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COVID-19 killed the American spirit. It’s time for a resurrection.

ATTARAN Q&A

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Dr. Ashkan Attaran is taking questions exclusively from Sun readers.


Thirty years ago, my family and I were refugees in Europe looking for a place to call home. My parents wanted to come to the United States. I asked my father, “Why America?” and his answer has always given me chills.

He said, “The American spirit, what America stands for, American exceptionalism. A ‘never say die’ attitude that is based on courage, innovation, bold decision-making and not backing down from adversaries, no matter how tough or dangerous. It’s a spirit that is nurtured and strengthened by liberty and personal choice.”

His words come back to me as I contemplate how we have responded to the COVID-19 pandemic.

We have cowered, we have surrendered, and it may have cost us our National soul.

Can we turn it around? Maybe. But not without “liberty and personal choice” to nurture and restore our wounded American spirit.

In the words of Patrick Henry: “When the American spirit was in its youth, the language of America was different: Liberty, sir, was the primary object.”

COVID-19: A pandemic of body and spirit

It was horrifying at first.

The medical community was shell-shocked by what they were seeing in countries like Italy and Spain – videos of body bags, ambulances, and medical workers in hazmat suits were unnerving. 

In that setting instead of consulting with people from multiple disciplines to form a plan of attack, governments in severely-affected countries took one person’s projection models and created a doomsday scenario.

No doubt, the projections were bleak. The models indicated that as many as 3% of all infected people would die. That’s 10 million Americans.

Faced with that possibility, I argue that asking for an initial quarantine period was not only reasonable, it was necessary. 

We were introduced to the concept of flattening the curve.  Plan was to shut the country down for two weeks so we can get our bearings straight, acquire more data, and see what resources are needed, to come up with best treatment plan. 

Ambiguity in messaging, communication, and policy

As weeks passed the question became, when did the request to “Shelter in Place” become a forced “Lockdown” and based on what data?

Remember when it was all about “flattening the curve” – making sure our hospitals weren’t overwhelmed by COVID-19 patients?

“Flattening the curve” was never about reducing the total number of infections, because we already suspected that mitigation strategies had minimal effect on stopping the virus. We were just trying to slow it down enough to make sure the healthcare system could survive the tsunami of sick people that were predicted.

And it worked! Except for a few locations – namely New York City – American hospitals had enough room, staff and equipment to care for their COVID-19 patients and mortality rates were far lower than expected.

This should have been good news, but every attempt at optimism was met with backlash by the media.

I submit that when credible evidence emerged that the projections could be wrong it threatened a plan that was already in place.

If the original projections came to pass, it would be easy to justify a China-style lockdown. Without them, maybe not.

So, as we moved forward, any analysis or research that suggested the virus would be less than apocalyptic was treated as heresy.

In fact, many media outlets, including online tech monopolies like YouTube and Facebook, refused to report or post information that refuted the projection models or questioned the efficacy of extending the quarantine period. These voices were deemed ignorant, even dangerous.

Now keep in mind, the World Health Organization’s guidelines for Mitigating the Risk and Impact of Respiratory Viruses suggest that any mitigation plans (social distancing, lockdowns) have only a small effect on the spread of respiratory viruses like COVID-19.

I wonder if Mark Zuckerberg knew about these guidelines when he was censoring people on Facebook for suggesting the exact same thing.

Or, to borrow from Laurie Halse Anderson, “censorship is the child of fear and the father of ignorance.”

Early on, a study done by Dr. John Ioannidis, a professor of epidemiology and medicine at Stanford University, suggested that infection rates were much higher than previously thought.

That meant our Infection Fatality Rate (IFR) was less than anticipated by a factor of 50-80 times. He quickly came under attack with critics saying that his research must be biased since, like many other epidemiologists, he believed that lockdown measures were not the best way to mitigate the spread of respiratory viruses.

Ioannidis’ actual findings were dismissed in and ridiculed. 

They questioned his motives, as well as his methodologies even though his methodology had greater data behind it than original doomsday model. 

