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Covid Public Comment from Annie BukacekCOVID 19 TESTIMONY Kalispell City Council Meeting 8/3/2020 Annie Bukacek MD physician in Kalispell_Mayor Johnson, Members of the City Council COVID 19 data does not warrant mask mandates nor shutting down the fair. Even taking the data at face value it does not warrant any version of shut down. When we look at the data please understand there is substantial reason to question the validity of the COVID 19 testing and death numbers. Ultra - brief summary of information referenced in handout:, If you consider that no specific COVID 19 virus has been identified, that means we don't know what we are testing for. The CDC admits with the IgM, IgG testing that a positive test could be for any corona virus. That includes the corona virus that can cause the common cold. Before reviewing the COVID data, some definitions are in order. On the handout, I define what it means to be a COVID 19 "case" and list last night's government sources of COVID numbers. Understand this fact: a "confirmed case" means a COVID 19 (+) test. An "active case" means a person with a COVID 19 (+) case has been quarantined. A COVID 19 (+) test is often in an asymptomatic or minimally symptomatic person say with sniffles. Understand also that the spikes and hot spots of COVID (+) tests correlate with over a doubling in the testing done in Montana ... from 1400 tests on June 23rd to over 3000 a day of tests in August. If you test more people exposed to common viruses, you are going to get more (+) tests. Now, onto the data ... In Flathead County, the confirmed "cases" are .25% of the population and with 2 deaths. So less than 1%, a quarter of one percent of people in the Flathead have a COVID (+) test. The two Flathead County deaths attributed to COVID 19 that go back to March or April, amount to .0018% of the Flathead population. •uoileuiSewi Inpeal Aq inoge 142noaq si yaiynn jeyj jou 'spaau leaa iiayl aol ino loot pue Suiyj 142IJ ayj op s,ja3 •a}oA osle Aayl•••sluailed panolaq pue'saoggBiau 'spuaiaj Aw aae suazilp asayj'aw of •1aej :)ijiluaias se palagelaa Suiisai paseq-epueSedoid uanoadun uo suoispap anoA aseq -LON of noA Ise I •:pewleM sumo jeyj Al!wel uolleM ayj jou 'AalleA ayj ui away saoggSiau pue spuaia j ano Suilany 'uo pue uo pue uo saoS juawAoldwaun uoilaeaa uiey:) jeyl •sanoy pied jo ssol ql!m 'lei:ped ui ao 'qof jo ssol ylinn'jejol ui aaylaynn'juawAoldwaun uoil:)eaa uiey:) asne:) noA'aie; 041:90 }nys pue asop of sassauisnq nnolle pue Aq pue}s noA 11 •a:)ijlo olui noA paJOA 04M aldoad ayj pue saoggSiau pue spuaiaj ano we Aayl •sanoy ao sgof aiayl asol lauuosiad asnoyaaenn ayj'saal:)ols asipuepaaw ayj'saal:)aya ayj'slaal:) AiaaojS ayj uaynn in:) aq ll!m leyl sanoy ayj pue Isol aq ll!m leyl sgof ayj aq Aluiew pinoys :pewle/N aM!l suoileaodio:) aSiel ayj uana ui Isaialui inoA •umoppol ayj of anp peayle13 ayj woaj auoS pue Suiog sassauisnq liews ayl}o aaeme aae noA •1saialui ,suazili:) Iladsile>l aq p1noys isaialui anoA pue'1iauno:) Alit ayj ai,noA •aleaado of Suinuilum iiel ayj pue uado,uiAels sassauisnq se yens sSuiyl palle suoispap asoyj uagm uoilowa uo suoispap Suiseq jo wopsim ayj uoi}sanb 1 Ing •Aep aqI saiaae:) uoilouaa leyl ea3 ylnal Isod SM ui aziuSo:)aa I •uoi}ouaa uey} aaylea e}ep pue a:)uai3s'u0seaa uo suoispap inoA aseq of noA Ise 01 away w,l si ouil wolloq Aw LAajjen ay1 ui aldoad Auew os of jue:podwi uoijipeaj iiel ayj Aoalsap snld juawAoldwaun uoilaeaa uiey:) asm ll!m jeyj sainseaw Wanas Ajilsnf aagwnu mol Alawaalxa jeyj saoa Definition of "confirmed case" —person with COVID (+) test Definition of "active case" --person with COVID (+) test who is quarantined In other words, a "case" does not mean the person is sick Number of COVID 19 PCR tests done per day in Montana has more than doubled in the last 6 weeks —a plausible explanation for "spikes" in "cases" June 23/2020: 1478 July 13 2079 July 14 2296 July 15 2477 July 17 2604 July 25: 2685 July 27: 2802 July 30: 3200 Aug 2: 3140 Montana "cases" Updated Aug 2 at 9:59 PM local site: covidusa.net montana Montana population 1,068,000 Confirmed 4,193 Deaths 61 Recovered 2,466 Deaths .0057% of MT population .39% of MT population tested positive Flathead County 263 confirmed "cases" and 2 Deaths 131 Recovered Flathead population 106,134 Flathead CO has had 2 deaths for several months... that's .0018% of the Flathead population COVID 19 positive tests are .25% of the Flathead population https:Hwww.