RFK, Jr.'s Book on Anthony Fauci: Chapter One

 Reviewing Robert F. Kennedy Jr.'s book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, my first four posts dealt with the Introduction. Those first four entries can be found: Entry #1, here. Entry #2, here. Entry #3, here, and Entry #4, here. On to Chapter One.

 

Chapter One.

Chapter One is titled: Mismanaging an Epidemic. The first section is titled: I: Arbitrary Decrees: Science Free Medicine. 

This chapter begins with something like a topic sentence. "Dr. Fauci's strategy for managing the COVID-19 pandemic was to suppress viral spread by mandatory masking, social distancing, quarantining the healthy, while instructing COVID patients to return home and do nothing–receive no treatment whatsoever–until difficulty breathing sent them back to the hospital to submit to intravenous remdesivir and ventilation."

That's a packed sentence. The first part, mandatory masking and social distancing were certainly part of the approach and will be discussed at the end of this post. Quarantining the healthy? Quarantines involve not leaving home. In quarantines you cannot go out to perform necessary functions. The stay-at-home orders, issued state-by-state (more on that below) permitted the healthy to go out for health needs and groceries, among other activities. Workers essential to such things as the food supply, health care, and other jobs were exempted. The governor of Florida extended the essential workers to those of the World Wrestling Foundation. 

As for asking the sick to stay at home unless they had an emergency: that came at a period when hospitals were overwhelmed. More on that below. (This is the introductory sentence and I will deal with individual parts as they are supported in the coming pages.)

Continuing with the opening sentence, I agree that remdesivir sucks. More on that in a future installment, where drugs are discussed.

Kennedy goes on to say, "Medicines were available against COVID–inexpensive, safe medicines—that would have prevented hundreds of thousands of hospitalizations and saved as many lives if only we'd used them in this country." I see this chapter will include hydroxychloroquine and ivermectin and those who promoted them. Here, Kennedy is in my wheelhouse. I have been teaching pharmacology and antimicrobials for thirty-some years. I am quite practiced at telling the difference between an effective treatment and a phony one. I've never hesitated going after big Pharm when they put forward a lame drug or balked at sorting out which therapies work and which ones don't. I look forward to responding to what he says. 

Okay, with his thesis statement out of the way, let me undertake a lengthy digression from critiquing Kennedy's fiction. It is necessary to provide context to my commentary. I've been criticizing what Kennedy says happened and giving many examples of where he was flat out wrong. Let me present a more accepted version of what happened including my own research.

The Early Phases of the COVID-19 Pandemic, The Threat, and the Response. 

At least through the end of 2021, the COVID pandemic in America consisted of roughly two phases with no clear date separating the two. First, I'm going to provide a lot of background and then get back to the two phases. 

At the beginning of the pandemic, there was the first wave. Health care officials in the United States were reacting to several things. One was the SARS outbreak that began in 2002. Although contained, it had nearly a 11% lethality rate.  That is crazy high for a flu-like disease, translating to rate of tens of millions of death if the disease spread worldwide. When COVID-19 infection was first mentioned, I heard the term "coronavirus." Coronaviruses, typically, are very infectious, but not that severe in terms of disease. I was calm. If I had heard SARS-COVID, I would have hidden under my desk.

Secondly, come February 2020 during the COVID-19 infection, there were reports from free countries (in contrast to China) including Italy and France where the disease was absolutely devastating local populations. Between February and April 2020, in Italy there were "143,626 confirmed cases and 18,279 deaths." The high rate of deaths probably related to an insufficiency of confirming cases. Nevertheless, absolutely shocking numbers, suggesting a once-in-a-century event.

Thirdly, and I find this the most instructive, during February 2020, was the cruise ship the Diamond Princess. Due to its time isolated from land and the ability to test and monitor most all its passengers, the world obtained a picture, albeit imperfect, of how the disease might spread and its effects. Imperfect efforts were made at lockdowns during the cruise within the passenger compartments. A summary of the cases: 

"Six hundred thirty-four (17.1%) cases were diagnosed in a total population of 3711 cruise passengers, and 328 (51.7%) cases were asymptomatic. As of April 24, 2020, 712 cases had been diagnosed and 14 (1.96%) deaths had occurred [additional diagnoses and deaths took place]. . . . Without an evacuation plan for passengers and crew, we estimated the total number of cumulative cases would reach 3498." [94.2%] From: A major outbreak of the COVID-19 on the Diamond Princess cruise ship: Estimation of the basic reproduction number. So, 94% of people infected in the worst case scenario and nearly 2% deaths. That could translate into over a 100 million deaths worldwide. Note: According to another study, only 80% the cruise ship passengers and employees submitted to COVID testing and 17.4% were asymptomatic.

