Measles, Influenza, Covid: Tales from the Crypt

 

Of all the people Mad Dog has seen die, and there were scores of them who died when he was training, one stands out from the rest. 

It's not entirely clear why, but likely has something to do with her youth and the unexpected nature of her course of illness.

Mad Dog had seen people die with great regularity at the Memorial Sloan Kettering Hospital for Cancer and Allied Diseases, but they had cancer and were expected to die and when they did, some of them welcomed death.

This woman was 21 years old and brought to the emergency room by her boyfriend. The ER resident called Mad Dog down saying, "She just looks...dusky."

The admission game in the ER is that the ER resident has to justify why he thinks a patient is sick enough to require admission because the intern getting that patient is going to be working for hours no matter how sick or not sick the patient may be, and the intern wants to be convinced the case justifies all that effort. 

But in this case, the ER resident was not calling an intern, he was calling Mad Dog, who by then was a senior resident, and it was Mad Dog's job to decide if the patient was sick enough to warrant a precious ICU bed. In those days even a big city hospital like The New York Hospital only had 12 intensive care unit beds, and those were on the Cardiac Care Unit and were, theoretically reserved for people with heart attacks, usually men in their 50's, but here the resident was pitching admitting this 21 year old woman to the CCU, and she had no heart problems. 

What she had was "dusky." Even in the fluorescent lights of the Emergency Room, you could see it. Dusky means sort of gray/blue. 

Mad Dog's job was to look at her and say either yes or no. If it was no, she'd go the ward, where each nurse had a dozen patients and more at night, and this was just before midnight. 

She was lethargic, but awake, not comatose, and the ER resident had done blood gases and her oxygen level was 60, which had to be a mistake.  Arterial blood oxygen was 90-98% not 60. This was in the days before those little finger gizmos which show you your oxygen saturation--to know the arterial oxygen level you had to stick an artery--usually we used the radial artery in the wrist and then plop the syringe in an ice cup and press on the wrist for 15 uninterrupted minutes. Sometimes, if you missed the artery you hit the vein next door and Mad Dog thought the ER resident had inadvertently sent off venous blood.

This being night time, there was no nurse to do the compression, so Mad Dog did all that and then ran the cup up to the lab on the 9th floor. By the time he got back to the ER, breathless and wondering what his own blood oxygen level might be, the lab tech was on the phone with the results: 60, again. And Mad Dog knew for sure that was an arterial blood--the syringe had pumped up a centimeter with each heart beat, just the way it should have. 

So Mad Dog wheeled her gurney up the the CCU where the intern and resident were nowhere to be seen, busy with other crises and Mad Dog remained with her for a while. She just got bluer and bluer and more and more obtunded and before we even had a chance to put her on a respirator, she arrested (cardiac arrest) and died right in front of us, the nurse and Mad Dog. 

It was flu season, so the hospital was packed, every bed occupied, some patients on beds in hallways, and when the autopsy results came back we understood why she never stood a chance: Her lungs were the consistency of liver. Normally lungs are sponge like, pretty fluffy and light and moist, but these lungs were thick and heavy and maroon, and there was no way air would come into contact with the delicate blood vessels carrying the red blood cells which were supposed to pick up oxygen across the delicate alveolar vascular spaces. 

The influenza test was positive. 

She had died of influenza.

Mad Dog presented her case to a half dozen conferences, asking everyone what he could have done differently. He knew he should have intubated her--put her on a respirator in the ER, but that was difficult and had its own risks and would have delayed getting her to the CCU. But beyond that, Mad Dog was looking for answers from the graybeards, the guys who had tricks up their sleeves, who had seen everything and done everything.

 But as he gave the story, he saw the flash of recognition in all the older doctors' faces: They had all seen patients die of influenza.

"This is what influenza does," they would say, shaking their heads. "It just does that." 

Not to everyone, influenza does that, but to a high enough percentage that more people and more soldiers died of influenza in 1918 Europe than died from bombs and bullets on the battlefield.

When COVID hit New York City, Mad Dog's son was doing his residency at Mt. Sinai. They had long refrigerated 18 wheel rigs parked outside the hospital on Fifth Avenue--to receive the bodies. The hospital morgue was overflowing. He had to strip down in the hallway outside his apartment and put  his scrubs and mask in a black plastic garbage bag, and walk straight to the shower before seeing his wife and baby. 

Given the death rate of COVID, early on in that pandemic in 2020,  about 3-4 million Americans were projected to die from that virus. In that first year only 1 million died, once the vaccine became available. "Only" a million died. Death statistics are endlessly arguable, but it's pretty clear the vaccine saved lives, and not just the lives of people at the far end of their lives, but little kids, twenty-somethings, all through the age ranges.

Watching "Gone with the Wind" in a movie theater Mad Dog was struck by the audience reaction when Scarlett O'Hara gets the letter which announces that her husband had died, not in combat, but from measles, in camp. 

The audience laughed.

Mad Dog knew why they laughed. Scarlett's husband was a well meaning nerd, a half man, not virile or a warrior and it seemed perfect that he would die of a child's disease, to which no strong man would succumb.

But, of course, measles took the lives of thousands of soldiers in their camps, men who had never been vaccinated or even exposed to measles because they lived isolated on farms. 

But, of course, to that 1974 audience, living in New York City, in an age of universal vaccination, these folks had never seen measles, nor heard much about it. Measles seemed to these 20th century New Yorkers a ridiculous thing to die from.