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm PCR TESTING —in the case of COVID 19 what are we testing for? 6 minute critique by Dr. Andrew Kaufman may be seen on my public facebook page Dr. Annie Bukacek Dr. Kaufman's longer version explanation https://www.youtube.com/watch?v=OYvNRno- JB8&fbclid=lwAR3e iXs2-ozyVsKCOtZQ-ZhhZxHOwmcwGTAoAymgFlDPg1Cd5FZ61kAPIE Dr. Kaufman's credentials https://www.andrewkaufmanmd.com/bio- credentials/?fbclid=lwAR3g2BAW7hCS3ZvEmi7UhgMJimOQnWahQ1pa36YnrsuKZF6ndF- gcyMe3UA COVID 19 listed as cause of death based on the death certificates... Is it accurate?... my video presentation on my public Facebook page RT- PCR testing (Reverse Transcription Polymerase Chain Reaction; RT for COVID 19 because it is RNA amplification/replication, not DNA) RT-PCR testing is what is being used to screen for and diagnose COVID 19. In Montana, about 2000 COVID 19 PCR tests being done per day. Polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies of a specific DNA sample, allowing scientists to take a very small sample of DNA or RNA and amplify it to a large enough amount to study in detail. You Choose a genetic sequence and amplify it. If you go beyond a number of cycles, you get a lot of noise. Since you amplify the sequence exponentially, the slightest error in measurement can lead to errors of tremendous magnitude such as many false positives Problems with using PCR Testing for COVID 19With PCR testing for COVID 19, we are relying on a test whose inventor disagreed strongly with using PCR for diagnosing infectious disease, said it was misleading Biochemist Kary Mullis invented PCR testing in 1984 got the Nobel prize for it in 1993. What are we testing for? Corona Viruses are ubiquitous. We have studied Corona Viruses since the early 1960s. There are 7 or 8 strains of corona virus that are thought to infect humans. The common cold is thought to be caused by corona virus 25-35% of the time. CDC admits a (+) COVID 19 serology test could be a cross reaction with other corona viruses... The following is from the CDC: "What do your results mean? If you test positive A positive test result shows you may have antibodies from an infection with the virus that causes COVID-19. However, there is a chance a positive result means that you have antibodies from an infection with a virus from the same family of viruses (called coronaviruses), such as the one that causes the common cold. Having antibodies to the virus that causes COVID-19 may provide protection from getting infected with the virus again. If it does, we do not know how much protection the antibodies may provide or how long this protection may last..." htt s: www.cdc. ov coronavirus 2019-ncov testin serolo -overview.html Donate Join Renew Newsletters Journal Press Releases Careers Contact Association of American Physicians AIAPS and surgeons MENU Q Featured , Public Health June 1, 2020 Mask Facts Share: f 0 G• C) curated by Marilyn M. Singleton, M.D., J.D. Transmission of SARS-CoV-2 Note: A COVID-19 (SARS-CoV 2) particle is 0.125 micrometers (pm); influenza virus size is 0.08 — 0.12 pm; a human hair is about 150 pm. "1 nm = 0.001 micron; 1000 nm = 1 micron: Micrometer (pm) is the preferred name for micron (an older term) 1 meter is = 1,000,000,000 nm or 1,000,000 microns Droplets • Virus is transmitted through respiratory droplets produced when an infected person coughs, sneezes or talks. Larger respiratory droplets (>5 pm) remain in the air for only a short time and travel only short distances, generally <1 meter. They fall to the ground quickly. https://www.thelancet.com/journals/lanres/article/Pl IS2213-2600(20)30245-9/fulltext • This idea guides the CDC's advice to maintain at least a 6-foot distance. • Virus -laden small (<5 pm) aerosolized droplets can remain in the air for at least 3 hours and travel long distances. https://www.nejm.org/doi/pdf/10.1056/NEJMc2004973?art:cleTools=true Air currents • In air conditioned environment these large droplets may travel farther. • However, ventilation — even the opening of an entrance door and a small window can dilute the number of small droplets to one half after 30 seconds. (This study looked at droplets from uninfected persons). This is clinically relevant because poorly ventilated and populated spaces, like public transport and nursing homes, have high SARS-CoV 2 disease transmission despite physical distancing. https://www.thelancet.com/journals/lanres/art;cle.'PIIS2213-2600(20)30245-9/fulltext Objects and surfaces • Person to person touching • The CDC's most recent statement regarding contracting COVID-19 from touching surfaces: "Based on data from lab studies on Covid-19 and what we know about similar respiratory diseases, it may be possible that a person can get Covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes," the agency wrote. "But this isn't thought to be the main way the virus spreads. https://www.cdc.gov/media/releases/2020/s0522-cdc- updates-covid-transmission.html. • Chinese