Many people have contacted me with concerns surrounding the coronavirus pandemic.  In an effort to update you on the latest information, I am sending this letter to answer some of the most commonly asked questions.  I would also like to try to put this crisis in perspective. Learn More: https://conciergemedicinemd.com/covid19/
Phone: (520) 887-8667 I Fax: (520) 887-8672

Fighting your Personal Battle Against COVID-19

I’ve taken some ribbing during my career for my interests outside of medicine, once described as “more of a warrior than a doctor.”  About 15 years ago, a family member of one of my patient’s put it another way.  I overheard him making a recommendation to a friend and saying, “Go see Knope.  That guy is a warrior.  He will go to battle for you.  He saved my grandma’s leg when everyone wanted to take it off.  He fights disease like it’s the enemy, and he never gives up.”

I don’t mind this reputation.  In fact, I have always looked at disease as the enemy, something to be eradicated and destroyed.  This is how our body looks at disease as well.  We fight invaders, be they bacteria, viruses or cancer cells.  We have armies of vicious white blood cells, killer T cells and antibody-producing plasma cells.

And my weapon of choice in battling disease is evidence-based medicine.  To acquire a body of evidence, you have to be trained in how to read the medical literature.  You have to continue to read extensively, which is what I do.  Evidence-based medicine is the sharpest sword I can wield against disease.  I am going to use that weapon on your behalf to slay some falsehoods about COVID-19 and to give you more knowledge to help you survive this pandemic.

As you know, I have been silent for several months on the COVID battlefield.  I stopped writing newsletters months ago.  The reason is that the discussions about COVID-19, even in my office, had started to become political and divisive.  I endured three challenges from patients who told me I should be following mask guidelines from the CDC.  I was attacked by one person for not paying deference to “the experts” in Washington.  One patient, citing the New York Times, told me I needed to install a new toilet lid in my bathroom, to prevent COVID-19 from aerosolizing during a flush.  These folks used information from press reports to try to convince me to conform to government recommendations, as opposed to thinking independently, which is what all doctors are trained to do.  If you are looking for conformity, send me an email and I will remove you from the mailing list.

At this point in time, I have decided to reinstitute The Pearl because we are now experiencing the highest number of COVID-19 cases recorded since this pandemic began.  This month we have also seen a record number of hospitalizations and ICU admissions.  Clearly, the strategy laid out by the experts has not accomplished the goals that they said it would accomplish.

If you are at risk of complications from COVID-19, you should protect yourself using evidence-based strategies, instead of blindly following the recommendations of bureaucrats.  Unlike the CDC, state governors and public health officials, I do not require that you follow my advice.  I am offering you an expert opinion in this newsletter, which you can take or leave.

Because I am going to provide a great deal of information to substantiate my reasoning in this newsletter, I am going to start by listing some final conclusions and recommendations.  If are short on time, you can just read the assessment.  If you want the rationale for my thinking, you can read the entire newsletter, which took several hours to compose and is 7 pages long.

My Assessment:

  • The public health mandates since March, including shutting down the economy, shutting down schools and the mask mandates have failed to prevent the inevitable spread of COVID-19. All these strategies not only delayed the inevitable, they made things worse.  The virus outsmarted the experts, as they often do.  Had these strategies been successful, we would not be facing a record number of COVID cases with hospitals and ICUs at the breaking point.  But this is precisely where we are.
  • Masks will not prevent you from getting COVID-19 and you should not feel safer wearing a mask in public places where your exposure to the virus may be significant. You will have to wear a mask if you enter most businesses, but there is no evidence that a surgical or cloth mask will prevent you from getting COVID-19.  (see data below)
  • The mask mandate should be replaced by ventilation and air purifying upgrades, both in public places, places of business and even in your own home. I have gone to extraordinary measures to create a negative pressure room in my office, which is essentially a hospital isolation room.  I have installed HEPA filters, which remove over 99% of viral particles from the air.  We have installed two UV light filters in the building.  This is the future of airborne disease prevention.  The following video from the WSJ outlines just some of technology I have implemented in my office and gives you ideas about what you can do at home or in your place of business, such as using portable HEPA filters.  https://www.youtube.com/watch?v=-jmzEQtGRXQ
  • For the past 7 months, we have known that COVID-19 is a different disease in different age groups. It can be a nasty disease for those over 70, and especially for those with health problems.  However, it poses little to no risk to the young and the healthy, regardless of rare case reports that have been sensationalized in the press.  Therefore, lockdowns should cease.  They have been a destructive policy.
  • The vaccines will be here soon, but this disease will likely be with us for quite some time over the coming year. We don’t know how the vaccine will be distributed, but the WSJ has reported that plans have been put in place to use grocery stores and pharmacy chains as a major method to distribute the vaccine.
  • Finally, you should not waste any of your precious time by waiting for this pandemic to end before you resume living your life. Don’t wait for things to return to normal.  The effects of COVID will likely be with through much of 2021.  And if there is a glitch in the vaccine, it could be longer.  The clock on your life is ticking.  You should take this opportunity, when there is more time to spend in solitary pursuits, to set some important personal goals.  You should work hard at those goals so that 6 months from now, regardless of COVID’s behavior, you will be happier, healthier or stronger in some way.

