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The Seen & Unseen of COVID-19

The vaccine is working, yet the government says we can’t go back to normal.

Dr. Jeffrey Singer is no “anti-vaxxer.” The Arizona-based surgeon and senior fellow at the Cato Institute has written and spoken clearly about his belief that the COVID vaccines are safe and effective, and that those who get vaccinated can return to normal activities like flying, indoor dining and visiting friends and family.

However, Singer also opposes mandatory vaccination from both a strategic and moral standpoint. When the government has to use force to induce compliance, the argument has already been lost. Skeptics, Singer points out, will be less trusting of the safety if they are forced to get the jab.

In quantum mechanics, the Totalitarian Principle states that “everything that is not forbidden is compulsory.” The government’s botched rollout of the vaccine seems to be following a similar pattern. Millions of potentially live-saving AstraZeneca vaccines remain held up in a warehouse in Ohio due to regulatory hurdles, while at the same time politicians like New York’s Governor Cuomo are pushing a kind of of mandatory vaccination with “health passports.”

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Making matters worse, Dr. Jeffrey Singer points out that the messaging from people like Dr. Fauci has been subpar at best. Rather than communicating that the vaccines are safe and effective, and that those who receive them can return to normal life, Fauci and others continue to lecture that little will change with the vaccine. He seems to be saying, “Keep masking. No hugging. No going out to eat. Just keep following the rules, even if it means an endless lockdown and ratcheting up of government’s permanent authority.”

What kind of message does this send to those who already have “vaccine hesitancy”? Where’s the incentive to take the risk?

Dr. Singer joined the show to clear up this confusing messaging and discuss the actual risks/reward ratio of the vaccines, as well as the all-important consideration of the freedom to make a decision for yourself.

Highlights of the interview with Dr. Jeffrey Singer

It seems like for the last year, we have all fired our health care professionals, and have replaced the information we were customarily getting from them with information from elected officials or unelected bureaucrats. If we had gotten the same advice from our physician, would we have the world’s most winnable medical malpractice case?

When we’re dealing with a pandemic, a public health emergency like this, it’s important for everyone to realize that it’s a work in progress. We should stop saying, “I follow the science,” because that makes it like dogma. We should say, “Science is a method. It’s a constant process of learning.” When you think you’ve gotten the answer, you actually want your fellow scientists to try to replicate what you did and see if they can come up with the same answer. As more information comes in, it is constantly changing.

When in the early days, Dr. Fauci said that this is going to be nothing more than a flu, everybody just calmed down. A few weeks later, it became obvious it was going to be something different than that.

It’s important for everybody to understand, and for these experts to emphasize every time that, “What I’m telling you is what I know, based upon this moment in time, this is subject to change.”

When it comes to us practicing physicians we come at it from a totally different perspective. Every hospital has a chief medical officer, which is a physician who is the liaison between the hospital administration and the medical staff. They get daily memos from the CDC, the national public health officials. These CDC people tell the chief medical officers, “This is what we recommend.”

Those chief medical officers pass that downstream to all of us practicing clinicians. But the recommendations coming from public health officials don’t take into consideration trade offs. They’re in their narrow silo. Their mission is to give advice on how to control and/or eradicate this particular public health threat. That’s all they are focused on. That’s their job.

“Every decision involves trade offs.”

We clinicians are dealing with patients and each patient has their own unique situation. Every decision involves trade offs. They have to weigh the risks and the benefits to them of any of these decisions. Our mindset is different from the mindset of these public health officials. It is much more tuned to the trade offs. The mindset of a public health official is not concerned with that.

Most of us practicing doctors are basically getting the edicts of the public health officials passed on down to us. There is this disconnect. It’s a different culture. Many of us are skeptical or saying that their recommendations are not workable, but we can’t say that because we’ve already been told this is what is the official recommendation.

Then you get to malpractice. We get worried that even though our personal thoughts may be skeptical of these recommendations, when it’s been publicly announced that this is the recommendation of the official medical experts of the United States government there’s a pressure on you not to openly deviate from that, because it puts you at risk. That’s the dynamic at play right now.