study with data taken from swabs on surfaces around the hospital https://wwwne.cdc.gov/eid/article/2617/20-0885—article?deliveryName=USCDC-333-DM25707 • The surfaces where tested with the PCR (polymerase chain reaction) test, which greatly amplifies the viral genetic material if it is present. That material is detectable when a person is actively infected. This is thought to be the most reliable test. • Computer mouse (ICU 6/8, 75%; General ward (GW) 1/5, 20%) • Trash cans (ICU 3/5, 60%; GW 0/8) • Sickbed handrails (ICU 6/14, 42.9%; GW 0/12) • Doorknobs (GW 1/12, 8.3%) • 81.3% of the miscellaneous personal items were positive: • Exercise equipment • Medical equipment (spirometer, pulse oximeter, nasal cannula) • PC and iPads • Reading glasses • Cellular phones (83.3% positive for viral RNA) • Remote controls for in -room TVs (64.7% percent positive) • Toilets (81.0% positive) • Room surfaces (80.4% of all sampled) • Bedside tables and bed rails (75.0%) • Window ledges (81.8%) • Plastic: up to 2-3 days • Stainless Steel: up to 2-3 days • Cardboard: up to 1 day • Copper: up to 4 hours • Floor — gravity causes droplets to fall to the floor. Half of ICU workers all had virus on the bottoms of their shoes Filter Efficiency and Fit *Data from a University of Illinois at Chicago review https://www. cidrap. umn.edu/news-perspective/202O/O4/commentary-masks-all-covid-1 9-not-based- sound-data • HEPA (high efficiency particulate air) filters — 99.97 — 100% efficient. HEPA filters are tested with particles that are 0.125 pm. • Masks and respirators work by collecting particles through several physical mechanisms, including diffusion (small particles) and interception and impaction (large particles) • N95 filtering facepiece respirators (FFRs) are constructed from electret (a dielectric material that has a quasi -permanent electric charge. An electret generates internal and external electric fields so the filter material has electrostatic attraction for additional collection of all particle sizes. As flow increases, particles will be collected less efficiently. • N95 —A properly fitted N95 will block 95% of tiny air particles down to 0.3 pm from reaching the wearer's face. https://www.honeywel1.com/en-us/newsroom/news/2020/03/n95-masks-explained. • But even these have problems: many have exhalation valve for easier breathing and less moisture inside the mask. • Surgical masks are designed to protect patients from a surgeon's respiratory droplets, aren't effective at blocking particles smaller than 100 pm. hftps://webeache-googieusercontent.com/search? q=cache:VLXWeZB117YJ:https://multimedia.3m.com/mws/media/9577300/resp� rators-and- surgical-masks-contrast-technical-bulletin. pdf+&cd= 1 3&hl=en&ct=c!nk&gl=us • Filter efficiency was measured across a wide range of small particle sizes (0.02 to 1 um) at 33 and 99 Umin. • N95 respirators had efficiencies greater than 95% (as expected). • T-shirts had 10% efficiency, • Scarves 10% to 20%, • Cloth masks 10% to 30%, • Sweatshirts 20% to 40%, and • Towels 40%. • All of the cloth masks and materials had near zero efficiency at 0.3 pm, a particle size that easily penetrates into the lungs. • Another study evaluated 44 masks, respirators, and other materials with similar methods and small aerosols (0.08 and 0.22 pm). • N95 FFR filter efficiency was greater than 95%. • Medical masks — 55% efficiency • General masks — 38% and • Handkerchiefs — 2% (one layer) to 13% (four layers) efficiency. • Conclusion: Wearing masks will not reduce SARS-CoV-2. • N95 masks protect health care workers, but are not recommended for source control transmission. • Surgical masks are better than cloth but not very efficient at preventing emissions from infected patients. • Cloth masks will be ineffective at preventing SARS-CoV-2 transmission, whether worn as source control or as personal protective equipment (PPE). "Masks may confuse that message and give people a false sense of security. If masks had been the solution in Asia, shouldn't they have stopped the pandemic before it spread elsewhere?" *The first randomized controlled trial of cloth masks. https //bmjopen.bmj.com/content/5/4/e006577 • Penetration of cloth masks by particles was 97% and medical masks 44%, 3M Vflex 9105 N95 (0.1 %), 3M 9320 N95 (<O.01 %). • Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. • The virus may survive on the surface of the face- masks • Self -contamination through repeated use and improper doffing is possible. A contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer. • Cloth masks should not be recommended for health care workers, particularly in high -risk situations, and guidelines need to be updated. *A