Yet, the doomsday model went virtually unchecked by those same critics.  Why? 

Shortly thereafter, studies done at USC, Massachusetts General Hospital, and random testing in New York City all suggested that the IFR of this disease was somewhere between .15-0.3%, far below the original 3% predicated by the models and more in line with the numbers for seasonal influenza.

What is so disheartening is that during this time many scientists placed their personal and political affiliations above the duty to evaluate and share all pertinent research findings.

Even now, Dr. Anthony Fauci, who behaved so credibly at the onset of this outbreak, has been silent on the encouraging IFR studies.

Reality of a vaccine and uneasy truths that must be heard

We must realize that the vast majority of citizens will have to be exposed to COVID-19.

For the past two months an underlying message has emerged that we must stay inside until we have a vaccine. 

But such coronavirus-specific vaccines are extremely difficult to make and similar efforts have failed many times in the past. 

Keep in mind that COVID-19 is an RNA virus, and we have zero RNA virus vaccines at this time.  That’s right zero. 

The pathophysiology of this disease is unique in that bad outcomes and most fatalities are caused by the extreme response of the immune system to the outer layer of the virus.  This is referred to as cytokine storm. 

The cytokine storm is further complicated by the activation of complement cascade of microthrombi that choke blood supplies to major organs, resulting in death.  This makes it difficult to make a safe vaccine, as vaccines are composed of the same lipoprotein outer layer that stimulate the cytokine storm/complement cascade. 

In the best case scenario, we are at least one year away from a reliable or safe vaccine that will be available for mass inoculations. 

We must realize that even if the vaccine becomes available, it will not be the silver bullet that people are expecting.  COVID-19, like influenza virus, has a high degree of antigenic shift, meaning that it changes at a high rate and the effectiveness of the vaccine varies from year to year.  The flu vaccine is effective 20-60% of the time year to year. 

This does not imply that people shouldn’t get the vaccine when it becomes available, but it won’t be the silver bullet people are hoping for.  

Knowing this, what is the strategy? Lockdown indefinitely?

Fearmongering and data manipulation must be replaced with a message of optimism

This virus is highly contagious and has a keen eye for a subset of population. 

That said, it isn’t the bubonic plague and shouldn’t be treated as such.  The constant media bombardment hell-bent on inciting mass hysteria has extracted an extreme emotional toll.

The reality of this pandemic is being overshadowed by sensationalism that focuses on minutiae.

Whenever there is a COVID-19 casualty that doesn’t match the identified risk group, the unfortunate death is held up as an example of why every child or perfectly healthy adult should also be in fear for their lives.

However, if the media was highlighting the fact that the median age of death is higher than the average lifespan in this country and the risk to children is statistically very close to zero, there would be a collective sigh of relief.

Where are the stories about all the people who have recovered?

Why do we treat this like the plague and make apocalyptic predictions?

Every American can tell you the original case fatality rate numbers they heard on the news of 3%, 4%, and even 7%, but not every American can tell you the estimated infection fatality rates (a much more accurate measure of mortality) from study after study that are a fraction of CFR at 0.4%, 0.3%, and even <0.2% which is about the same as seasonal influenza.

Simply put, the scare tactics get much higher ratings.

Dr. Fauci was quick to tell us that the official CFR from the World Health Organization was 3.4%, but he remains silent on the IFR estimates.

The leaders of our country with the greatest power for change, Dr. Fauci being at the top, are failing to restore rationality and quell the hysteria by simply refusing to engage in the fear mongering.

It is the equivalent of crying wolf.

When the reality is unveiled, that the COVID-19 crisis was not a once-in-a-lifetime pandemic it was billed as, we will lose all credibility for future pandemic responses.

Recently we heard horror stories of a mysterious complication of Covid-19 in kids, the Kawasaki disease?

The Kawasaki disease is a mysterious inflammatory condition associated with a wide range of viruses seen in kids below the age of at 5. It occurs at a rate of approx. 10 to 20 per 100,000 children, with a peak in presentation in months of February and March. 

