A day in the (unethical) life of the Covid Physician
30 November 2020
Medical Ethics?
Lockdown has dire, hidden consequences for unwell patients in general practice. Take for example the 34-year-old patient with motor neurone disease, English is a second language, she is an asylum seeker who thought she was escaping persecution and tyranny. In addition to the general muscular spasticity and weakness which will eventually lead to a slow death by respiratory failure she has a progressive bulbar palsy which means she can no longer speak nor swallow well. These will worsen. Each morning she risks a death by choking on her puréed breakfast. A feeding tube has been proposed, but she pretends to her specialist it hasn’t been. She is on medicines that sedate her. She can barely handle a mobile phone. Let us say life is already a multiple misery.
Covid-19 has brought her a special new hell. Carers avoid her due to the vulnerability her medical conditions bring to her. Speech and language therapists (SALTs) avoid her and make-believe care through Microsoft Teams. To make this virtual dystopia impressive and even better than the real thing they have given it an incredible name: The SALT proudly states: “Consultation done with AAC meeting”. What is that? I keep reading. My goodness, another Fourth Industrial Revolution thing? Augmentative and Alternative Communication. To me, a simple video-call is demoralising doublespeak, for non-existent care by proxy.
My patient’s neurologist does the same: multi-conferencing the locked-down patient as she slowly rots in her asylum accommodation amidst a cold, bleak post-industrial pseudo-apocalypse. A pathetic dripping roast for everyone to make even easier money off. It occurs to me that the dehumanising, forced-impoverishment and restrictions of my refugee and asylum patient group is now upon us all – meagre social credits, not allowed to work, restricted movement, restricted access to healthcare. We are all in the same Lockdown boat, now.
I am the same. I’m getting used to dealing with digitally zipped and unzipped patients through an optic fibre. It’s so much cleaner this way. I wear 20-year-old surgical scrubs from my bygone dynamic, hospital youth, de rigueur to ward off SARS-CoV-2 these days as holy water was for vampires, but probably more useless. I sink my aching, middle-age bones into my morning cybernetic surgery seat. I won’t be moving much but my jaw. All dressed up like a hero, with no one to see. No defibrillating nor precordial thumps today, except that is perhaps to keep myself alert to the stupefying task of seeing, yet not seeing patients. Of examining, yet not examining patients. I slip on the headset and log in to the video-portal.
I wonder. How many can I prevent from coming in, today? Then a brief thought comes to me … like a sliver of light illuminating a former career … yes … I remember now … where have all the unwell patients gone? Where are all the children with high fevers – we used to see so many. Now none. Where are all those unexpected emergencies that should have dialled 999? Where did they go? What happens to them, now? Does Covid really displace and cure all else? I shrug off these heavy questions with a disturbing ease. I still need to put food on the table. Is this how the doctors coped in Auschwitz? Am I losing my compassion?
Fluvid-20?
No. Covid does not displace absolutely everything because Professor-Elect in Covidology at the University of Parliament, Matthew Hancock announced today we must have a vaccine to reduce the risk of getting Covid and ’flu together. Most unlikely, but as this is the thoroughly abnormal new normal what can we do in a parliamentary dictatorship to correct him?
Last year in the nice. old normal I taught young medics keen to diagnose everything in every patient the old wisdom: there is usually only one diagnosis for each presentation. Earlier in the year, Prof. Hancock had already rewritten the medical manual into a monolithic Little Red Book and announced a PCR test that is more worthy of a shot in the dark than a diagnostic test and would magically diagnose asymptomatic, well patients with a terrifying new fatal condition, Covid-19. Even most medics fell for it. It is not only simple words that are being politically redefined.
The post-Covid pseudo-medical order has not only destroyed the medical paradigm I faithfully practised as a medical doctor last year. It has inverted it. I do not recognise the government apocalypse in my medical reality. The breath-taking speed and ruthless efficiency with which the media-industrial complex have co-opted our medical wisdom, democracy and government to usher in this new medical order is a revolutionary act. A medical tyranny transitioning to a technocratic totalitarianism. A cis- to trans-medicine moment.
