14 Months Later: A Pathway Forward

Authored by Paul Alexander via The American Institute for Economic Research,

Is there a chance to recover and to effectively vanquish Covid-19, at least to end the pandemic and return to normal lives again?

We function here as prognosticators and contrarians that seek to inform and share and to learn, and we thus argue yes, and while we were blindsided and there were grave initial mistakes and some very consequential such as the very flawed and botched initial testing by the CDC that left the United States vulnerable and flying blind and allowed the virus to seed for 4 to 5 weeks initially, the following are the key components of the Covid-19 response that should have been enacted from inception (save 3-4 weeks initially to understand the pathogen) and which should be urgently implemented based on the experiences over the last 14 months or so. In our opinion. 

We offer this as a pathway forward and ask that we consider these as we try to deal with essentially failed approaches thus far, and use our common sense and deductive reasoning and logic to interpret the science and make informed decisions. We call on the medical experts who inform governments to likely for the first time, use some common sense and logic and some critical thinking; if it is all about the science, we implore the medical decision-makers to follow the data and science and to use it and use critical analysis of the data; we argue they have not; these decision-makers must understand the impact of their policies and stopping Covid ‘at all costs’ is not a policy and not attainable; if a policy is devastating and causing great harm to the population, you stop it, you do not harden it and reapply it as that is patently absurd and harmful; as such, we also ask our decision-makers to conduct the appropriate hazard analyses and cost-effective analyses.

Our pathway forward is as follows:

1. Properly and strongly protect the high-risk elderly persons with medical conditions and vulnerable persons e.g. frail persons with comorbid conditions, obese persons; elderly persons in nursing homes, assisted living facilities, long-term care facilities etc. are most at risk for severe illness or death from Covid-19 and they must be protected as a basis for any response to work; staff infecting nursing home residents remains the key breach in transmission and the rate-limiting step and has to be focused on immediately; stop staff from entering the nursing homes and infecting residents (sequester staff on site for one to two weeks at a time with no prejudice if they cannot, or use nursing home students or nearby hotels for residence to control transmission); we have failed to secure our nursing home residents and we have caused tens of thousands of deaths and we still continue to not secure the nursing homes

2. Immediately end all societal lockdown, shelter-in-place, mask mandate, and school closure policies; we must reopen all of our economies in the US, Canada (provinces such as Ontario), UK etc. as there are tremendous harms to these economic closures; there are catastrophic costs to these policies and evidence accumulated across one year now strongly suggests that these are highly ineffective and do not work; they are absolutely baseless and without merit; stop relying on hypothetical ‘worst case scenario’ projection models, as they have been incredibly inaccurate and grossly flawed; the crushing harms and devastation from these far outweigh any benefit and the harms are most pronounced among the poorer in society who are least able to afford the restrictions; the lockdown itself kills people, destroys families, prevents education of our children; child abuse is being missed by closed schools and the lockdowns promotes child abuse; lost jobs cause stress in the household and with closed schools, children are vulnerable as the visibility is gone and this is catastrophic; there is near zero risk to children from Covid and we are harming them by school closures, it was one of the most devastating misapplications of public policy; most of the decisions made by the governments and their medical advisors including Dr. Fauci who I have much respect for, are illogical, absurd, irrational, nonsensical, specious, and in most part reckless and have caused far greater harms with their policies

3. Isolate ONLY the sick/symptomatic persons (no isolation of asymptomatic persons); stop contact tracing where the virus has already spread extensively as it confers no benefit; stop isolating persons who are not sick/not symptomatic (are asymptomatic); stop wide testing of asymptomatic persons

4. Foster improved hand-washing hygiene and improved sanitation

5. Promote and offer early ambulatory outpatient therapeutics including combined and sequenced antivirals and anti-infectives and for some drugs as prophylaxis (hydroxychloroquine, ivermectin, doxycycline, bromhexine, colchicine, favipiravir, quercetin etc.), corticosteroid (budesonide, dexamethasone, prednisone and methylprednisolone etc.), and antithrombotic drugs (aspirin, enoxaparin etc.) as needed for those who do become ill, especially high-risk persons and those in congregate settings such as nursing homes, assisted living facilities, long-term care facilities etc.; we recognize that future research would clarify and define the benefit of these early treatments; we believe that it is not possible to overstate the philosophy that since early in-center treatment with already available medications (repurposed) in nursing homes and similar settings is associated with a large reduction in mortality among nursing home residents, there can be no scientifically sound reasons, nor moral rationale for not utilizing these forms of treatment; we are trying to prevent hospitalizations and save lives and strongly believe that this approach can be impactful and merits strong consideration; the accumulating early treatment evidence is compelling and deserving of very serious consideration and study as a therapeutic option, given this emergency. To do otherwise is to fail our patients 