When you think about it, in the 21st century, it still is a ridiculous thing to die from. But watching someone die from measles does not seem ridiculous. It is bleak, maddening, agonizing.

And we will see more of that now. Because of just a few men, our President and his chosen new vaccine expert, RFKJR. Neither should ever be forgiven that. 

Diptheria has just claimed several victims. Influenza will always claim victims, but fewer if enough people get vaccinated. COVID is less likely now to claim the young, but it will still claim some unvaccinated. And measles now is doing its terrible work again.

Measles does that. It just kills people with a pneumonia. That X Ray at the top of this blog post is a measles pneumonia. 

Paul Offit and RFK JR: The Truth v The Big Lie

 

Reading Mein Kampf is not easy reading. It is repetitious, self absorbed, petty and something of a slog, but along the way you realize a few things about Hitler: he is a man who has thought about his life and his experiences and how they shaped him, and he has some genuine insights buried among all the obvious pathology. 

One insight is that it is easier to sell The Big Lie than little ones. 

He notes that all of us tell little lies every day, from idle comments like, "You look lovely today," to other innocent white lies. But most people faced with a big lie, like we lost the war because the Jews stabbed us in the back, is believable because most people think you would not dare to lie so infamously, so it must be true. And it is often hard to marshal counter arguments to big things.

So it is when Dr. Paul Offit exposes the Big Lies Robert Kennedy tells--that polio vaccine has killed more people than it has saved by causing soft tissue tumors or the Big Lie that germ theory saying specific bacteria or viruses cause specific diseases is wrong. 

Where do you even begin with that?

In his op ed in the New York Times,  Offit patiently marches through the specific things RFK JR has said which are simply put, dead wrong: the COVID vaccine is the "deadliest vaccine ever made"; that pasteurization of foods, milk is harmful rather than life saving, “The ubiquity of pasteurization and vaccination are only two of the many indicators of the domineering ascendancy of germ theory as the cornerstone of contemporary public policy;" that AIDS was not caused by HIV but by drug use  "was most likely caused by recreational drugs like poppers and the antiviral drug AZT." that the drug used to treat HIV, AZT was "mass murder."

A cynic knows the cost of everything and the value of nothing, Oscar Wilde observed, and RFK taps into the large and deep well of cynicism in the American public. RFK JR knows that by going after the strongest part of the "elite establishment," doctors and medical science, he has the best chance of defeating the establishment. 

Paul Offit, MD

Trump knows that, too.

If you allow any segment of American society to be trusted, respected by the general public that segment, should it turn on you, criticize you or correct you, poses the only threat to your power.

That is why when Tony Fauci heard Trump say you can cure COVID with intravenous bleach and Fauci hit his own forehead, and shook his head in silent disavowal, that was more damaging to Trump than a hundred CNN and MSNBC journalists singing in unison. Rachel Maddow, Paul Krugman, even Bernie Sanders were never a threat to Trump, but Dr. Fauci was. 

And that's why he and his family got death threats. 

People trusted Fauci, and they ultimately trusted him more than they trusted Trump, or at least Fauci gave them pause. 

Which is why he had to be attacked as the man who gave China the money to develop the SARS-COVID19 virus in that lab in Wuhan with all the talk of "furin cleavage sites" and "gain of function" stuff came from. 

But those were the little lies and could be easily debunked. The Big Lie is that China developed the virus to attack the West and bring Western economies to their knees. That particular lie was a little hard to sell when it was revealed that China suffered as much or more from the pandemic, although that could be dismissed as China bungling. There are still Congressmen who vow to get to the bottom of the origins of COVID 19. 

As Offit, and many others have said, "Good luck with that."

Not that it really matters if China did develop the virus as a weapon and it simply got out of hand. What would we do with that information?

In medicine there's an old adage: don't do a diagnostic test if there is no therapeutic implication. Even if China was the nefarious villain in COVID, what is the therapeutic implication? That we stop studying virus? That we stop trying to monitor viruses in the real world, that we stop trying to see where viruses are leaking from bats to pangolins and hogs? That we stop making vaccines? Or, if we believe in the Chinese lab, you can say it was US NIH money that funded it. 

Nonsense. 

The Chinese don't need our money. The piddling grant from the NIH did not support the Wuhan lab which is enormous and gets enormous support from the Chinese government. 

And, in fact, the Chinese scientist, Zhang Yongzhen, who released the genome of the COVID 19 virus early on, was the man with the best chance of allowing test kits to be made nearly instantaneously, and gave labs around the world a jump on developing a vaccine. 

True, in the finest bureaucratic version that scientist got his wrist slapped by the bureaucrats in the Chinese government, but he was a scientist first, and he behaved like one--and he's still working. And he collaborates with scientists around the world, including Dr. Barney Graham at the NIH who was part of the team which got the COVID vaccine done.

Dr. Zhang Yongzhen

One thing which happened in New Hampshire during the height of the pandemic is the National Guard, those twenty something kids in their camo uniforms, lined up at parking lots, and long streams of people in their cars drove by and got vaccinated. 

Government in action to protect you. 

That was the best argument against the Big Lie. You could pound back your beers in your basement and growl about the elites and the establishment and cleaning out the swamps, but were you really going to sit home and not get vaccinated? 

Some did, but the vast majority voted with their feet and their bare arms, saying, no, well, actually I'll take the vaccine.

When push came to shove most of those cynics who take such glee in giving the finger to those elites who want to control the little guy still know that you don't want a deadly virus, intubation on a respirator, withered limbs, dead children and they embrace germ theory.