These children have tested positive for the antibody to COVID-19 and therefore it is presumed COVID-19 must have caused the Kawasaki Disease. 

While it’s highly possible that COVID-19 is responsible for this, the timeline matches that of other viruses causing this condition.

And while every doctor has been trained to be able to tell the difference between correlation and causation, for some reason when it comes to COVID-19 we have thrown out science and scientific process.

Has lockdown truly been successful in defeating the virus?

No.

Has it slowed down the virus’s spread? Possibly.

The lockdown model we implemented was a quasi-lockdown and was therefore set up to fail. While the initial quarantine was successful in sparing hospitals from overwhelm, the continued lockdown has not been successful in stopping the spread of the virus. Even New York Governor Cuomo admits that 66% of their infections and fatalities have occurred in people who were implementing social distancing and shelter in place orders.

In my area, vast majority of COVID-19 fatalities came from nursing homes. Similarly, in Los Angeles County, more than half of deaths are nursing home residents. 

This cohort – that is most vulnerable to the virus – technically are the most isolated. If there was to be a success story to lockdown practices, it should have been there.  

Our current lockdown plan is immoral, unethical and impractical 

Now that we have more data, the current measures are ineffective, unethical and in many ways immoral. 

Our current trajectory is based on fear and emotions, not facts or a long-term view.

The unprecedented, self-inflicted unemployment rate has eroded confidence in a great many industries, but disproportionately in small businesses.

When you are a small business owner the world is on your shoulders. You are taking an enormous amount of risk and feel an intense responsibility to the welfare of your employees, partners, and clients.

This makes every business decision an emotional powder keg that necessitates a strong sense of confidence to implement.

Losing that confidence will make you think twice before taking out a loan to start or maintain a business. It means not hiring employees unless you are sure you need them or firing those you fear that may not need.

Confidence is the very crux of every business owner’s decision to push forward through adversity or cut losses and mitigate damage.

The quixotic lockdown approach to COVID-19 kills confidence and the looming threat of implementing “waves of lockdowns” buries it. 

The only businesses that can withstand the destructive force of lockdowns are the multibillion-dollar conglomerates that are still being allowed to operate in spite of lockdown thanks to the powerful forces of lobbying.

Without a clear pandemic plan that does not include closing vulnerable businesses, who is going to risk opening a dine-in restaurant, a movie theater, a retail shop, a hair salon, a gym, a massage spa, or other “non-essential” business?

Not only are businesses being unfairly shut down by partisan gubernatorial fiat, but the designation of being “non-essential” implies a highly pejorative tone, as much as “essential” is quite the superlative.

This deepens the divide between those who can afford work from home indefinitely with money in the bank and food on the table versus those who society has summarily thrown away as non-essential because their job is a luxury and cannot be done from home while they live paycheck to paycheck.

Of course, we understand that the implication is that an essential business is one that is necessary to sustain life, but is it really?

Executive lockdown orders claimed that golf courses, marijuana dispensaries, liquor stores, and abortion clinics are “essential” while actual lifesaving and life-sustaining surgeries, dental care, physical therapy, and chiropractic treatments are banned.

The implication that a person is “non-essential”, and therefore the world can do without them, is an extremely depressing and invalidating concept.

This is likely going to cause depression and suicide rates to increase more than predicted from economic downturn and unemployment.

In previous crises, there has never been a class of victim that garners so little empathy while simultaneously attracting so much disdain. As a moral truth, every one of our citizens is essential and the value of one life inherently has no more importance than another.

Since a vaccine is at least one to two years away, we can no longer justify separating essential and nonessential work.

The true immorality arises by continuing to ask so-called essential workers to continue to expose themselves to a fatal disease, and to expose their loved ones to the disease, while those that are “nonessential” are being protected.

An example of this is a 60-year-old nurse or grocery clerk with diabetes, lung disease, or a heart condition who is deemed essential and continues to go to work, while a 25-year-old office worker is deemed nonessential. 