So, as of February 2020, we could be looking at a high rate of lethality for a highly contagious disease. So what was the response? A terrifying concept: flattening the curve. Italy showed us what it was like to have a rapid steep peak in COVID cases. If you overwhelm health care services, if you have 50 to 80% of people with symptoms, everything shuts down and you have a lot more deaths. Fauci's guidelines aimed to flatten the curve. America only partly listened to him and only partly flattened the curve. 

Other countries were quicker to act than the United States. Beginning March 2, 2020 Japan shut down its schools (and perhaps to no useful effect). March 19 would be the first state called for mandatory state-at-home. 

Why flatten the curve? Beyond blunting an overwhelming spike in cases, pandemic organisms that cause severe disease and death weaken over time. Why? Those with minor infections and those who are asymptomatic are more likely to be out there in public spreading weaker strains of the disease. Pandemic organisms also tend to become more infectious. The strains that are more infectious spread to more people. COVID-19 might well have started with a 10% lethality rate. It was soon down to 2%. Eventually, over time, it became closer to 1% (in part because good management of the disease finally kicked in). (Wordometers reports approximately 700,000,000 cases worldwide with 7,000,000 deaths.) A 1% death rate from a flu is also absurdly high. The early goal was to slow the spread of virus infections.

The Two Phases

With this setup, let me describe how the COVID pandemic came in two phases in America. On February 29, 2020, America had its first official COVID fatality. (Later research would find earlier cases.) On March 12, 2020 with COVID raging in a number of European countries, President Trump announced in a nationwide address, a suspension of "all travel from Europe to the United States for the next 30 days." This was an incorrect pronouncement. He was inaccurately describing an order limiting non-citizens from entering the U.S. 

American tourists, thinking they might be stuck in Europe, fled from COVID-infested areas. No efforts were made to stem the infections they brought with them. Many of the first wildfire outbreaks of COVID in America came at the sites of airports that received high amounts of European flights: Massachusetts, New York, New Jersey, Chicago. The virus at the height of its morbidity and lethality flooded into America. In the next few weeks, hospitals overflowed and hospital cots were set up in Central Park. The hospitals being overwhelmed is why those without the more serious symptoms were for a time advised to stay at home.

O'Hare Airport, March 14, 2020, two days after Trump's televised address

The first phase continued with superspreader events seeding the virus around the country. I detailed some of these in my previous posts (here and here). Were these events following "lockdown" orders? Many of them took place in states that snubbed Fauci's recommendations. 

The second phase came at the beginning of 2021, after a vaccine had become available, and after some imperfect treatments had appeared. This also overlapped with the deadly Delta version of the virus. 

I performed an analysis to learn which states fared better and more poorly during the period of February 23, 2021 (the first appearance of the Delta virus) and October 1, 2021, the time of my analysis. February also corresponded to a time when the vaccine was becoming generally available. I contrasted these rates to the mortality rates in the first phase (defined as before February 23). The table below includes all states and the District of Columbia ranked according to death rates.

COVID death rate by state per 100,000 population
February 23, 2021 to October 1, 2021.

The phase one lethality numbers are higher: 72.7% of all deaths between the start of the pandemic and October 1, 2021, occurred before 2/23/21. That was a full year (versus seven full months of phase 2) and, as said above, the first wave overwhelmed the system. For Phase 2, the states that fared worse are in general those that chose Trump and his superspreader policies over Fauci and his cautions. Florida actively pushed against vaccination. The top 15 states with the highest Phase 2 lethality were those who voted for Trump in the 2016 and 2024 elections, indicative of following the lead of a man who held superspreader rallies and promoted spurious treatments in contrast to following the advice of Fauci.

Most of the highest rates of death in Phase Two were in states with lower vaccination rates. Most of the highest rates of death in Phase One had airports that were hit by the evacuation order from Europe. Exceptions include South and North Dakota, hit by their own superspreader event. 

It is easy to describe a third phase. The super-infectious omicron variant took hold in December 2021 causing numbers to hugely spike with total cases increasing by 50% in two months. By that time, the death rate had fallen well below 1%. 