6. Vaccines should be mainly available to those over 70 years of age who are high-risk and only after shared decision-making with their clinicians whereby patients can make informed decisions and consent to being fully informed; offer vaccines to high-risk front line medical staff who interact with high-risk persons; we however believe that this pandemic could have been and can be ended without vaccines e.g. via the simultaneous use of combined strong protections of the elderly and high-risk, early outpatient treatment, isolation of the sick only, hand-washing hygiene, and allowing the low-risk portion of the population to become infected naturally and harmlessly with reasonable precautions as part of normal living; a vast amount of our views on this is based on the lack of safety data and testing for these vaccines, leaving us unable to judge the future impact; we are already seeing adverse effects and even deaths recorded due to the vaccines

7. Thus, vaccines are not to be given/prioritized for those under 70 years of age who are healthy, and at no time be given to young persons e.g. those under 19 years of age; no vaccines are to be administered to pediatric/children age e.g. 6 months to 19 years or so as there is no evidence to support vaccinations; the benefits do not outweigh the risks

8. Begin immediate testing for T-cell immunity before vaccinating the designated group, if we are vaccinating the higher-risk persons; we do not vaccinate persons who have active infection or who have recovered from infection

9. Routine public service announcements (PSAs) are to be given on the benefits of Vitamin D supplements for persons with darker skin colours and those confined within congregate settings for prolonged periods, as well as messaging about the benefits of weight loss for those overweight and obese

10. Use a more reliable test other than the RT-PCR test and if this is to be used, use a positive threshold cut-point or cycle count threshold (Ct) of 25 cycles/amplifications and below to denote a positive case (infectious and possibly pathogenic); above Ct of 25 denotes nonculturable, nonviable virus and essentially prior infection or viral dust or fragments

11. Allow and foster the low-risk persons in the population e.g. infants, children, teenagers, young adults, middle-aged adults and all those who are reasonably healthy with no serious medical conditions, to live unfettered normal lives with sensible precautions so as to allow for natural exposure immunity; it is this portion of society that will substantially help develop population level ‘herd’ immunity (either via natural exposure, a vaccine, a combination of both, or even from therapeutics such as early treatment that reduces symptoms and thus transmission)

12. Recognize that asymptomatic spread is rare if at all and urgently provide messaging to the public that all persons who get infected are not at equal risk of severe illness or death; that there is an age gradient to severity of outcomes e.g. 25-year old David who is a healthy male is not at the same risk of severe illness or death if infected with SARS-CoV-2 as 80-year old Janet who is very sick with 2 underlying medical conditions such as renal disease and cardiovascular disease and who is obese

13. Recognize that a more ‘focused’ pandemic response (Great Barrington Declaration) approach that is targeted to age and risk is the best approach; ‘one size does not fit all’ when we are devising a pandemic response

14. Ensure hospitals are equipped and do not get overwhelmed

15. Understand that the immune systems of children are developing and being set for life and as such, we must allow them to engage freely with the environment; we may be damaging their immune systems long-term and we must allow their immune systems to be taxed and tuned up daily; children must not be confined indoors as transmission is far greater when confined indoors and it is just common sense

16. End masking and social distancing in any manner for children given their near zero risk of infection or spreading Covid virus as well as their exceedingly low risk of severe illness or death if infected; the science behind 6-feet social distancing was not there and was pseudo-science, embarrassingly weak and fear-based

17. Stop the mass media hysteria and fear about variants and mutations, as this is a good aspect, as when viruses mutate they typically mutate to much milder versions; the vast majority of people who are infected do not have a serious problem with Covid; infections are not important and a serious problem and one may argue ‘who cares’ about that number; what is critical is not the fear over infections, it is the hospitalization, ICU use, and deaths, not the number of infections; we need to get a grip and stop the fear mongering; if the infections do not result in consequential cases that need hospitalization or end in death, then we must stop the misinformation, hysteria and fear to the public

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Contributing Authors

• Paul E Alexander MSc PhD, McMaster University and GUIDE Research Methods Group, Hamilton, Ontario, Canada elias98_99@yahoo.com

• Howard C. Tenenbaum DDS, Dip. Perio., PhD, FRCD(C) Centre for Advanced Dental Research and Care, Mount Sinai Hospital, and Faculties of Medicine and Dentistry, University of Toronto, Toronto, ON, Canada howard.tenenbaum@sinaihealth.ca

• Dr. Parvez Dara, MD, MBA, daraparvez@gmail.com