How would the results have been different if more decision-making were given at the individual physician level, rather than at the mandated government level?

As libertarians, we can agree that when you have a true public health emergency, we have to be concerned about externalities and your behavior. While it should be your choice, if it’s going to threaten the lives of your neighbors, in principle, we could certainly agree that you should be restricted until the emergency passes, because everyone is threatening everyone else’s life.

When this originally started hitting the fan, it looked very bad, and we didn’t know enough. I think it was reasonable a year ago to recommend everybody to hunker down because this looked bad. As we learned more over the next several months, we needed to make adjustments in our policy.

For example, we now know a year later that 80% of all deaths occur in people over the age of 65. 40% are in nursing homes. We were actually sending people back to nursing homes who presented to the emergency department diagnosed with COVID where they could then share it with their fellow residents.

We also know that over 95% of people have pre-existing comorbidities. Most prominent one is obesity.

We also know that over 95% of people have pre-existing comorbidities. The most prominent one is obesity. We also know that if you’re a young person under 20, COVID is actually less dangerous than influenza. If you’re somewhere between 20 and 45, it’s about the same as influenza.

We should have adjusted our recommendations as the information came in. When you have a governor put in place a mandate that sets a whole different set of incentives in place.

It’s what Frederic Bastiat talked about in the 1800s as “that which is seen, and that which is not seen.” For example, if the Governor decides, “Okay, let’s lift up on some of our restrictions.” Then case numbers start to go up. It’s natural for the press to focus on case numbers. This looks very bad for the politician politically. The politician comes into criticism for what he would do. He lifted some of these restrictions.

Now cases are going up. Meanwhile, what is not seen is that the longer everybody is hunkered down, there are economic costs. There are personal lives and futures that are destroyed by the economic hit. There are young people whose basically future plans. They’re already starting college. They’re being derailed and maybe permanently. There are even younger people who are not getting in-person education in school.

Particularly, inner city kids who don’t have access to high speed internet are actually regressing educationally. This is going to horribly affect their future and widen the wealth disparity. There are delayed diagnoses of cancer. There are people not getting their routine preventive screening test done because doctors offices have been closed. People are afraid to come to the doctor. There are elective procedures, which doesn’t mean they are unnecessary procedures, it just means it’s not an emergency and you can schedule it. They’re being delayed.

People who have substance use disorders are being cut off from their rehabilitation programs. People in chronic pain can’t get into their doctors because those offices are closed. Their ramifications are much more diffused and delayed in their presentation. That’s what Bastiat will call the unseen. What is seen is the case numbers go up, what is unseen is all the damage from the restrictions that if they remain in place.

Some states are still restrictive, having lifted their restrictions. Other states have been less restrictive or minimally restrictive. A year later, it doesn’t really matter. The states that were less restrictive and the states that are more restrictive both got to the same place when it comes to case numbers, hospitalization numbers, and mortality numbers. Some have done so with much more damage to their population in other areas than other states have.

“There doesn’t seem to be a lot of difference between states like California, which is just now lifting restrictions, and Arizona, which completely lifted all restrictions two weeks ago.”

In terms of just focusing on that one virus, there doesn’t seem to be a lot of difference between states like California, which is just now lifting restrictions, and Arizona, which completely lifted all restrictions two weeks ago. Even before then since the summer, we’ve been having in-person dining and there’s never been a statewide mass mandate. I don’t think we’re any worse off than California in terms of COVID. I think we’re better off than California in terms of everything else.

Should I have all my listeners put on their mask while they’re listening to you? From a health standpoint, it’s a wash. From all other standpoints, the restrictive states have profoundly harmed their citizens. From an overall standpoint, is it profoundly clear beyond discussion that less restrictive policy has shown to be the better approach?

