2020

October 8, 2020

This is an unprecedented editorial from the best medical journal in the world. If you want to know what virtually all good doctors think, read this editorial. As a political conservative, I regret the need for this message, but, …”truth is neither liberal nor conservative.” Jim Harris, MD

CLICK HERE TO READ THE NEW ENGLAND JOURNAL OF MEDICINE ARTICLE

From the MNM: Harrison County reported 3 new Covid cases. “The county judge reminded that free walk-up testing will be offered, again, this weekend, from 9 a.m. to 4 p.m., Friday and Saturday, at Marshall Convention Center, located at 2501 E. End Blvd. South.”
Cases at Marshall Independent School District are also climbing with six new active cases reported, on Wednesday.

“We have six new active cases to report, which gives us a total of 11 active cases currently in MISD,” David Weaver, MISD’s pubic information director, indicted.

Weaver said three of the new cases were at Marshall High School; the other three were at Sam Houston Elementary.

“With 13 recoveries overall on the year, we now have had a total of 24 cases throughout the district this year,” he said.

The county judge reminded that free walk-up testing will be offered, again, this weekend, from 9 a.m. to 4 p.m., Friday and Saturday, at Marshall Convention Center, located at 2501 E. End Blvd. South.

Dying in a Leadership Vacuum

Editorial from The England Journal of Medicine

Covid-19 has created a crisis throughout the
world. This crisis has produced a test of leadership.
With no good options to combat a novel
pathogen, countries were forced to make hard
choices about how to respond. Here in the
United States, our leaders have failed that test.
They have taken a crisis and turned it into a
tragedy.

The magnitude of this failure is astonishing.
According to the Johns Hopkins Center for Systems
Science and Engineering,1 the United States
leads the world in Covid-19 cases and in deaths
due to the disease, far exceeding the numbers in
much larger countries, such as China. The death
rate in this country is more than double that of
Canada, exceeds that of Japan, a country with a
vulnerable and elderly population, by a factor of
almost 50, and even dwarfs the rates in lowermiddle-
income countries, such as Vietnam, by a
factor of almost 2000. Covid-19 is an overwhelming
challenge, and many factors contribute to its
severity. But the one we can control is how we
behave. And in the United States we have consistently
behaved poorly.

We know that we could have done better.
China, faced with the first outbreak, chose strict
quarantine and isolation after an initial delay.
These measures were severe but effective, essentially
eliminating transmission at the point where
the outbreak began and reducing the death rate
to a reported 3 per million, as compared with
more than 500 per million in the United States.
Countries that had far more exchange with China,
such as Singapore and South Korea, began intensive
testing early, along with aggressive contact
tracing and appropriate isolation, and have ….

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Willie Shakes

By George Smith

Willie Shakes said it all at one time or another. His immortal words ring true today on a variety of subjects. He talked about all things and the lines he wrote speak to us today.

I became infatuated with his turn of phrases in high school and took two Shakespeare courses in college.

No writer, before or since, cut to the core of a matter with more clarity than The Bard.

Let your imagination run free as mine did.

“It is not in the Stars to hold our Destiny but in ourselves” – Julius Caesar

“I am disgraced, impeach’d and baffled here, pierced to the soul with slander’s venom’d spear, which no balm can cure but his heart-blood which breathed this poison.” Richard II

“The man’s undone forever; for if Hector break not his neck in the combat, he’ll break it himself in
vain-glory. Troilus and Cressida

“Strong reasons make strong actions.” Lewis in King John

“My pride fell with my fortunes.”
As You Like It

“I will not jump with common spirits,
And rank me with the barbarous multitudes.” The Merchant of Venice

“Go wisely and go slowly. Those who rush, stumble and fall.” Romeo and Juliet

“This sanguine coward, this bed-presser, this horseback-breaker, this huge hill of flesh!” 1 Henry IV

“You sign your place and calling, in full seeming, with meekness and humility; but your heart is cramm’d with arrogancy, spleen, and pride.
Henry VIII