Using our current plan, this 25-year-old should be sheltered in place and be protected, even though his relative risk of dying from the virus is substantially lower than the 60-year-old’s.

Furthermore, he is being paid to stay home—and in some cases making more than he would under normal circumstances—while medical workers in the field are losing their jobs or being forced to take pay cuts because the hospitals where they work are running on half capacity. 

How is this just or moral?

Data and the emergence of hope

Recent antibody testing data from California, New York and Massachusetts suggests that the prevalence of this disease in the country is much higher that initially perceived.  This in turn suggests that the Infection Mortality Rate (IFR) is less by a factor of 20-40 times than previously thought.  Other US data, as well as testing in Germany and Denmark, suggest that approximately 90% of infected individuals are either asymptomatic or only mildly symptomatic.

This suggests that the IFR of COVID-19 is only about 0.2-0.4%—or roughly 1.5-2.5 times more than that of the seasonal influenzas and that rate could drop as deaths attributed to COVID are “revised”.

Dr. Deborah Birx, the response coordinator for the White House COVID task force, has stated that, “Right now…if someone dies with COVID-19, we are counting that as a COVID-19 death.”

She believes that the CDC numbers are inflated by at least 25%. For example, if someone dies from an overdose of drugs or alcohol and happens to test positive for COVID-19, they are considered a COVID-19 death and added to the fatality numbers for the virus.

In light of this, States like Colorado are revising their numbers to reflect only deaths directly caused by COVID-19. These types of revaluations may lower the IFR even further as time progresses.

Furthermore, data suggest that vast majority of population will either be asymptomatic or mildly symptomatic from this disease.

With this data coming out of CDC why are schools shut down? Why aren’t the young and healthy at work?  Why aren’t we allowing those at virtually no danger to shelter in place?

These groups must be allowed to interact, get exposed to the virus and create a level of herd immunity in order to shield the elderly and those with medical conditions.

Swedish model is working and will be the gold standard in the future

Remember, not every country or state shut down or stayed closed as long.

The Swedish model has been working.

Although Sweden had higher infection and fatality rates initially, they’ve fared much better that most of Europe to date with the exception of few neighboring Nordic countries.

By allowing the population to absorb the virus organically, they created a rapid immunity that countries who limited exposure didn’t achieve.

“…those countries that have been on lockdown will continue to have wave after wave until herd immunity is achieved. This is exemplified by the resurgence of COVID-19 in Hong Kong, Singapore, and even China, which used extreme draconian measures to enforce their lockdowns.”

Now, let’s look at the projection between Sweden (in red, no lockdown) versus the United Kingdom (in purple, lockdown).

Once we adjust for population difference, the UK’s projected fatality number adjusted for population difference is approximately 200% more than Sweden’s. Sweden was able to find a way to keep their economy open and save lives.

They had the same information we had, but they chose to preserve their economy for future generations, for all those young people who were never really at risk for dying from COVID-19. 

Why didn’t we?

The United States model for reopening

In the United States, several states never closed down and several more have been reopened for several weeks.

Despite the media’s narrative, these states have not had a second wave. 

To have a second wave, the first wave must have already ended.

As can be seen below, the number of daily cases in the United States has plateaued but not disappeared, meaning our first wave has not ended.

The good news is that the number of deaths has decreased due to a better understanding of pathology of this disease, as well as somewhat promising (albeit far from perfect) treatment and increased availability of personal protective equipment.

Every day across social media and the mainstream media we hear doom-and-gloom reports of increased COVID-19 cases in states like Texas and Florida.  These reports are, at best, misguided and, at worst, misleading. 

Yes, the number of new cases has increased, but this is secondary to the increased number of tests being conducted in these states. 

If we analyze data properly and without agenda, the it is clear that the percentage of positive data is decreasing despite easing of lockdown measures. The rate of hospitalizations, ICU admissions, and fatality are also decreasing in these states.

