Indefatigable

By Dr. Jim Ferguson

How do you know what you know is correct? After watching the Super Tuesday election results, it is apparent TV pundits are clueless. It begs the question, why do we still listen to people who are so often wrong?

The crux of my original question concerns facts. Using our senses, we gather facts (data) by reading, listening and observing the world around us. However, common sense is required to sift through and then correctly interpret any data.

I have a friend who once challenged me with the notion that facts are conditional. A fact is something that is always true. For example, a meter is an observable and measurable fact. Yet, at the extremes of reality, such as the speed of light, Einstein proved that our notions of facts are conditional. Though I like to consider philosophical constructs, I live in the realm of practical science and common sense, so enough philosophizing.

Lately, it’s hard not to think about the novel coronavirus (Covid-19). I wrote about viral infections a month ago, but I now offer an apology. I made a mistake calculating influenza mortality.

Experts use a complicated series of estimates to come up with their “facts.” In sifting these facts, my math failed me. When experts only consider verified cases of influenza, excluding colds and generic “flu” cases, and adding complications such as pneumonia, etc. to their complicated formula, influenza mortality is around 0.1% or one in a thousand.

The death rate from the new coronavirus is perhaps 2-3%, if you believe the Chinese data (facts). Our experts put the mortality of coronavirus at three times that of the flu, but these “facts” don’t line up so, I remain skeptical of most things these days.

At this writing, there have been twelve deaths in America due to Covid-19. By comparison, 8400 Americans have already died from influenza in January and February. And in the same two months of 2020, there have been 141,000 abortions, 127,000 deaths from cardiovascular disease and stroke, and 96,000 have died from cancer.

We moderns trust test results. But should we? Every flu season doctors use swabs of the nose and throat to test for the influenza viral protein. These tests depend on the nurse or doctor obtaining a deep and uncomfortable specimen from the nose and throat. Then, high tech colorimetric strips are used to detect viral protein, assuming sufficient quantities of the virus are present to be measured and have not degraded in transport to the lab. Lastly, the influenza test strips are imperfect technology.

When considering test results, I have preached to medical students for more than forty years that any test must be considered in the context it is done. This is the practicality of Thomas Bayes’ probability theorem which says results must be interpreted within a clinical situation, and I might add, with common sense. I’ve had patients evaluated in the ER for chest pain who were erroneously diagnosed with influenza by a flu swab. I’ve had others whose diagnosis was missed by a negative swab test. If you do enough tests you will eventually get false positives and negatives.

I am concerned about the testing capabilities of the Chinese and certainly the Iranians. I read on the Internet that dozens of South Korean companies are promoting their own coronavirus tests. I have greater confidence in testing procedures of the CDC and far less confidence in World Health Organization bureaucrats. Rapid tests for coronavirus are being developed in America, but this is a highly technical enterprise. Tests must be accurate, done appropriately and interpreted correctly or the results may do more harm than good.

Doctors use the terms sensitivity and specificity in considering test results. You can design a test which is very sensitive, but this will lead to some false positive results. Alternatively, a test designed to be very specific will lead to some false negative (missed) results.

The definitive diagnosis of Wuhan coronavirus is identifying its DNA. This is a high-tech process requiring PCR (polymerase chain reaction) amplification of specimen protein and then genetic analysis.

I spoke with a colleague representing many Knoxville area ER doctors and the Knoxville Health Department regarding coronavirus testing. Until such time when local testing is reliable and feasible, samples are collected from patients, transported by courier to the Knox County Health Department and then to the Tennessee Department of Health in Nashville where the PCR process and genetic analysis takes another 48 hours.

Though Covid-19 infection may be more dangerous than influenza, the risk of infection is still low in America. As a result, I’m not panicked by the media’s politically motivated fear mongering. I am however practicing prudence. I recommended two patients not travel to Southeast Asia for a cruise. I recommend frequent handwashing and carrying a pocket hand sanitizer. It seems reasonable to wipe down your personal space with Handi Wipes during any flu season, especially this one. Also, staying an arm’s length from others is advisable, especially if they look sick or are coughing. I read that the French are suspending their Gaelic custom of La Bise, greeting others with kisses on the cheek. We should be using the “elbow bump” rather than our traditional handshake greeting.

Interestingly, I read a recent Gallup poll where 77% of Americans are confident in President Trump’s management of the coronavirus crisis. I didn’t find this data in the “Drive-by media,” who have called for renaming the Wuhan virus, the Trump virus, and called his January China travel restrictions, racist.

Honestly, how can you support Democrats who say Trump’s Coronavirus Task Force is “too white,” cheered the falling stock market and labeled the coronavirus crisis as an opening for Democrats? Despite Biden and Bloomberg’s clueless parroting of Politico’s lie, Trump did NOT say the coronavirus was a hoax. Perhaps the hype is the newest coup d’état attempt since Mueller’s Russians failed, the Kavanaugh and “golden shower” assaults were unsuccessful and the Ukraine phone call impeachment was a bust.

And through it all, our indefatigable leader, Donald Trump towers over “mini Mike, Pocahontas, Sleepy Joe and Bolshevik Bernie.” We need a leader, not a gaggle of “nattering nabobs of negativity.”

As I’ve said before, Donald Trump was not my first or second choice, but now I’m unabashedly supportive of our President. I can’t begin to keep up with seventy-three-year-old Trump; he has far more energy than me.

So, I will do what I can to stay informed, “speak the truth in love” and support our country and the President. This is just common sense.

For further information you can access the Tennessee Department of Health website for answers and updates at www.tn.gov/health/cedep/ncov.html.

 

 

 

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