Where Are We Now and How Did We Get Here?

So, How’s All This Central Planning Working Out?  Ask yourself a few questions about the outcome of the policies and mandates that have been issued by the CDC and state public health officials.  First, how is that mask thing working out for you?  You haven’t been allowed to enter a place of business in Arizona for 6 months without wearing a mask, so we know that mask compliance in public buildings has been very high.  The majority of states have mask mandates.  If you look at the new massive increase in infections nationally, how can you logically conclude that masks have had any impact at all?  The answer is that you cannot make such a conclusion.

I should mention that the international data on masks is no different.  If you look at infection rates before and after the institution of mask mandates in countries around the world, there has been no correlation with mask mandates and a change in disease activity.

And how about all those lockdowns?  Are you happy with the impact they have had on your physical and mental health?  How has it affected your loved ones, your elderly parents, your children and grandchildren?  How about the financial impact that business and school closures have had on us all?  How well do you think on-line education is working out for most children?  The data are not good in this regard.  And those in inner city school are faring even worse.

After 8 months of obeying public health recommendations, this is what we are now facing:  On Thanksgiving Day, the U.S. reported a new record high in COVID-related hospitalizations.  This marked the 32nd day in a row that COVID cases have increased in our country.  On Thanksgiving Day, there was a record 90,481 people hospitalized in America, 17,000 of whom were in the ICU.

Rural hospitals and big city hospitals alike are overrun.  Many are close to the breaking point.  I was called by concerned family members about their sick father with COVID-19 two weeks ago.  He was about to be put on the ventilator at TMC in the ER, because there were no ICU beds.  We tried to have him transferred to Mayo Scottsdale, UCLA and other major centers.  They were all full.

The History of CDC Recommendations:  We were initially told by the CDC 8 months ago that we needed “two weeks to flatten the curve.”  Given the complete absence of evidence about COVID at the time, this was a reasonable course of action.  We had little data regarding COVID.  We didn’t know that this disease disproportionately killed the elderly and essentially spared the young and children.  This initial lockdown strategy, we were promised, would prevent our hospitals from being overrun.  However, the “two weeks to flatten the curve” morphed into months of lockdowns.  There was a suspension of all but emergency surgical procedures in many hospitals.  There were mandatory school closings, arbitrary classification of some businesses as “essential,” like liquor stores, while restaurants in Los Angeles have been closed even for outdoor dining.

Regarding the CDC and mask recommendations, Dr. Fauci initially mocked the use of masks on 60 Minutes in March of this year.  You should watch this brief video in Dr. Fauci’s own words, because at the time, his statements accurately reflected the lack of any data that masks protected people from COVID-19 in public.  https://www.youtube.com/watch?v=PRa6t_e7dgI  However, Dr. Fauci reversed his position on masks one month later, without any new data offered to justify his change in national policy.  He later added that people should also consider wearing goggles in public.  Based upon what new information or evidence, Dr. Fauci?

Two months ago, Dr. Redman, the Director of the CDC, doubled down on this mask recommendation, taking it to the level of absurdity.  He argued that masks were the most effective tool people had to protect themselves against getting COVID-19.  Watch this extraordinary 90 second video:  https://www.youtube.com/watch?v=NYRAZxcp_hU 

Dr. Redman assured members of the Senate Appropriations Committee and the American people two months ago that the science behind masks was incontrovertible, stating, “I might even go so far as to say that this facemask is more guaranteed to protect me against COVID-19 than when I take a COVID vaccine.”  Based upon what evidence, Dr. Redman?  Does Dr. Redman still hold this position two months later, despite near universal mask wearing in public with COVID-19 cases shooting through the roof?

Let me say this as charitably as I can:  There is no evidence to support Dr. Redman claims about masks on that video tape in September.  None.  To the contrary, there is plenty of evidence to refute this hypothesis.  And the danger of saying, so emphatically, that masks protect people from COVID-19 is that it made many people, including many of my patients, take unneeded risks with their health.  I had two male patients in their late 70’s, working out in public gyms two weeks ago, operating under the misconception that their masks made them safe around young people with significant COVID exposure.  Both men are at high risk!