What of my patient? Well, I can’t follow her. The thick accent combined with her bulbar palsy means she speaks unintelligibly, as if her mouth is packed full of cotton-wool balls. “Pardon? Say it again, sorry, I’m really sorry … please say it again …” and so it goes on and on. It is truly awful, soul destroying and so unnecessary, but she is surprisingly resilient. More so than privileged me. Finally, I feel we’re getting somewhere, which is a relief, for how is an isolated, impoverished and spastic patient meant to come in independently even if I elect to utilise one of my precious few face-to-face slots? “Yes, ma’am … so you have a severe cough?” I become worried; this could be a Covid-special in a vulnerable patient. The positive for me is that it’s a remote easy hand-off to the hospital; or in a well, mobile patient to a commercial swab joint, where everything and nothing magically becomes Covid-19. Medicine has become an arbitrary political act.
But I need to assess the severity … ambulance? It is painfully slow to corroborate the story for multiple reasons, so I do the GP re-cap manoeuvre … “so you’re saying you’re unwell because you have a severe cough?” I believe I am becoming attuned to the cotton wool. “No,” says she, “I’m not alert so I need seven coffees, I was told to ask you if it was ok?” Blimey, what a relief. “Carry on!” I say, “carry on!” and in my relief I believe I end the consultation too soon for her to dislodge another cotton-wool ball and add something else. Then it occurs to me. Is she still obeying Boris literally and trying to STAY ALERT to deter the virus? Perhaps, I should call back and explore her ideas, concerns and expectations around Covid-19, but that would be a difficult conversation in ideal conditions on a good day, even with my medical colleagues.
WhatsApp beckons. GP colleague messaging, “How the hell do we deliver this vaccine at just three weeks’ notice, where do we get the extra staff from? Suspect it will take 2 months” Only the business of vaccine delivery seems his concern.
Well, that timescale will still suit Prof. Hancock, who strikes me as one of politics’ really blunt instruments. He would still be able to inject some of his cringeworthy pharmaceutical “hope in millions of arms” with boots on the ground before another Ides of March mortality spike. Certainly, a vaccine is the only hope for his political career. But I feel sure AstraZeneca, or a Health Informatics company like Babylon or OWKIN would ease his pain with a lucrative sinecure as he happily revolves out of government. Either way, live or die, the chances are any vaccine will be political win-win for him.
This March/April’s seasonal cull of the elderly has cleared a major proportion of Covid-naïve patients; many people have acquired natural immunity imbuing us with some herd immunity. Add to that a little medical progress, an allowance for influenza and other illness being conflated again in Covid deaths. Add also a potential removal of all those PCR false positives by a better-conducted test.
If cases and deaths consequently fall, he might claim all the credit: “mortalities reduced by twenty-five thousand.” He might say, “See! I was right. My totalitarianism and vaccination by coercive-control, physical assault and GBH worked. Collapsing the economy, suppressing the population, denying it access to work and normal healthcare, pouring six times the daily NHS budget daily for a year into lockdown, lining the pockets of my friends and Pharma was justified. I saved you, and you should thank me for it.” He could add, “You may now take off your useless masks.” Tragically, I think most might believe him. I guarantee, come another year and a bad flu year of say 28,000 deaths, it could all go very unnoticed because it suits government for it not to be.
In the alternative, if there are the same or more deaths, he may say, “I told you so. We need more arbitrariness, more violation of liberty, and more undirected vaccination.”
Primum Non Nocere
I swivel in my chair and ponder how to reply to my colleague. PCR madness, statistical delusion, multi-billion-pound moonshots, and headless chickens flood my mind. The suspension of civil liberties and the strangulation of the economy. Super-rushed, novel vaccine technology. Coercive-control, vaccine passports, and vaccine mandates. An undiscriminated, experimental cash cow of eight billion subjects. A flutter of a butterfly wing at the WHO has released an irrational tsunami of organised global chaos.
At worst, if one fancifully believes that the fifty-five thousand UK deaths this year were all due to Covid-19, the population mortality rate is 0.08 per cent (globally it is 0.02 per cent). The average age of a Covid death about 82 years – similar to the normal lifespan, the general survival rate of a Covid “case” is 99.6 per cent. In the under 20s it is virtually 100 per cent.
It is worth restating the danger of the government’s controversial blind, mass-testing Moonshot approach. The vast majority will be asymptomatic for cardinal Covid-19 symptoms. Most will be well enough to not need a doctor that day for any reason. A tiny minority may actually have an active SARS-CoV-2 infection that day (the government estimated 0.05 per cent). Most of those will be fine. Then, understand current tests and reasoning have the potential to falsely classify over 90 per cent of that whole population as actively infected. Then repeat this same test in the same population regularly and define any death within 28 days of that very misleading test as Covid-related.
