Vol. 230 April 1, 2020 Biden Picks His Running Mate

March 31, 2020

Press Conference

Former Vice President

Joe Biden

(Official Transcript   April 1, 2020)

BIDEN: Good morning everyone. I am glad to see all 8 reporters are sitting 6 feet from each other. I know it is burdensome, but we must work together to defeat this awful Zika. . . Rebola. . . flu . . . er, what?,  . . . I mean, you know, the Coroner virus.

Speaking of the current virus crisis . . . boy that has a nice ring to it, doesn’t it? . . . it almost rhymes . . .I would like to announce my pick of a running mate; Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease of NIH since 1984. . . almost twenty or . . .  er. . . many years ago.

Now before I start to answer your questions, let me give you some reasons for my choice.

Number 1: Dr. Fauci is smarter than I am, but I am taller and younger than he is.

Number 2: He is very experienced. He has worked with many Presidential administrations since he came to Washington . . . in the 1980’s as I remember. He told Ronald Reagan about the AIDS epidemic, advised two Bushs . . .  one of them gave him the Presidential Medal of Freedom . . . by the way, Ben Carson got his medal during that same ceremony, . . . where was I? Oh, yeh . .  .two Clintons . . .  yes two, remember Hilary’s Health Care Plan?. . . and, of course, an Obama or two. 

Number 3: He gives very good TV interviews, even on Fox News with Sean Hannity trying to mislead the viewers.

Number 4: His medical training has given him that special skill that all physicians must have to succeed  — “Always sound right,  and if you don’t know an answer, make one up.”  But he is more like my famous namesakes on Dragnet . . .  Sgt. Joe Friday . . .”Just the facts, Ma’am.”

Now I’ll take your questions.

[Sounds of shouting, general loud babbling, a baby crying, a chair falls over]

REPORTER:  “ Mr. Biden have you moved away from your promise to pick a female running mate?”

BIDEN: Did I say that?  When was that? . . . Oh, it was during one of those debates? . . . I wouldn’t call it a debate, and I wouldn’t call it a promise. It was a statement from which I am now socially distancing myself, and its a very timely question.  .  . .This social distancing is for the pits. I haven’t smelled somebody’s hair in weeks. . . for the record, my test was negative . . . and I will ensure that women’s voices will be heard in my administration by appointing several to my cabinet. Elizabeth Warren naturally will be Secretary of the Treasury. Kamala Harris as an experienced prosecutor would be an excellent head of the Department of Justice . . . I think she is Latino too, isn’t she?. . . I am not sure about Senator Amy Kolbuchucker from Minnesota, but she has great hair. Marianne Williamson, . . . remember her, the physic healer. . . could serve as Chief of Alternate Universes  . . .excuse me, Alternate Therapies within HHS.  Adding Senator Gillibrand to the cabinet would weigh the group too heavily towards New York, since Dr. Fauci is from Brooklyn.  I will, of course,  appoint Tulsi Gabbard as Ambassador to America Samoa.

REPORTER: “Do you have any concerns about any regrettable incidents in Dr. Fauci’s past?”

BIDEN: Not really. My staff has vetted him very thoroughly. The only whiff of scandal we found was his medical school yearbook picture where he was being lifted by two of his taller classmates so as to appear even taller than they. None of them were in black face.

 Also some people may have difficulty knowing how to pronounce his name correctly. It is pronounced as “Fow-chi” with the soft  “chi” sound common to many Italian names, . . .  and as the Senator from Nevada I wish to say that I have many Italian-American friends who are hard-working, decent citizens, but I must excuse myself from this Corleone hearing for another important committee meeting . . . oh, sorry . . . was I channeling the Godfather again?. . .  a great movie.

There is another small concern, since he is from New York City and his name ends in a vowel people may think he is associated with Rudy Giuliani. . . . but  we know that he is taller than Mike.

We have completely debunked the New Yorker Magazine stories that Dr. Fauci has recommended internal alcohol to kill the coronavirus since external alcohol really doesn’t work. In fact, he only recommended it as an antidote to the daily briefings of the White House Coronavirus Task Force. Dr. Fauci also noted that internal alcohol effects may be briefer than the briefings, so viewers may repeat a dose “PRN” (as necessary). 

REPORTER: “ Is it true that as noted in your background Press Release you just handed out that Dr. Fauci was born on Christmas Eve, and are you concerned about any back lash from Trump supporters who regard Trump as the “Second Coming.”

BIDEN: Dr. Fauci is an American. Even though he was born in Brooklyn, as I remember, there is no question about his eligibility for this office. I think that a resurgence of the Birther Movement which was so viscously directed at my close friend and mentor, Barrack Obama, . . .  there I finally got his name out there. . .  would be very unfortunate. Next question.

REPORTER: “Has Dr. Fauci made any significant contributions in fields other than virology and infectious diseases.”

BIDEN: Well let me tell you a down-to-earth, fascinating story of one of Dr. Fauci’s most recent contributions. It will be a short story, I promise. Since the Coroner virus pandemic has taken over all the headlines, editorial pages, social media memes, political cartoons, TV shows, graphic artist shops, and a lot of other things which has displaced our awareness of the Opioid Death epidemic, Dr. Fauci has developed a new attention-getting graphic to replace the familiar 1-10 faces of pain;  the 1-4 faces of Pandemic Panic levels.

REPORTER: “But face 4 is the same as face 2. Isn’t that a confusing message.”

BIDEN: Exactly

“Thank you Mr. Biden, and Happy April Fools Day.

