Review of America's Frontline Doctors COVID-19 presentation

I just finished watching a video presentation from Dr. Simone Gold, from the group named "America's Frontline Doctors".  Her narrative is compelling and practiced, and may seem to be a serious discussion of issues relating to COVID treatments and vaccines.  Unfortunately, her premise is based only partly in truth, mixed also with substantial speculation, mischaracterization, and counterfactual statements.  She paints a picture that stirs up fear and uncertainty, and assigns sinister motives to individuals, companies, and government entities where there likely is none.  She makes some interesting claims without good evidence, such as that the "vast majority of deaths would have not ever happened if information wasn't suppressed."  I'll try to break these down as best I can, because this kind of sensational misinformation could lead to deaths that might have been prevented otherwise.

As an observation, it's interesting to note that the group hearing the presentation (which seems likely to be a church or other faith-based group) is meeting together without any distancing or personal protective equipment.  

NAMING

She starts by stressing the importance of naming the disease after Wuhan, China rather than COVID-19.  She then goes on to say names of other viral diseases named after places.  I thought it quite funny that she brought up "Spanish flu", a name for the 1918 influenza pandemic.  The influenza of 1918, despite its infamous moniker, did not have its origin in Spain - which she would have known!  It's only called that because Spain was neutral in World War I, and thus didn't censor information about the virus.  The fact that information about the pandemic was only talked about in Spanish newspapers gave rise to the name.

Is there any specific importance to the name of a virus, other than political?  Not really.  The virus itself is called SARS-CoV-2 and the disease is COVID-19.  What value can be added by naming it after the city of origin, other than to prime the listener into thinking that information is suppressed?

HYDROXYCHLOROQUINE

She proceeds to talk a lot about the drug named Hydroxychloroquine (HCQ), and its use as an antimalarial drug.  She previously had shared anecdotal experience about 350 patients her group treated that had COVID.  We have personal experience with HCQ, as it is a primary treatment for Sjögren's Syndrome, an autoimmune disorder that Camille has had for a long time.  She tolerated it well.  I was quite hopeful that the initial anecdotal reports of the effectiveness of HCQ on COVID would be true, as that would provide a cheap and readily available medication to treat COVID patients.  Unfortunately, it has not lived up to the hype.

I think it's fair to say that no drug has been studied more intensely in the last 10 years than HCQ has been during the pandemic.  Hundreds of studies (including some at Intermountain Medical Center and University Hospital locally) have been conducted.  The promise shown in the laboratory (in vitro) just has not been shown in vivo (in a living organism).  The effect seen in petri dishes just doesn't work in living cells.  Simply put, not enough of the drug, when metabolized, makes it to the cells where it could have an effect.  A huge dose would be necessary to do so, which is impractical because that size of dose would cause serious cardiac problems.  Every time that HCQ has been put into a rigorous, double-blind, placebo-controlled test, it has proved to be ineffective.

I have no doubt that the 350 patients that this doctor treated recovered.  Most people do - less than 0.7% die, if well treated, and of those, 90% of them are in the high-risk groups.  We have no idea of the complement of the 350 patients she treated, but the probability is high that the HCQ had no real part in their recovery - they would have recovered either way.  

Alas, HCQ is just not the miracle drug that we would have hoped it was.  Is it dangerous?  Not usually.  If taken for a year or longer, it does build up in the tissue of the eye, and requires yearly assessment by an ophthalmologist.  For COVID patients, the scenario changes.  COVID causes blood clots in the lungs in severe patients, which HCQ can exacerbate.  In fact, it has been demonstrated in controlled tests that HCQ actually makes their recovery worse.

COVID EFFECTS

She says that "Odds are that you'll survive COVID if you get it".  This is true.  The death rate has been small, partly because of public health measures and personal responsibility which have kept our hospitals from being overrun.  If they had been overrun, as we saw with Italy at the beginning of last year, the death rate would have been substantially higher.

This is only part of the story, though - she doesn't talk about the high hospitalization rate, nor the lasting effects of COVID for those who recover, especially significant damage to the lungs.  If we only use the death rate to talk about the severity of a disease, we're missing a huge part of the total picture.

The most callous statement she makes in the presentation is, "The people who die from COVID-19 are kind of destined to die in this period anyway".  While there is an element of truth here (that the effects are greatest on those with the most health problems), as a matter of statistics, it's just not true.  300,000 more people died last year in the United States than the average of the previous five years.  Those "excess deaths" - a way to track the impact of the pandemic - occurred at higher rates among minority groups.

RACISM

The Tuskegee experiments were a horrible example of unethical experimentation conducted on minorities.  She invokes this freely, claiming that the government is trying to push the vaccines on unsuspecting minorities and low-income groups, making them the guinea pigs.  This seems rather disingenuous, imputing sinister motives where quite the opposite is intended.  The NIH and CDC want to take particular care to enable access to the vaccine for those who might not have the means to get them otherwise.  As she also said, the African-American community is particularly wary of vaccines, partially due to Tuskegee, so a concerted effort to dispel fears about the vaccine might be necessary in these communities to stop the spread of the virus.

VACCINE FEAR, UNCERTAINTY, AND DOUBT

She wants everyone to not refer to them as vaccines, instead to call them "experimental biological agents".  This name is clearly meant to invoke fear.

Is it "brand new technology"?  Yes and no - the mRNA-based vaccines are a new technology, but it's important to realize they have not been rushed to market.  They've been in development for 30 years.  Rather than use genetic material from an inactivated or weakened form of a virus (as has been done in the past), this technology replicates an identifying protein on the outside of the virus, and gets your body to target anything that has that protein.  This is what researchers have been seeking to do for a long time.  The biggest reasons that they haven't come to market before this is due to logistics (they need to be kept cold) and funding (there just hasn't been enough focused attention to get it to move forward quickly).