If, as may be proposed, it tests 10 million every day, in a week it could “quarantine” over 90 per cent of the UK entire population who in fact do not have Covid-19. That might leave just 7 million of the whole population free to circulate for the next 14 days. Then, if the government tested that 7 million on the eight day, virtually the entire population would be interned by day nine. It would be cheaper to simply put the entire population under continuous house arrest and send the 100 billion of tax-payers’ money to next year’s NHS budget. In effect, this is an infinitely looping version of the genuflecting Dr. Keir Starmer’s preferred two-week circuit breaker.
The government could spuriously conclude after 28 days of the Moonshot detonation that over 90 per cent of all deaths in the UK are Covid-related. Let us change one thing in the Moonshot: let’s say the mass testing was with an equally bad test for cancer. In 28 days, over 90 per cent of all UK deaths might become cancer-related deaths and not Covid-related. I would rather get my odds from Ladbrokes than Operation Moonshot.
The cost of Boris’s Moonshot may be £100 billion according to a leaked government document, which is about three-quarters of the total annual cost of NHS England. That is an unnecessary, astronomical punt by the government. The government shields and spins the facts. The hasty, poor scientific response has made the medical issues indeterminate. This suits the government. It can flip-flop forever within a smokescreen like this, turning up and reducing the heat like an instrument of torture. Sadly, our only chance to thwart the dictatorship is in four years thanks to the constitutionally-damaging, anti-democratic Fixed Term Parliament Act. However, maybe by then another election will be postponed due to a coronavirus, as with London.
The other upshot of the Moonshot for the government is it will take regular mass samples of the whole population’s pharyngeal mucosa cells. These could be the basis for many fascinating experiments including population DNA and RNA auditing, in a similar way a toxicologist might monitor the radiation or chemical exposure-related effects on an experimental mouse’s DNA and RNA compositions over time. I’d be fascinated to see how these changed, particularly with the introduction of novel vaccine technologies, I’d be curious to know how modified RNA behaves once injected and whether its conferred properties were vertically transmissible from mother to baby, for instance. Operation Moonshot might be able to answer those particular questions. It would be a geneticist’s dream. Operation Moonshot’s magnificence reads like an experimental protocol for an altogether different agenda.
Patient consent?
Have we or will we be consented for this? Or has the government already legally-waived our consent? Lawyers, is this material to my concern: The Coronavirus (Retention of Fingerprints and DNA Profiles in the Interests of National Security) (No. 2) Regulations 2020 ? Is this legislation applicable only for criminals and terrorists or for any old national security reason? Let me know at @tcp_dr.
When we NHS workers were mass-tested in June, they took whole-blood samples. I was not consented for anything other than the inaccurate Roche antibody test. A business colleague had developed a finger-prick test which was far more accurate at the time, but someone trained in the humanities at the civil service declined it. It seemed feckless, but whole-blood means other tests can be done later, such as T-cell immunity studies. Sure enough, that data has subsequently emerged from PHE. So, what’s to say Moderna will not be given access to our samples and/or our data without explicit consent? This has been occurring elsewhere in the NHS at an unregulated pace with Google’s DeepMind project.
Big Tech players such as OWKIN’s director Nicole Junkermann are appointed by Hancock as advisors on his NHS Healthtech advisory board. Her NJF CAPITAL is the venture capital arm of NJF Holdings. NJF’s portfolio includes investments in deep tech companies, such as OWKIN, Blockchain and Deep Genomics.
I think of the Nuremberg Code, medical ethics, and patient choice. I cannot believe how disproportionate the massive political response is to the relatively small magnitude of the medical problem. I recall the UN declaration of Bioethics and Human Rights. Why are states breaking so many sacred global covenants for something which has killed somewhere on the scale from flu to Hong Kong flu? Such a flimsy, phoney pretext with which to bring the world to its knees. My concern is a medical version of communo-fascism has captured the WHO and our nation states.
I decline to reply to my WhatsApp colleague. For him it is a matter of vaccine logistics, not proportionate medical response. Not of safety, nor efficacy. No consideration that the coronavirus may mutate outside the range of the vaccine. No colleagues speaking of alternate mitigating manoeuvres nor therapeutics. Mention Great Barrington, ivermectin, the Borody Protocol and hydroxychloroquine and one is met by blank stares or worse, a cold silence redolent with a concern for clinical competence. I would rather not end up in a Jacinda Ardern flulag camp for medical dissidents. Her impressive teeth have taken on altogether different connotations for me. They are sinister, pristine OCD-masticators of dissent.