I think so. That’s taking into consideration the trade offs. If you just focused on numbers of cases or hospitalization numbers, then you may come up with a different answer. If you’re looking at this holistically, like what are you giving up in return for this, it would have been much better. In the beginning, it’s very reasonable to do what we did because we didn’t know and we needed to think and be prepared for the worst. As we learned more, we should have modified our approach and focused more on minimizing the risk to those most vulnerable and minimizing the chances of spread while allowing as many people who are less vulnerable to get back to what they needed to do.

You have 50 different experiments that took place here in the United States. There’s such a variation among the different states as to what their restrictions were. I don’t think you could argue that those states that were the most restrictive have had the better outcomes. Look what’s going on right now in Michigan. Michigan stands out in the United States as a state in which not only case numbers are going up but so are hospitalization numbers. In other states like Florida, which just had a big Spring Break thing, case numbers are going up, but hospitalization numbers and mortality numbers continue to come down.

To what extent is the advice you give to your patients based upon information you have gotten from the government, as opposed to from medical literature, training, seminars and the like? Is this another example of either physicians allowing, or governments imposing their medical advice between physician and patient?

There’s the same kind of pressures in the medical profession that are right now affecting people throughout life. There’s an official way to think, and if you don’t think according to the conventional wisdom to the narrative, you’re immediately derided as anti-science. You might be blocked on social media now.

“There’s an official way to think, and if you don’t think according to the conventional wisdom to the narrative, you’re immediately derided as anti-science. You might be blocked on social media now.”

When I’m talking to my patients, I tell them, “This is what the CDC recommends. If you want my personal opinion, this is my personal opinion, but I have to tell you that this is what the CDC recommends that you make your choice.”

I happen to think it’s unfortunate because this is groupthink. This affects every field, not just medicine. This is not unique. I remember reading in history books about Semmelweis, who believe that you should wash your hands between patients and you may stop infections. He was derided. We find it hard to believe that he was derided. You have a lot of that going on in the medical field as well.

There’s such mixed messaging from CDC about how Americans should behave once we get vaccinated. Rachel Walensky who says, “Once you’re vaccinated, you can’t get infected. If you do get infected, it’s gonna be very mild You can’t affect others, and highly unlikely, almost impossible, you’re gonna end up hospitalized, if you do get affected.” Then she says, “We’re doomed.”

How do you behave now that you are vaccinated? Are you cautious? Fauci would say wear at least 15, maybe 20 masks at the same time just to be on the safe side. What is the advice you give to the people you care most about?

First of all, the mixed messaging is really harmful because our ticket out of this mess is to get something close to herd immunity. To reach herd immunity, it doesn’t require everyone to get vaccinated.

Another way to get immune is to get the infection and have natural immunity. I don’t recommend that approach. I’d much rather have vaccination than get sick and risk death. I don’t want to feel the sickness.

Obviously, vaccination is the preferred way to go. We’re incredibly fortunate that these vaccines — particularly the mRNA vaccine — which are brand new technology, doesn’t even involve using alive or dead or modified viruses. It just uses messenger RNA. It’s incredibly effective. While there’s always exceptions and people need to understand that medical science is never 100%, generally speaking, if you get vaccinated with any of the three available vaccines right now, you’re pretty much 100% guaranteed that you will not get severely ill enough to be in a hospital, and you will not die.

“There’s almost 100% guarantee against severe infection leading to hospitalization or death. Depending on the vaccine it could be upwards of 95% or more protection against even getting the virus.”

There is a very tiny percentage of people who may get infected from the virus and be one of those asymptomatic cases. They’re unknowingly carrying the virus with them. Before we had a vaccine, they could be spreading it to others. However, now there’s a lot of data coming in originally from Israel. The CDC just reported on this last week. Even among those who’d become asymptomatically infected, the viral loads seem to be that greatly reduced by the fact that they were vaccinated.

Asymptomatic people tend to have lower viral loads and are less likely to spread than symptomatic people. Vaccinated people who become symptomatically-affected have even lower [spread]. It’s possible that you could be immune and feel great and unknowingly spreading a virus to other people. That’s extremely unlikely.