Back to Kennedy's Arguments

Kennedy's depiction of "lockdown" orders is wholly delusional. He speaks of stay-at-home orders as quarantines (they were not: they always allowed people out for necessary activities) and speaks as though they were universally imposed. They were not. Stay-at-home orders were decided and implemented (or not) state by state. Here is a chart from an excellent article that looks the nature of the individual state stay-at-home orders, whether they were mandatory or advised, how long they lasted, and whether they were for everyone or, for high-risk groups, or for high-risk counties.

Through May 31, 2020, three months into the pandemic, no stay-at-home directives, advisory or mandated, took place in the following states: Arkansas, Connecticut, Nebraska, North Dakota, and Wyoming. The following states issued only advisory stay-at-home directives: New Mexico, Massachusetts, Kentucky, Utah, Texas and Iowa. Two more states issued mandatory stay-at-home directives only for those at high-risk or for certain counties: South Dakota and New York. Another twelve states had mandatory stay-at-home order that lasted six weeks or fewer (let's open up again for Memorial Day was a big rallying cry): Nevada (5 weeks), Arizona (6 weeks), Virginia (6 weeks), Maryland (6 weeks), Kansas (5 weeks), Rhode Island (4 weeks), Alaska (4 weeks), Florida (1 month), West Virginia (6 weeks), Colorado (4 weeks), and Georgia (4 weeks). (Georgia continued with mandatory orders for those who were deemed at high-risk.) (Note: I live and teach in Puerto Rico. We had the first mandatory stay-at-home orders in the nation, before any state, and had one of the best responses in terms of death rates for COVID in the country. If we were a state, we would have ranked 47th lowest in the rate of mortality. From: Worldometers. (sort by death rate)) 

This leaves twenty states that had mandatory stay-at-home orders lasting more than six weeks. Kennedy believes that represents Fauci being all-powerful and stay-at-home mandates being so devastating to everything from the economy to mortality by other causes. Those states with mandatory stay-at-home orders that lasted more than six weeks made up 55.3% of the United States population (in part because the massive population of California was included).

Masks

Kennedy goes on to discuss masking mandates. He quotes an early statement by Fauci, stating that masks were much more effective in preventing an infectious person from spreading the disease than protecting a person against infection and saying that (typical) store-bought masks had "leakage around that doesn't really do much to protect you." Yes, masks are much more effective in preventing infection from an a symptomatic person. That doesn't make masking futile. He further quotes Fauci, "Now, in the United States, there is absolutely no reason to wear a mask." That "now" referred to February 17, 2020, approximately two weeks before the first recorded US death by COVID. It is clear that Fauci updated his recommendations. 

Kennedy goes on to quote Fauci saying asymptomatic transmission does not drive the outbreak of respiratory diseases. Kennedy concludes Fauci said masking asymptomatic people is fruitless and later that "asymptomatic transmission of COVID-19 is infinitesimally rare." That is not what Fauci said.

Kennedy says 52 studies found ordinary masking useless. He goes on to say, some 25 studies supposedly showed that masking causes a "grim retinue of harms," and "fourteen of these studies are randomized peer-reviewed placebo studies." 

The problems with that statement. First, it combines a minimal standard (peer review, the others weren't peer reviewed?) with a gold standard (placebo studies). Placebo studies in this context make no sense. It is impossible to blind a participant to knowing whether or not they are wearing a mask.

So, 52 studies support the notion that masks don't work? The supporting footnote references Kennedy's website. One general reality that Kennedy overlooks is that there is a whole LOT of research out there. If you want to pick and choose a contrarian finding, it is not difficult to do. Kennedy does not present any of the many studies that contradict him. For example, this recent review looked at 400 studies of masks and came to the conclusion "Our review confirms that masks work, with a clear dose-response effect." 

Kennedy deals only briefly with social distancing "mandates" quoting a former FDA Commissioner Scott Gottlieb saying that the six-foot distancing was arbitrary and example of "a lack of rigor by the CDC around making recommendations."

Okay, the six-foot rule was arbitrary and based on large droplet spread. Small droplet spread would have recommended 24-feet, impractical short of a total shutdown of businesses. There are certainly studies that did find social distancing worked which stand unchallenged since Kennedy didn't offer anything more than an opinion that the six-feet dictum lacked rigor. 

Kennedy goes back to the "unprecedented" lockdowns to conclude his first section of his first chapter.

To be continued. 

Martin Hill Ortiz is the author of several novels including most recently the thriller, Floor 24. 

Floor 24
Oliver-Heber Books

"From the mob underworld to the tops of new skyscrapers, Floor 24 is a heart-thumping New York 1920's historical mystery!" - Holly Newman, bestselling author of A Chance Inquiry mystery series.