study of 4 patients in South Korea https://www.acpjournals.org/doi/l 0.7326/M20-1342 Known patients infected with SARS-CoV 2 wore masks and coughed into a Petrie dish. "Both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS—CoV 2 from the coughs of patients with COVID-19 to the environment and external mask surface." *Singapore Study — Few people used mask correctly https://www. medpagetoday.com/infectiousdisease/publichealth/86601 Overall, data were collected from 714 men and women. About half the sample were women and all adult ages were represented. Only 90 participants (12.6%, 95% Cl 10.3%-15.3%) passed the visual mask fit test. About three-quarters performed strap placement incorrectly, 61 % left a "visible gap between the mask and skin," and about 60% didn't tighten the nose -clip. *A 2011 randomized Australian clinical trial of standard medical/surgical masks https://onlinelibrary.wiley.com/doi/epdfl10.1111 /j.1750-2659.2011.00198.x? fbclid=lwAR3kRYVYDKb0aR-su9 me9 vY6a8KVR4HZ17J2A 80f fXUABRQdhQlc8Wo Medical masks offered no protection at all from influenza. Conclusions from Organizations The World Health Organization (WHO): hftps://apps.who.int/iris/bitstream/handle/l 0665/331693/WHO-2019-nCov-I PC—Masks-2020.3-eng. pdf? sequence=1 &isAllowed=y "Advice to decision makers on the use of masks for healthy people in community settings As described above, the wide use of masks by healthy people in the community setting is not supported by current evidence and carries uncertainties and critical risks." "Medical masks should be reserved for health care workers. The use of medical masks in the community may create a false sense of security, with neglect of other essential measures, such as hand hygiene practices and physical distancing, and may lead to touching the face under the masks and under the eyes, result in unnecessary costs, and taKe masks away from those in health care who need them most, especially when masks are in short supply." "Masks are effective only when used in combination with frequent hand -cleaning with alcohol -based hand rub or soap and water." WHO acknowledges that most people do not use masks properly. Dr. Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases: https://www.cdc.gov/media/releases/2020/tOl 31-2019-novel-coronavirus. html "We don't routinely recommend the use of face masks by the public to prevent respiratory illness," said on January 31. "And we certainly are not recommending that at this time for this new virus." The Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.`itm In March 5, 2019 regarding the flu: "Masks are not usually recommended in non -healthcare settings; however, this guidance provides other strategies for limiting the spread of influenza viruses in the community: • cover their nose and mouth when coughing or sneezing, • use tissues to contain respiratory secretions and, after use, to dispose of them in the nearest waste receptacle, and perform hand hygiene (e.g., handwashing with non -antimicrobial soap and water, and alcohol -based hand rub if soap and water are not available) after having contact with respiratory secretions and contaminated objects/materials. From the New England Journal of Medicine hftps://www.nejm-org/doi/full/10.1056/NEJMp2OO6372 "We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic." Final Thoughts • Surgical masks — loose fitting. They are designed to protect the patient from the doctors' respiratory droplets. The wearer is not protected from others airborne particles • People do not wear masks properly. Most people have the mask under the nose. The wearer does not have glasses on and the eyes are a portal of entry. • The designer masks and scarves offer minimal protection — they give a false sense of security to both the wearer and those around the wearer. "'Not to mention they add a perverse lightheartedness to the situation. • If you are walking alone, no mask — avoid folks — that is common sense. • Remember — children under 2 should not wear masks — accidental suffocation and difficulty breathing in some • If wearing a mask makes people go out and get Vitamin D — go for it. In the 1918 flu pandemic people who went outside did better. Early reports are showing people with COVID-19 with low Vitamin D do worse than those with normal levels. Perhaps that is why shut-ins do so poorly. hftps://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4 If you are sick, stay home! Additional Resource: Healthy People Wearing Masks, Should They or Shouldn't They? This ER nurse with over two decades of experience took a deep dive into the science to find out: https://jennifermargulis.net/healthy-people-wearing-masks-during-covidl9/ Share this: W Twitter Facebook