicians and the voters. The other symptom which even you can look for is difficulty walking, in particular beginning to walk. People with this seem to have feet glued to the floor and have problems initiating walking.

Diagnosis — in Biden’s case, a CAT scan to see if the cerebral ventricles are larger than they should be — https://en.wikipedia.org/wiki/Ventricular_system has great pictures and explanation.

Why not an MRI — because the clips used back in 1988 contain magnetizable material, and entering the strong magnetic fields of an MRI scanning would rip the clips off the aneurysm and kill Biden.

I think the chances of occult hydrocephalus developing 32 years after the aneurysm are remote. If it were going to happen it would have already. In the meantime, watch him start to walk.

Biden is in early dementia — yet more evidence

This is the third post arguing that Biden is in early dementia.  Today’s post is  based on his performances on the 18th of August and today 20 August.  The previous 2 posts can be found below the ***

Addendum: 23 August.  Don’t take my word for it.  All the material in this post  is evidence — please look at the linked videos and quotations and decide for yourself.  Your conclusions may be different from mine, but at the least you will see the evidence on which mine are based.   If you disagree, I’d love to see a comment. 

On the 18th in an interview on ABC with George Stephanopoulos a transcript contains the following exchange

“STEPHANOPOULOS: I– I think a lot of– a lot of Americans, and a l– even a lot of veterans who served in Afghanistan agree with you on the big, strategic picture. They believe we had to get out. But I wonder how you respond to an Army Special Forces officer, Javier McKay (PH). He did seven tours. He was shot twice. He agrees with you. He says, “We have to cut our losses in Afghanistan.” But he adds, “I just wish we could’ve left with honor.”

BIDEN: Look, that’s like askin’ my deceased son Beau, who spent six months in Kosovo and a year in Iraq as a Navy captain and then major– I mean, as an Army major. And, you know, I’m sure h– he had regrets comin’ out of Afganista– I mean, out of Iraq.”

Doesn’t he know which branch of the service his son was in? Did he think his son was in Afghanistan?  My wife and I know where our 4 uncles served in world war two.

Unsurprisingly, ABC did not put this exchange on the air.  It was only found by reading the transcript.  Pravda could have done no better.

Today

“President Biden: (12:15) Look, let’s put this thing in perspective here. What interest do we have in Afghanistan at this point with Al Qaeda gone? ”

They aren’t gone according to Pentagon spokesman John Kirby.  At a briefing following Biden’s remarks Kirby said that there remains an al Qaeda presence in Afghanistan.

Wasn’t Biden told this?  If he was did he forget it?  Where is the shrink from Yale who wanted remove Trump using article 25 of the Constitution back in the day.

At least the questions he’s getting are no longer of the “what’s your favorite ice cream?” variety.

Here are two such questions.

Stephanie Ramos: (18:42)
Yeah. Thank you, Mr. President, two questions for you. The military has secured the airport, as you mentioned, but will you sign off on sending US troops into Kabul to evacuate Americans who haven’t been able to get to the airport safely?

President Biden: (18:56)
We have no indication that they haven’t been able to get in Kabul through the airport.

Given the incompetence of our intelligence this may actually be what Biden has been told.  Reports from Kabul say exactly the opposite.  It is also possible that Biden has been told what is going on there and simply forgot or is lying.

I have friends who have told me they’d rather have a demented Biden than an undemented Trump.  It looks like they’re getting their wish.

Here’s the previous post which contains older evidence.

*****

Biden is in early dementia — more evidence

In an earlier post (reproduced below the ***) I gave my reasons based on (presumably unedited) tapes of the President for concluding that President Biden is in the early stages of dementia.  I am a retired board certified neurologist and occasional board examiner with 34 years of clinical experience.

Here is further evidence.

In a town hall meeting put on by CNN 21 July President Biden became rather incoherent and confused when answering “When will children under 12 be able to get vaccinated.”

Here is the (presumably) unedited video of the meeting — https://www.cnn.com/2021/07/21/politics/full-president-joe-biden-cnn-town-hall-july-21/index.html.