Death scoreboards should be replaced with maps of local hospital beds and ICU availability so we can plan accordingly and mobilize resources to those areas. 

We must accept that we will see a resurgence of the virus in winter, and that there is no escaping it.

If we do not open the country and wait for fall or winter when other respiratory illnesses manifest themselves, now combine that with a reduced capacity in hospitals bed availabilities, we create a perfect storm for devastation.

Add to it the possibility of social unrest due to our economic devastation, we will end up with a doomsday scenario of biblical proportions.

Resurrection of the American spirit

As of May 20, based on available numbers, COVID-19 had infected over 1.5 million Americans and killed 98,000.

When you consider that we’ve spent over $6 trillion, or roughly $60 million per each fatality.

The purpose of it was to “stimulate” an economy that was thriving before this hit, ruined many people’s financial futures and stripped our citizens of basic human rights.

It appears as if we brought a rocket launcher to a knife fight.

Of course, all human suffering is regrettable, but we’ve never been willing to give up our sovereignty as a nation or betray the Constitution because of it.

The values of “life, liberty and the pursuit of happiness” used to be worth fighting and dying for.

It’s interesting that the generation who was most at risk for dying from COVID-19 is the same generation who willingly gave their lives in huge numbers to stop the spread of Communism, which was also considered to be a “deadly virus” that threatened our Nation.

Vaccine or no vaccine, there are many ways we can live with COVID-19. People need to realize that even if a vaccine becomes available, it won’t be a magic bullet, it won’t be a cure.

COVID-19 created the same panic within our nation as it does in the human body. Our overreaction to the “invasion” may be what kills us.

When COVID hit we had the best economy in history paired with the worst political climate. It became hard to find any information that was unbiased. New scientific evidence is censored or sensationalized depending on what narrative it supports.

Any COVID-19 casualty that doesn’t match the identified risk group is exploited to cause fear among people who have little statistical possibility of dying from the virus. The reality is that the median age among COVID-19 deaths is higher than the average life-span in this country and the risk to children is statistically close to zero.

Any concern about the long-term economic impact of the shutdown is depicted as cruel, as if people were more concerned about money than human life. There is a core hypocrisy in this based on the way many states have used their power to designate businesses as “essential” vs “non-essential”. This lockdown has only deepened the divide between the social classes, showing preference for and rewarding chain stores over small businesses, executive positions over service positions, liquor stores over churches and outreach centers, elite students over struggling students. While the wealthy may be comparably vulnerable to physical risk, they are insulated from economic risk and many have benefited from this crisis by buying stocks and businesses that were forced into failure.  Our response to COVID-19 has eroded a fundamental value we once held – that all people are equal – no one has more importance than another.

“How can we love our country and not love our countrymen? And loving them, reach out a hand when they fall, heal them when they’re sick, and provide opportunities to make them self-sufficient so they will be equal in fact and not just in theory. “Ronald Reagan

There is no doubt that we will be feeling the economic impact of this virus long after we’ve learned how to treat its physical effects. Unfortunately, what’s done is done and we must find a way to move forward.

Shutdowns are not sustainable. Although polls suggest that more than 55% of Americans are in favor of continuing shutdowns and social distancing, behavioral data suggests otherwise. The economy and society can’t wait forever, and we must not allow local, state, and federal governments to continue to restrict personal liberty. Self-empowerment is necessary for our healing – physically, emotionally and economically.

In the US, several states never closed down and several more have reopened in the last few weeks. As seen below, the number of daily cases in the United States has plateaued, and deaths have decreased. We must remember that the number of cases will continue to rise as more people are tested, but there is little evidence to support a looming spike in the overall Infection Mortality Rate. If we analyze data properly and without an agenda, we have every right to be optimistic.

The leaders of our country with the greatest power to promote beneficial change, Dr. Fauci being at the top, are failing to soothe or encourage people and are instead continuing, in partnership with the media, to promote fear. I have the utmost respect for Dr. Fauci and others who helped us navigate the early days of this disease. However, I think it’s time we started listening to those that correctly predicted the natural course of this virus, as well as economists, community leaders and common-sense thinkers who have ideas about how to get back on track.