“…When he is drunk asleep, or in his rage, or in the incestuous pleasure of his bed; at game, a-swearing, or about some act that has no relish of salvation in’t; then trip him, that his heels may kick at heaven, and that his soul may be as damn’d and black as hell, whereto it goes. My mother stays:this physic but prolongs thy sickly days.
Hamlet

“He that is proud eats up himself: pride is his own glass, his own trumpet, his own chronicle.
Troilus and Cressida

“It is a tale; full of sound and fury, signifying nothing.” – Macbeth in Macbeth

“There is no more mercy in him than there is milk in a male tiger.” Coriolanus

“If a Jew wrong a Christian,
what is his humility? Revenge. If a Christian wrong a Jew, what should his sufferance be by Christian example? Why, revenge. The villany you
teach me, I will execute, and it shall go hard but I will better the instruction.”
The Merchant of Venice

“We know what we are but know not what we may be.”– Ophelia in Hamlet”

“More of your conversation would infect my brain..” Coriolanus

“A pox on both your houses….”
Mercurio in Romeo and Juliet

“Such antics do not amount to a man.” Henry V

“He is white-livered and red-faced.”
Henry V

“They were devils incarnate.”
Henry V

“They are hare-brain’d slaves.”
1 Henry VI

“I have more flesh than another man and therefore more frailty.” – King Henry IV

“He is deformed, crooked, old and sere, Ill-faced, worse bodied, shapeless everywhere;’vicious, ungentle, foolish, blunt, unkind; stigmatic in making, worse in mind.
The Comedy of Errors

“Your abilities are too infant-like for doing much alone.” Coriolanus

“I can see his pride peep through each part of him.” Henry VIII

“The croaking raven doth bellow for revenge.” Hamlet

“Infected he the air whereon they ride,
And damned all those that trust them.” Macbeth

“The tartness of his face sours ripe grapes.” Coriolanus

“My hour is almost come, when I to sulphurous and tormenting flames must render up myself.” Hamlet.

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Confederate Statues Come Down Around U.S., But Not Everywhere

About 60 Confederate monuments have come down across the U.S. amid a national reckoning on race — but nearly half as many localities that considered removing their statues have decided to keep them.

…

NPR recently visited Marshall, Texas, and Shreveport, La. — neighboring cities that fiercely debated their Confederate monuments and had two different outcomes.

Back in July, it seemed like officials in Marshall — tucked in the piney woods of northeast Texas — were on the verge of moving their marble statue of a rebel soldier. The curly-haired infantryman gripping a muzzleloader rifle has stood beside the courthouse for 114 years.

Even Bill Elliott with the Sons of Confederate Veterans, which defends the monuments as important parts of history, was pessimistic.

“We ain’t won anywhere. I’ll be honest with you,” Elliott said earlier in the summer. “If it’s got to be moved, we’re for working with everybody. We just want it to go somewhere that’s gonna be safe.”

But Marshall’s experience shows that Confederate statues are not so easy to topple.

Click here to read the complete NPR article

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 10/6/2020

October 6, 2020

On Monday, Harrison County had 6 new Covid cases and the MISD reported a total of only 4 active cases. The USA reported 42, 223 new cases yesterday which is a 6% increase in the daily count. As Dr. Yogi Berra said, “The opera ain’t over till the Fat Lady sings.” I might add that the Fat Lady is available at any time to sing at funerals.

FROM JAMALong-term Health Consequences of COVID-19

FROM JOHNS HOPKINS SELECTIONS:

1. CARDIAC ARREST & CPR Researcher from a number of US medical institutions published findings from a study on the use of cardiopulmonary resuscitation (CPR) in COVID-19 patients who experience cardiac arrest. The researchers note that “anecdotal reports of poor outcomes in critically ill patients with COVID-19 who have had in-hospital cardiac arrest have prompted discussions on the futility of [CPR] in this patient population.” The study, published in BMJ, included more than 5,000 COVID-19 patients who were admitted to intensive care units at 68 hospitals across the US. Among these patients, 701 participants (14%) experienced cardiac arrest while hospitalized, and 400 (57.1%) of those individuals received CPR. Among the 400 patients who received CPR, 48 (12%) survived to discharge, and 28 (7%) exhibited normal neurological function or only mild neurological impairment. These percentages are relatively consistent with studies of CPR among non-COVID-19 patients, which indicates that CPR does provide benefit to COVID-19 patients. Additionally, the study illustrates the high rate of cardiac arrest among COVID-19 patients, and hospitals and health systems should be prepared for the increased demand among severe COVID-19 patients.(J. Harris: another recent article had indicated even less survival post CPR. Wear your mask).

2. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 28 September – 1 October 2020EMA’s safety committee (PRAC) has started a review of a safety signal to assess reports of acute kidney injury in some patients with COVID-19 taking Veklury (remdesivir).
Kidney injury can be caused by other factors as well, e.g. diabetes; importantly, COVID-19 is itself known to be a cause. The PRAC will now carefully assess all available data to evaluate if the medicine may have been responsible for the kidney problems and if there is a need to update the existing information for Veklury. Recommendations for the use of this medicine have not changed.(J. Harris: Just how likely this new drug is to cause or to accentuate kidney damage is being studied, but it needs to be used with caution and not whim.)

3.Face Masks, Public Policies and Slowing the Spread of COVID-19: Evidence from Canada (National Bureau of Economic Research) We estimate the impact of mask mandates and other non-pharmaceutical interventions (NPI) on COVID-19 case growth in Canada, including regulations on businesses and gatherings, school closures, travel and self-isolation, and long-term care homes. We partially account for behavioral responses using Google mobility data. Our identification approach exploits variation in the timing of indoor face mask mandates staggered over two months in the 34 public health regions in Ontario, Canada’s most populous province. We find that, in the first few weeks after implementation, mask mandates are associated with a reduction of 25 percent in the weekly number of new COVID-19 cases.

4.Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020 During June–August 2020, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. Younger adults likely contribute to community transmission of COVID-19. Across the southern United States in June 2020, increases in percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days. Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce infection and subsequent transmission to persons at higher risk for severe illness. (CDC MMWR, 10/2/2020)

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Dr. Jim Harris

October 4, 2020

Yesterday, Friday, Harrison County had 5 new cases, Gregg 8, and Smith 23.
Smith County schools see increase in COVID-19, most among staff, students in grades 7-12

DOES AZITHROMYCIN HELP COVID (Z-PACK)
J. Harris: As I understand this and other similar articles:1. No help in sever hospitalized cases with or without hydroxychloroquine2. Does it help if used very early in the disease? ‘UNKNOWN3. If I got sick and had a Z Pack, would I take it early even for mild symptoms? Probably.4. Would I panic if I got sick and didn’t have a Z Pack? No. But I’d talk to my doctor about it, especially since I am still fortunate enough to have a personal physician who I know and trust and who knows my medical history and who is associated with Christus.

HOW TO SIGN UP OF JOHNS HOPKINS MAILOUTS
(JHarris: Their free emails concerning COVID and medicine with several weekly publications and summaries in several categories are the best source of current information that I have found. I try and pick and choose and “translate” the information that I think is most pertinent for our local and area situation, but readers might want to read in more detail. Now, as Hopkins continues to expand and improve, I less often dig around in the multitude of various journals for bits of truth. If you like charts, they have the best.)

FROM JOHNS HOPKINS:1. FOR THE LAST TIME, HYDROXYCHLOROQUINE PROPHYLAXIS DOES NOT WORK:Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers (JAMA Network) Among hospital-based HCWs at high risk of exposure to SARS-CoV-2, hydroxychloroquine, 600 mg, daily, for 8 weeks did not reduce the incidence of SARS-CoV-2 infection compared with placebo. Our findings are consistent with what is to our knowledge the only other randomized COVID-19 prophylaxis trial published to date.
Risk of COVID-19 During Air Travel

President Trump tests positive; Wisconsin sees record death increase — 5 COVID-19 updates

Regeneron’s REGN-COV2 Antibody Cocktail Reduced Viral Levels and Improved Symptoms in Non-Hospitalized COVID-19 Patients

2. AUG 20: A promising new coronavirus cure just failed in its Phase 3 trial A potential coronavirus cure has failed to meet the primary goals of its Phase 3 trial despite the promise the drug has shown elsewhere.