Has the vaccine development been rushed?  Yes.  Of course.  That's the whole point.  It's not necessarily a bad thing, nor does it mean that development was done recklessly or in a capricious manner.  Think about it: what value is a vaccine that's only ready in 5 years?  By that time, the whole thing will be moot.  The standards for approval have still been quite rigorous, even if the lead time is shorter.  It's easy to get at the testing data, see the sample sizes, effectiveness, side effects, adverse events, etc.  

Previous coronavirus (not COVID) vaccines have failed because they haven't had this technology.  There was a SARS-1 mRNA vaccine in development, but the funding dried up when the pandemic ended.  This research was immediately put to use in the development of the SARS-2 vaccines.

Most everything else she says about the vaccine is based on wild speculation or unknowns.  "There's no proof that it is actually reducing mortality," she says, which is a silly statement since the vaccine hadn't at the time of the video even been distributed.  She decries the vaccine as "untested, untried", when in fact that is simply not true - nearly 100,000 volunteers were part of the Phase 1, 2, and 3 trials of these vaccines.

ANTIBODY ENHANCED DISEASE

Antibody-Enhanced Disease, or AED is indeed a concern among vaccine developers.  Vaccine candidates for RSV and dengue fever (based upon inactivated viruses, not mRNA) did have well documented challenges with this problem.  Because of this history, both the researchers and the approval bodies specifically looked for signs of this phenomenon.

Her assertion that no tests for AED were run relative to the SARS-CoV-2 vaccines is simply not true.  Data was collected at every stage, first in mice, macaques, and hamsters, then in the Phase 1, 2, and 3 stages of the vaccine trials.  They specifically looked for statistical comparisons between the immunized and placebo control groups.  No statistically significant data demonstrating AED concerns have been noted.

As the vaccine has demonstrated 95% efficacy, that means that 5% of the 100,000 original vaccine volunteers did develop disease post-vaccination.  It seems clear that if AED was likely, there would be a statistical difference for the worse between those so vaccinated and the placebo group.  None was noted.

This is partly due to the differences between a vaccine of this type (mRNA) and one from an inactivated virus.  Because the mRNA vaccine is so highly targeted (causing the body to look for a very specific protein), non-neutralizing antibodies that attack other targets on a virus (and therefore can cause AED) are far less likely.

ADVOCACY

She tells the crowd to take up a "call to action", and "go to Washington, D.C. to advocate".  Apparently she did just that, as there is video of her among the protest/riot group which entered the Capitol building, although her actions were not violent.

CONCLUSION 

There are things in her presentation with which I agree.  I don't think that there should be a general mandate on the vaccine.  The situation due to government meddling in New York and New Jersey nursing homes is absolutely unconscionable, perhaps even criminally negligent.  But on the whole, her whole presentation is meant to stoke fear and uncertainty, and her proposed solution - HCQ - just isn't effective in the way she suggests.  

In conclusion, her assessment that the vaccines should be "prohibited or discouraged due to unknown risk" just doesn't fit the situation, nor the data that has already been gathered.  It is up to us to make our own risk assessment, taking into account also the very real risks that come from contracting the disease, which are not just the death rate.  The vaccines are based on well-researched data and have been subject to real testing across a wide spectrum of ages and races.  To put it simply, the vaccines are the best way to end the pandemic and return to normal life.

Don't date my daughter...

Application to date my daughter.

Win hangman every time : ) or 99%, at least

This person did a mathematics study of the probabilities of certain words to be guessed in a hangman game.

Go Jazz! :)

Check it out!

Old NVIDIA drivers

I was looking for some older NVIDIA drivers tonight, but they weren't on the NVIDIA site.

This site maintains old NVIDIA drivers.

Boost Thread tutorial

I found this tutorial on setting up Boost threads quite useful:

Creating Boost Threads

Boost Producer Consumer thread safe queue

Here's a simple boost-based thread safe queue, using wait conditions.

http://www.justsoftwaresolutions.co.uk/threading/implementing-a-thread-safe-queue-using-condition-variables.html

Select on boost asio tcp socket

Boost asio does not provide a method of doing select on tcp::socket directly, but I found this example on the web:

    // socket here is:  boost::shared_ptr a_socket_ptr

        // Set up a timed select call, so we can handle timeout cases.

        fd_set fileDescriptorSet;
        struct timeval timeStruct;

        // set the timeout to 30 seconds
        timeStruct.tv_sec = 30;
        timeStruct.tv_usec = 0;
        FD_ZERO(&fileDescriptorSet);

        // We'll need to get the underlying native socket for this select call, in order
        // to add a simple timeout on the read:

        int nativeSocket = a_socket_ptr->native();

        FD_SET(nativeSocket,&fileDescriptorSet);

        select(nativeSocket+1,&fileDescriptorSet,NULL,NULL,&timeStruct);

        if(!FD_ISSET(nativeSocket,&fileDescriptorSet)){ // timeout

                std::string sMsg("TIMEOUT on read client data. Client IP: ");

                sMsg.append(a_socket_ptr->remote_endpoint().address().to_string());

                throw MyException(sMsg);
        }

        // now we know there's something to read, so read
        boost::system::error_code error;
        size_t iBytesRead = a_socket_ptr->read_some(boost::asio::buffer(myVector), error);

        ...

A little ugly, since it uses the native socket, but should be okay on most systems.