I believe there are three main things that need to happen:

1. We need to speed up the reopening and get as many people back to work as possible.

People who were declared to be “non-essential” are, in some cases, being paid more to stay home than they were at their jobs. Members of Congress are actively advocating that the government give families of four as much as $96,000 per year.

Not only are these new “entitlements” unsustainable, they are unhealthy.

Hard work and entrepreneurship are the basis for American prosperity and a feeling of purpose and community is essential for good mental health.

But people should retain their power of choice.

If someone feels that returning to work is a risk, they should be free to stay home, but unemployment rates should return to normal. If someone makes the choice to return to work and contracts the virus, they should not be able to sue their employer.

2. We should be actively planning for a resurgence in the fall.

It’s going to happen, but the closer we get to herd immunity over the summer, the better the outcome will be. 

Having said this people should wear masks in public in order to protect the vulnerable. 

Instead of stimulus check going out in forms of handouts for sitting at home, or corporate bailouts, we should redirect these funds to programs that increase testing, contact tracing and providing necessary resources for health care workers and hospitals to identify, isolate and treat those infected. 

This policy will allow the economic engine of the country to continue roaring. We should be able to have COVID positive and COVID negative health care facilities, and nursing homes. The death rates in nursing homes would have been lessened if patients who were hospitalized with COVID-19 or contracted the virus while in the hospital were not sent back to those facilities when they were no longer symptomatic. 

This will also ensure that the rest of the population has access to healthcare, even during the peak season.

3. We need to end the government and media-driven game of emotional manipulation and demand they behave like the intelligent and educated people they are supposed to be.

It’s shameful the way this crisis has been used to further political agendas, trample on our founding documents, and subjugate the citizens of this country.  The plan forward needs to be clear, data driven, bold, and universal.

The rancor and dictatorial posturing of certain state leaders has been utterly shocking. But as the old saying goes, “Absolute power corrupts absolutely.”

Perhaps this moment is an opportunity to remember that America was created to avoid this exact scenario.

Although the attribution of this quote is still debated, a cursory study of human history supports the analysis: “A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship. The average age of the world’s greatest civilizations has been 200 years. These nations have progressed through this sequence: From bondage to spiritual faith; From spiritual faith to great courage; From courage to liberty; From liberty to abundance; From abundance to selfishness; From selfishness to apathy; From apathy to dependence; From dependence back into bondage.”

In a three month period we have moved our country from abundance to dependence. Bondage is next.

Our nation is 243 years old, so we’ve done better than most, but it’s time to resurrect that ‘never say die’ attitude, that creative, innovative and energetic spirit that made my Father long to be here and defy that bleak prophecy for our future.

In his book, The American Spirit: Who We Are and What We Stand For, David McCullough writes, “When bad news is riding high and despair in fashion, when loud mouths and corruption seem to own center stage, when some keep crying that the country is going to the dogs, remember it’s always been going to the dogs in the eyes of some, and that 90 percent, or more, of the people are good people, generous-hearted, law-abiding, good citizens who get to work on time, do a good job, love their country, pay their taxes, care about their neighbors, care about their children’s education, and believe, rightly, as you do, in the ideals upon which our way of life is founded.”

I want to communicate the same feelings about America to my daughters as my Father did to me.

I don’t want to say that “America used to be this or that,” I want to tell the story of how, in my day, we fought this great battle and were triumphant.


The author wishes to extend special thanks to Dr. Anker J Patel and Dr. Jason Friday.

Ashkan Attaran, M.D.
Ashkan Attaran, M.D. is a board-certified cardiologist practicing in Visalia, Calif. and a native of Tulare. He graduated from the University of Cincinnati Medical School and completed his residency at the University of Southern California. He also completed a cardiology fellowship at the Medical College of Georgia.