Armed with the information that you are, number one, almost guarantee almost not 100% guarantee that you won’t get sick enough to go to the hospital and you won’t die. If you get a case, it’ll be a mild case, and you’re highly unlikely to be spreading the virus to others. That tells me a couple of things.

Number one, I can hang out with other immunized people without concern. I can get my mask off, I can hug, I could kiss, I could shake hands and do all the things that human beings need to do because I’m highly unlikely to be able to spread my virus to that person who is on a highly unlikely to contract it in the first place because they’re immunized as well.

Number two, if I’m among other people who have not been vaccinated, I don’t have to worry about them giving me the virus. The chances of me spreading a virus to them is extremely unlikely.

I would still recommend being cautious among vulnerable people who are not immunized. If you want to visit a relative who is immunocompromised or is in a nursing home — most nursing home patients have been vaccinated now but if you want to visit some very chronically ill frail relative, you may still want to wear a mask around them, but visit them. Otherwise when it comes to interacting with people immunize people don’t really have to worry.

Even before we had the vaccine, it made no sense sense to wear a mask outside. What we know is that this spreads usually by aerosol at relatively close contact. The CDC has been telling us for a year that you have to be six feet away, but now they’re modifying it. Many other kinds of World Health Organization were always saying about a meter away and countries in Europe have varied from three feet to five feet to two feet. Nobody really knows for sure. Six feet is safe. 100 feet even safer, but between three to six feet distance, and usually for a length of enough time for that aerosol to land on the person.

For example, if I’m walking down the street on a beautiful day and breathing in the fresh smell of orange blossoms here in Phoenix, and another person passes me on a sidewalk for one second, we cross each other’s paths. Unless I hold that guy still and breathe closely into his face several times, I’m not going to give him the virus and he’s not going to give me the virus. I see people actually dawn a mask as they approach me for fear that they’re going to catch something as we pass by for that one second.

If you’re riding a bicycle out in the open air, who are you going to catch the virus from?

“If you’re riding a bicycle out in the open air, who are you going to catch the virus from?”

If you’re riding a bicycle out in the open, I don’t know why you’re wearing a mask. If you’re in a car by yourself, who are you going to give it to? I think a lot of people think that this is a virus that’s flying around like mosquitoes or something, who could land on you. It’s not like that. When you’re out in public places where it’s a wide space, you don’t need to wear a mask. When you’re in an enclosed space where there’s not good ventilation, unless you know who you’re with, it’s probably still advisable until we get more immunity in society to wear a mask.

As a libertarian, I respect property rights. When I’m coming into a store, if it says masks are required, I obey that because that’s their right to say that. Not only that, but from a practical standpoint, if I’m going into a supermarket, I don’t want to frighten the other people in the supermarket. Since there’s no way of knowing among all these dozens of strangers in a supermarket, who’s been vaccinated and therefore is no threat to others, and who hasn’t been vaccinated, it’s just easier for everybody to wear a mask in there. Nobody gets anyone frightened, at least if you’re considerate to your fellow neighbors.

What is this issue about vaccine passports? As a libertarian, Jeff, I jump to the ID card, “show me your papers.” Right away, I jump to the darkest parts of western cultural and military history. Are they imminent?

As a libertarian, I believe that if a property owner has a sign on their store that says “no shirt, no shoes, no vaccine, no service,” that’s their right. I have to respect that. It’s reasonable for countries to want to make sure that you’re not carrying an infectious disease into their country when you’re landing at their point of entry. That could hurt their citizens.

Many of us who travel are familiar with these yellow vaccination certificate cards. They’ve been around for decades. I have one. I’ve traveled to parts of the world where yellow fever is endemic. I had to prove that I had vaccination against yellow fever. I had a card with me. It’s approved by the World Health Organization and the Department of Health and Human Services. It has on there that I was vaccinated in this state with this and this vaccine, lot number, and a little stamp by my doctor showing it with, and that’s acceptable. Now, if you have something like that, I don’t see that as necessarily invasive of my property. I own the information and it stays with me.