The Denmark Mask Study:  Is there any evidence in the medical literature, in addition to the massive spike in COVID cases this month, that masks don’t work?  Yes, there is.  For several months, Danish physicians have been sitting on the results of the largest randomized-controlled mask study ever done in COVID-19.  And three of the world’s top medical journals declined to publish this study, reportedly because the results were “too controversial.”  This study was finally published this month in the Annals of Internal Medicine.

The study took 6000 Danes and divided them into two groups.  Half of the people were told to wear masks and the other half were told not to wear masks.  The study used surgical masks, the same mask that you saw Dr. Redman holding up before members of the Senate, claiming that it provided more protection than a vaccine.  This randomized-controlled study showed that masks did NOT protect the wearer against COVID-19.  The study found no statistically significantly difference in coronavirus infection rates between mask-wearers and non-mask-wearers.

Instead of showing some humility about the mask study results and the effectiveness of their overall health policies, the CDC became even more dogmatic this month.  Dr. Fauci made the following statement from his perch atop the CDC about the behavior of the American people and their disobedience.  He said, “I was talking with our U.K. colleagues just today who are saying the U.K. is similar to where we are now, because each of our countries have that independent spirit, we don’t want to be told what to do.”  Fauci then said, “Well, I understand that, but now is the time to do what you’re told.”  Excuse me, Dr. Fauci, but we have been doing what we we’ve been told.  And the results of that obedience have been catastrophic.

What About the Shutdowns?  In my 3rd newsletter, I warned that there would be a serious loss of life if we continued a public health policy focused solely on COVID-19, to the exclusion of other diseases and social problems.  It will take years to tabulate the fallout from these shutdowns.  However, the United Nations has already estimated that these worldwide lockdowns will be responsible for an additional 130-million deaths from starvation alone.  Children in the United States and across the globe are missing critical vaccines that prevent devastating illnesses, like polio, whooping cough and diphtheria.  These diseases will spike in the absence of routine vaccinations, and children will suffer.

How about the affects on mental health of these shutdowns?  According to a CDC survey done in June, 1 in 4 adults between the ages of 18 and 24 in the United States reported seriously considering suicide.  In a KFF Tracking Poll conducted in mid-July, 53% adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus.  And the Wall Street Journal just reported that as of July of this year, 52% of young adults ages 18-29 were living with one or both of their parents – numbers that we have not seen since the Great Depression.  And just wait until the death tolls have been tabulated as a result of missed chemotherapy visits, missed appointments for heart disease, diabetes, fear of going to the ER and delayed cancer screenings.

I have had patients with chest pain and coronary disease refuse to go to the ER for emergency care.  I have been forced to treat life-threatening bacterial infections in my office, because people were so worried about going to the hospital that they said they would rather take a chance of dying by using outpatient treatments.  Many of us in medicine believe that these lockdowns will kill far more people than COVID-19 would have ever killed.

An Alternative to Governmental Bureaucratic Medicine:  If you get your medical information primarily from the major news networks or social media, you likely assume that the only real experts on COVID-19 and viral pandemics are members of the bureaucracy.  This is not at all true.  There are many eminent physicians outside of government, in academia and in private medical practice, who have voices worth listening to.  And when these voices disagree with government experts, you should listen even more closely. Conformity does not result in better science or medicine.

If you are not familiar with the Great Barrington Declaration, I urge you to take a look at this short document.  The Great Barrington Declaration is a public health statement on COVID-19 authored by 3 renowned academic physicians, one from Harvard, one from Oxford and one from Stanford.  https://gbdeclaration.org/  I am a cosigner of the Great Barrington Declaration, along with 48,830 (and growing) other medical practitioners and medical scientists.

Tens of thousands of medical professionals and scientists believe that we are on the wrong path by following current public health guidelines.  The signers believe that many of these policies have caused more harm than good.  We do not believe that everyone should simply go out and get infected and let nature take its course.  We believe that the elderly and those at risk should be protected, while standards for the young should be loosened.  We also believe that life, healthcare and public health is about more than COVID-19.  And if we continue to focus on only one disease to the exclusion of all other diseases, there will be even more hell to pay.

What About the New COVID-19 Vaccine?  Contrary to what Dr. Redman said before Congress and the American people, reports are that several vaccines are more than 90% effective against COVID-19.  Let’s hope that is the case.  Let’s hope that the side effects remain low.  But we will not have a clearer picture about the vaccines’ performance until they are given on a larger scale.

It should be clear to most people by now that the only way out of this pandemic is through the development of herd immunity, whether that herd immunity comes in the form of a vaccine or by younger, healthy people becoming infected and developing immunity to stop the spread.