The question was asked 6 minutes and 20 seconds into the recording.  The response starts to make not much sense at 7 minutes and at 7 minutes 21 seconds, he briefly becomes incoherent.  He continues on in this vein up to about 8 minutes.

This is what early dementia looks like.

Well that’s my opinion.  Look at the tape and make your own.

****  The earlier post

Biden is in early dementia — the evidence

As a neurologist I am often asked about Biden’s mental capacity.  My first post on the subject occurred after the first debate with Trump.  I thought he was intact — you can read about it here.

https://luysii.wordpress.com/wp-admin/post.php?post=5200&action=edit&calypsoify=1

Then I was asked to comment on the possibility that his previous operation for aneurysm could be causing trouble. I didn’t think this was likely as so much time had passed.  Interestingly, I knew the neurosurgeon as a Penn undergraduate when I was a neurology resident.  You can read the post at the end — Biden’s cerebral aneurysm.

That was written last December.

I changed my opinion after his press conference. of 14 June ’21 https://www.youtube.com/watch?v=PAWRHM4i3Dg
I strongly suggest you look at the segment at 15 minutes where his response makes little sense, and then he shuts down completely for 7 seconds, apparently quite confused. That’s my reading of the video. Form your own opinion.

Then on June 23rd I was sent another clip where he was confused

It is an 8 minute speech, and the clip can be found at 2 minutes, again showing an episode of confusion.

 

But first a story:

As a third year medical student on psychiatry rotation,  I interviewed a Bryn Mawr student who was on the psych ward (my wife was also an undergraduate at the time).  I well knew the intensity of the place, and how much pressure the girls (see the end of the post) put on themselves.  So I talked and talked and commiserated with her.  After a pleasant enough time the I concluded the interview and left.   The teaching psychiatrist asked me what I thought, and I told him how frigtening I found it given what I knew about Bryn Mawr. He asked me if I found out that she thought the television was talking to her.  Basically by yapping when she went off track, I kept her sane.

So I learned to shut up, and let people tell me what was wrong with them.  This is why Biden likely did well during the debates. The short time given to answer and the barrage of questions and interruptions kept him focused.

It really came home as I looked at the whole 8 minutes of the second clip trying to find the brief period of confusion.  Please look at the whole clip yourself and draw your own conclusions.  I see a pleasant,  rambling, slow thinking,  occasionally confused old man.

 

This is what early dementia looks like.

I was severely criticized by a follower after the first post.  Here it is,  “Issuing alarmist statements about his mental health is reprehensible. You are not his physician. Moreover, armchair diagnosis is frowned upon by the American Psychiatric Association.I’ve been following your blog for several years and also have been reading you comments on the “in the pipeline” blog. On the basis of that experience I had not expected to stoop that low.”

In my defense, I was defeated by the new WordPress editor which wouldn’t let me bring in the evidence shown here.  Apparently it was a (still extant) incompatibility of Safari with the editor.   I was still impressed enough by how confused Biden looked that I posted it anyway.

As the late Carl Sagan said “extraordinary claims require extraordinary evidence”. So here is the evidence (finally).  Apologies for the delay.

As children, our least favorite explanation was ‘because I say so’.

Essentially that’s part of what I’m offering here.  I was involved in clinical neurology from ’67 to ’00, and at a minimum saw at least 1 demented patient a week during that time.  That’s an underestimate, as I’d make rounds on other neurologists patients when covering weekends.  I doubt that anyone reading this has similar extensive experience.

So Biden just looks like all the early dementia patients I saw during that time.  Given my experience, I think that should carry some weight.

The fact that Biden appears sharp at times is typical of early stage dementia.  I’ve certainly seen it in family and friends, with such things being excused as ‘it must have been the heat’ or ‘they must not have been feeling well’.

Why is this important?  Khrushchev’s estimate of President Kennedy’s weakness lead to the Cuban Missile Crisis of 1962. Khrushchev’s son confirmed this when he spoke at the Kennedy Center at Harvard.   Kennedy was receiving narcotics for his back.  The side effects of what little medicines we had back then weren’t appreciated.  Example: thyroid and amphetamines were used to help people lose weight.

Biden does not appear mentally strong to Putin or Xi (or me).