If you have on the other hand, what we heard discussed, a centralized government database that controls your vaccination information. Then you download onto your smartphone and app where you could have a QR code that you show people — there are a lot of problems with that. Number one, in order to have that in a centralized government database, there’s gonna have to be some other vital information about you to find you in that database. That’s subject to hacking. There are privacy concerns. Every place that you use that, there’s going to be another opportunity for that information to be stolen.

Experience has told us these things could evolve into ways to track people throughout the country, every place you go, every place you use it, there’s now a digital trail that you’ve left behind.

Even though it would be implemented without this intention, a skeptically healthy libertarian would say, “Yeah, I hear that you have no intention but I also know that these things have a way of evolving into that.”

I read recently that Israel came up with something like that. They call it a green certificate. It wouldn’t be a passport. It would be a certificate, basically. There was a report in the New York Times earlier in March about that. I’m told by a couple of Israeli libertarian friends I have that people have stopped using it, they just started ignoring it. For a few weeks, it was very helpful. Now apparently it’s falling out of favor there in Israel. If you come up with something like that, I don’t have an issue with that, because you don’t have to worry about privacy, about tracking. You just basically have a certificate that is less easy to forge. If a person wants to be convinced that you are immune and not a threat, you can show it to him.

You’ve told us that younger Americans, young kids, the K through 12 group of Americans, are highly unlikely to contract the virus. If they do, they’ll be asymptomatic. Is there any reason from your specialized vantage point that all schools should not be open, business as usual?

Grade school is highly unlikely to contract or spread the illness. When you get into adolescence and high school age, the risk of contracting and spreading the illness is approximately the same stat of adults. There’s only 226 deaths in the United States out of 560,000 that are under the age of 20. If you’re under the age of 20, your chances of getting seriously ill to the point where you have to be in the hospital and die is extremely small. But in K through six, let’s say these young kids, there’s very little risk of spread. There has been research on that showing that for over a year.

Interestingly, Rochelle Walesnky who’s the new CDC director, herself was an author of a research paper last summer showing that. Many countries have not closed the schools at least K through six grade school level. The younger children who are in the early development years, they are crucial milestones, both in their cognitive development and in their socialization development that they’re missing out on right now.

There have been reports, for example, in students in the Virginia suburbs of DC, who have actually had regression in their reading skills because they’re missing school. Younger children generally need in person education, they don’t do as well remotely on the screen.

When you’re dealing with high school or middle school kids when the caseload is high in the community and it’s going around, you can make the argument of either hybrid or remote learning for these older kids. Number one, they’re older, and they seem to do okay with remote and hybrid learning.

Is there any case made for K through six? Is there any rational scientific justification for anything other than business as usual in those grades today?

No, in fact, even the CDC a few weeks ago revised their guidelines for that. They said that the research shows that three feet distancing is just as good as six feet distancing. You don’t need six feet distancing, which is important because if you require six feet distancing, a lot of schools can’t accommodate every student with that distance between desks. Three feet distancing is sufficient. If they’re taking necessary precautions, mask wearing hand washing, that kind of thing. In fact, it might be the safest place to be.

The CDC has said this. There’s no correlation to the rate of spread within the community. When you’re in a classroom three feet apart from one another wearing masks and it’s good ventilation in school, you’re actually safer there than in the general community where if you’re accompanying your parents to the supermarket, you’re much more likely to pick it up from an adult there. There is no scientific reason to keep schools closed. There are some representatives of the teachers union that are basically insisting on zero risk.

Now that many states have prioritized vaccination of teachers, now that they’re immune, they’re saying, “That’s not good enough. I need the children to be immune too.”

There’s no such thing in life that is zero risk. The teacher driving to the school to teach the children took a risk of getting killed in a car accident driving to the school. When you are immunized and you’re facing a classroom of young children who are highly unlikely to contract or spread the virus, and they’re wearing masks and you’re in the front of the classroom. There is no scientific rational basis for not insisting that they get vaccinated.



-- • host of The Bob Zadek Show on 860AM – The Answer.

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Bob Zadek

Bob Zadek • host of The Bob Zadek Show on 860AM – The Answer.

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