 


Vol. 229 March 15, 2020 Beware the Ides of March

March 14, 2020

In Shakespeare’s play Julius Caesar, a soothsayer attracts Caesar’s attention and tells him:
            “Beware the ides of March.”
Caesar demands:

            “What man is that? Set him before me, let me see his face.”
When the soothsayer repeats his warning, Caesar dismisses him, saying:

            “He is a dreamer; let us leave him. Pass.”

When I started writing this blog a couple of days ago I was going to call it “A Politically Incorrect View of the Coronavirus” because I wanted to say that the virus will not be contained, that it will very shortly be community-wide,  and that we should marshall our efforts at monitoring, protecting, and treating the high risk people. But today, that is no longer “politically incorrect.” Many of our civic leaders and our leading medical scientists (Anthony Fauci, MD is my most famous medical school classmate, Class of ’66 Cornell Medical College) are now labeling COVID-19 as “community spread” , i.e. not containable through contact tracing since the sources are so numerous that we can not pinpoint a source, like the common cold and the flu.  We are now “mitigating” COVID-19, not “containing” it; just trying to “blunt the peak” on the graph of numbers of infected people.

The stakes are higher for COVID-19 (the name of the disease) then for the seasonal flu because it is more deadly to certain segments of our population. The name of the actual virus that causes COVID-19 is SARS-cov-2, and that is a real clue as to the nature of this virus given our experience with previous coronaviruses.

The good news is that the death rate is not expected to be as high as the past two coronavirus epidemics SARS (10% death rate) and MERS (35% death rate). SARS originated in Southeast Asia bats and civets (small, cat-like mammals) . MERS originated in Middle Eastern camels. SARS-cov 2 has been attributed at various times to be transmitted from bats, snakes, and now, pangolins (anteater-like reptiles with scales); all animals available in Southeast Asian “wet markets” of live animals. There is no evidence that implicates domestic dogs and cats as vectors for the virus. There is also no confirmed evidence that a mother can transmit it to her newborn during delivery.

As the number of identified cases increases (the denominator) we were hoping that the calculated death rate would decrease since the actual calculation =  #of deaths/#of cases. It appears now that the death rate could be between 1.6% (University of Bern, Switzerland estimate based on China’s CDC data) to 3.4% (WHO’s estimate from selected outbreaks), clearly at least 10 times the death rate for seasonal flu (0.1%). However, South Korea has the largest number of tested cases with cold symptoms (140,000) and their death rate is 0.6%. Of even more interest, of those 140,000 South Koreans with cold symptoms who were tested, only 4% were positive for SARS-cov-2, i.e. 96% of those with symptoms were infected with the flu virus or some other non-coronavirus.

The bad news is that about half of those in high risk populations who develop significant symptoms will require hospitalization.  80% of those hospitalized will be so sick that they will require ICU care for a number of days. The people at highest risk of requiring hospital-based medical care are those with underlying chronic diseases, called co-morbidities, like congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and those over 80 years old (a stage of life, NOT a co-morbidity thank you!).

Nearly 90% of COVID-19 cases have been in people between 30-79 years old. Less than 1% were in children under 9 years. Despite this fact that children are not the primary vector for this virus (unlike influenza), we are closing many elementary schools. In the swine flu epidemic of 2009 we closed 1300 schools for 7-14 days because of evidence that children were primary vectors for its spread. Despite the run on toilet paper resulting in empty market shelves, diarrhea is not a common symptom of the disease.

If COVID-19 is going to be as common as a cold or the flu, but has a lethal potential for select groups of people, how do we triage the people who think they have it while we wait for the coronavirus nasal swab test to become widely available?
The simplest triage diagram has just three branches in the decision tree:

  1.  If you have cold symptoms (but remember a runny nose is not a common symptom of COVID-19) — treat it like a cold with rest, fluids, and decongestants and try not to spread it to other people. (YOU wear the mask, not everybody else)
  2. If you have a fever over 101 and a cough — go see your primary care provider.
  3. If you have the above and feel weak or tired and are short of breath — the PCP may send you to the hospital.

How do people with COVID-19 die?  In the severe stage of the disease (called ARDS- Adult Respiratory Distress Syndrome) respirator machine support (a ventilator) in an ICU is usually needed. Another cause can be an overwhelming secondary bacterial pneumonia and sepsis later in the disease (similar to deaths caused by the flu) and, unexpectedly, some deaths have occurred without pneumonia or severe lung inflammation, particularly in patients with very high blood pressure or those on kidney dialysis.

Watch out for advertisements of fraudulent cures or “protections” from COVID-19. The FDA has formally warned 7 companies, including the Jim Baker Show, that their advertisements for “silver solutions” to kill the virus must stop. There is no evidence that solutions of colloidal silver can kill the virus. Vitamin C is no help either. If Purell with alcohol can kill the virus some people think that alcohol by mouth could kill it. Unfortunately alcohol does not kill the virus. Soap and water or bleach does. Do NOT gargle bleach.

The AMA has responded quickly to the epidemic and filed a request for a rush approval of a CPT code for COVID-19 testing (necessary for insurance reimbursement, hence maybe the urgency of the request). AMA President Patrice A. Harris, M.D., M.A. has said,  “By streamlining the flow of information on novel coronavirus testing, a new CPT code facilitates the reporting, measuring, analyzing, researching, and benchmarking that is necessary to help guide the nation’s response to the public health emergency.” Also as I said, health insurance companies will be asked to pay for the test.

Two surveys released this week show that the Corona beer brand is suffering from a negative buzz. A 5W Public Relations poll of 737 beer drinkers in the U.S. showed that 38% of them wouldn’t buy Corona “under any circumstances”, and another 14% said they wouldn’t order a Corona in public.  However, Corona beer and seltzer sales actually increased in February.

 


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