I think of a disturbing parallel Jordan Petersen made between dissenting words, germs, authoritarianism and the Nazis. A parallel which lulled the population into colluding in a mass Rentokil extermination of a human pest. That is what the unmasked, and soon the non-vaccinated, will become to the ignorant yobs who do their leader’s every bidding. Even UK Christians have gone underground.
I understand, Jacinda cares. She has a toddler; she is a clean-freak mother freaked out by the germ. She doesn’t want her or anyone’s child to die (stats tell us the child will most certainly not). She is not a scientist, a medic, nor a statistician. She wants to protect us, and her lay intellect under immense scrutiny and pressure has decided zero-Covid is best. Doesn’t she appreciate that zero-Covid is impossible unless she permanently imprisons or culls her entire human population? We haven’t managed to eradicate polio in 231 years. She, nor corporations are skilled or appropriate for making proportionate, balanced and informed life-death medical decisions based on risk-benefit. Doctors are skilled for individual patients, and medical epidemiologists may be when it comes to populations – but neither have much special expertise balancing their ideas with human rights, liberty and individual autonomy.
Sometimes judges intervene in an incapacitous individual’s treatment and life-death issues. Whom do we approach but self-interested, inappropriately skilled and devious professional politicians to intervene on behalf of the whole population? I am not sure there is a judicial alternative on matters of such public policy. What we require is a wisdom and an empathy which cannot be taught. We need individuals who will make difficult decisions not based on political face-saving and media hysteria. The wise are not in preponderance in the executive. I long for the wise ones. We could do with a Court of Protection from our own government.
SAGE dismissed herd immunity. PHE formally acknowledged it in September. Whitty later dismissed it again in an interview given on 28 October to the BMJ. He was also politely scathing about some of most able medics and scientists on the planet who authored and co-signed the Great Barrington Declaration. In fact, it appears the CMO was at least 5 weeks behind PHE’s science. If Whitty was not following the science, this is a fatal incompetence at the heart of the government. Whitty dismissed hydroxychloroquine based on in my opinion a questionable premise. It looks, all in all, like a really poor job.
Et tu Brute?
It was a breath of fresh air when someone with compassion, knowledge and wisdom finally spoke. Dr. Mike Yeadon, former VP of Pfizer and briefly, ex-colleague of Chief Scientific Adviser Patrick Vallance. His film was censored by YouTube within 24 hours. In the same week Facebook censored a medical post by Dr. Carl Heneghan, an Oxford Professor of Evidence-Based Medicine and GP as coronavirus “false information”.
Now everyone must acknowledge a malevolent, seismic shift is happening. Bare faced lies by Zuckerberg of Big Techversity. How long is it before Oxford sacks Professor Carl Heneghan and installs a fact-checker? What separates the West from global communism is a democratic sham. A virtual pogrom against dissident doctors and scientists is afoot. Big Tech is digitally vaporising us in a Fourth Reich book-burning exercise.
Caring, very intelligent medics and scientists rarely reach these echelons of power and influence. They are simply too nice. They are politically sabotaged or self-sabotage through their own inability to dishonestly follow the official line. They quietly do good work while others plot incompetent ascents to the top. When they speak for us, they are no-platformed and censored. They are not allowed to tell the truth but would be shielded and richly rewarded for telling official lies.
The prime minister is fond of saying he is following the science. He is not. He is absolving himself of command, control and blame by saying so. He may also be too classically-educated to appreciate he is not following the science with lockdown, masks and social-distancing. Nor is he with moonshot, woefully inadequate and flawed strategies. SAGE has its own crony selection bias. He is ensconced in an echo-chamber following a narrow body of nominal rubber-stamping medics, scientists and mathematicians without the correct skill sets, incentive nor personality traits to think outside of the box. They are the ones who ruthlessly rise to the top and become the best government mandarins in Whitehall. Ambitious, ladder-climbing, back-stabbing Et tu Brute? sociopaths in the image of their Caesar.
While they do politics, we are suffering and dying in their Yes Minister tragifarce for real. They could lock us up forever based upon their over-reactive criteria. Johnson, Whitty, Vallance, Hancock, and SAGE worry me more than Covid-19 and are far more dangerous to the UK. They have infantilised medicine. What would they do to us if a truly awesome contagion were to turn up?
Professors Hancock and Whitty have erased another fundamental medical principle from medicine: Primum Non Nocere – first do no harm.
30 November, 2020
The Covid Physician is an unheroic NHS doctor. This article is a personal view and does not necessarily represent the views of the NHS. Dr. TCP tweets at @tcp_dr
The patient’s details have been modified for anonymity.