Whether or not to take the vaccine will be a personal decision for you to make.  I have always been a strong proponent of proven and safe vaccines.  For most older Americans, and those with underlying medical conditions who are at high-risk of complications from COVID-19, the available numbers suggest that the risk of getting COVID will far outweigh the risk of the vaccine.  However, this is based upon preliminary data.  The long-term safety data on these vaccines will not be available for quite some time.

We are about to embark on one of the biggest experiments in medical history with this vaccine, because a couple of these vaccines are new.  We have never used RNA vaccines on the population.  What will happen when we give this vaccine to hundreds of millions of people on the planet?  We do not know yet.  So, the decision to take the vaccine will be a personal one.  I do not support vaccine mandates and no one should be forced to have one.  But many will want to be the first in line.  I will be happy to talk to any of you about the potential risks and benefits in your individual case if you wish.

What About Children and Young Adults?  What should we do with our children and young adults during this pandemic?  Thus far, I have been addressing you, my patients, most of whom have a significant risk of complications from COVID-19.  Statistically speaking, children and young adults need not worry about dying from COVID-19.  The mortality of influenza in children is 2-3-fold higher than the mortality from COVID-19.

We have known for a long time that this disease disproportionately kills those 70 years of age and above, especially those with chronic medical conditions.  There is a 1000-fold difference in mortality between those over age 70 and children.  Those 70 and older have a mortality rate of 4% vs. a 0.2 percent mortality in the overall population.

Given that we have had this knowledge for the past 8 months, why are we locking down the entire society when there is little to no risk to the young and healthy?  This is irrational.  It is harming the young and the healthy.  They are paying a tremendous price in the name of trying to prevent the spread of a disease which will largely not affect them.  Do we really want to subject them to this tremendous burden?

What Would the Greatest Generation Have to Say?  I had the pleasure of taking care of hundreds of WWII veterans at the Wadsworth VA Hospital in Los Angeles during my training.  These men and women would never have put their children or grandchildren’s future at risk by demanding to be kept safe in their older years.  I’m pretty sure most of those men would have said something like this to their children had they been faced with the COVID pandemic: “This disease doesn’t kill young people like you.  Go out and run the country and run the economy.  Keep the country strong.  Go make your way in the world.  Send your kids to school.   Your mother and I will stay home or be outside in the sunshine until there is a vaccine.  Drop some groceries on our doorstep to help us out when you have the time, so we don’t have to be exposed at the grocery story.  But the future rests with you.  The country cannot afford to be out of commission because of virus.  Go out and live your life!”

We have an obligation to our young.  I’ve heard too little discussion about how this is affecting them.  It is time to pay more attention to what is happening to them

Summary for Those at Risk:

To reiterate, we are currently in the midst of the biggest outbreak of COVID-19 since the pandemic began.  The experts, with their draconian public health policies, have not delivered on their promises and have in fact made our situation worse.  My advice is that you be more vigilant about keeping your distance from others, at least until the case numbers decrease in Arizona.  If you have to go out into a public place, you will be wearing a mask because we all have to do this.  It will not hurt you to wear a mask.  But it will also not lower your risk of becoming infected, so do not put your faith in a mask.  Limit your exposure.

Do not socially isolate from others.  I have seen several patients in my practice with depression and adjustment disorders from all the social isolation.  This is terrible for your physical and mental health.  People are meant to be connected.  Spend time with your loved ones outdoors, or call them or Facetime with them.  You will not get COVID from others if you are outside and you remain at a reasonable distance.  People do not get COVID from a passing encounter on the sidewalk.  Do not lock yourself indoors.

Continue to see me in the office for your medical problems, especially if you have chronic or new medical problems.  Our office is as safe as I can make it.  For those who would be comforted by wearing a mask, or in having me wear a mask during your visits, I have a mask hanging on my wall.  It costs me nothing to put this mask on if it makes you feel better.  However, given the lack of data on masks and the measures we have in place to lower your risk, those who do not wish to wear a mask may continue to come into the office without one – provided that you do not have active symptoms of a respiratory illness.

Protect yourself against despair by setting tangible goals.  If not a goal, take a low-risk vacation and spend some time in nature.  You can’t survive psychologically by “not thinking” about COVID.  You need to fight a negative by engaging in positive, life-affirming activities.

Finally, be grateful for what you do have in life, even if it’s just the fact that you don’t currently have COVID-19.  Be grateful that there are many things you can do to limit your risk of getting this infection.  Be grateful that a vaccine is on the way.

As Dennis Praeger has said, it is impossible for an ungrateful person to be happy.  Don’t be that person.  Strive to be that rarest of animals that flourishes in the face of adversity.  If you take this approach, it will not only benefit you, but it will also help those around you.

Merry Christmas and Happy Hanukah

Steven D. Knope, M.D.