Tocilizumab did not improve the clinical status of COVID-19 patients and did not reduce patient mortality in Roche’s Phase 3 testing.
The drug still holds potential and will continue to be studied. Several other researchers have been working with tocilizumab and other interleukin-6 inhibitors in COVID-19 therapies, and have seen some success.

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Judge Staci Williams, Democratic Candidate for Texas Supreme Court in Marshall October 3

October 2, 2020

Judge Staci Williams, Democratic Candidate for Texas Supreme Court, to speak at Harrison County Democratic Headquarters in Marshall on Saturday, October 3

Judge Staci Williams, Candidate for the Texas Supreme Court, will speak at a “Meet the Candidate and Voter Registration” event held by the Harrison County Democratic Party at their headquarters, located at 213 West Austin Street in downtown Marshall, on Saturday, October 3 at 2:00-4:00pm.

The event will also be a kind of “Welcome Home” event for Judge Staci Williams, since Judge Williams was born in Gregg County and lived her early childhood in Marshall before moving to Dallas. Her father, Dr. Claude Williams, was a well-respected dentist in our community.

Judge Williams shared: “Even though my family moved from Marshall to Dallas when I was 9 years old, Marshall has always been and will always feel like home. Coming back to Marshall, it reminds me of hard work, integrity, and my roots in East Texas.”

Judge Williams is a judge of the Texas 101st District Court. She assumed office in 2014. She received her bachelor’s degree from Smith College in Massachusetts and her law degree from Georgetown University in Washington, D.C.

Judge Williams’ biographical information includes that she has worked as corporate counsel in the defense telecommunications and retail industries. She has also served as a trial attorney and an administrative judge for the Equal Employment Opportunity Commission, counsel to the United States Judiciary Committee, as well as a municipal judge in Dallas and an attorney in private practice. She has also been on the arbitrator panels of the U.S. Postal Service, Dallas Area Rapid Transit (DART), Federal Mediation and Conciliation Service, and the Financial Industry Regulatory Authority (formerly the National Association of Security Dealers.)

If elected, Judge Williams would be the first African-American female elected in the 174 year history of the Texas Supreme Court.

The Saturday, October 3 event for Judge Williams in Marshall event is also designed to provide a continued opportunity for citizens of Harrison County who are not yet registered to vote to register before the voter registration deadline.

Maxine Golightly, chairman of the Harrison County Democratic Party, shared: “We’ve had a very successful voter registration campaign in Harrison County and we’re continuing to encourage community members who are not yet registered to get registered to vote before the registration deadline on Monday, October 5. It’s important that people make sure they are registered so they can vote in this critical election.”

Christina Anderson added: “In addition to registering to vote, we invite community members to join us in welcoming Judge Williams back to Marshall. Judge Staci Williams is an outstanding candidate for the Texas Supreme Court and the event on Saturday is a great opportunity to meet and ask any questions you might have of this excellent candidate who has her roots in Marshall, Texas.”

The event will be held in the backyard of the Democratic headquarters at 213 West Austin so that people can enjoy the beautiful fall weather and to assist in providing room for social distancing.

Also, community members are welcome to visit the Harrison County Democratic Headquarters during the week in these final days before the November 3 election. The headquarters is open every Monday, Wednesday, Thursday, and Friday from 11:00am – 2:00pm.

If these times are not convenient, persons are encouraged to call Maxine Golightly at (903) 908-0521 to make an appointment and she or another volunteer will arrange to meet the person at the headquarters at an appointed time.

Due to the ongoing COVID-19 pandemic and the Democratic Party wishing to take all measures to help stop the spread of the coronavirus, the Democratic headquarters follows all Centers for Disease Control and Prevention guidelines for social distancing and wearing masks. If a person does not have a mask and wishes to visit the headquarters, a mask will gladly be provided.

Early voting begins on Tuesday, October 13 at seven locations in Harrison County and runs through Friday, October 30, 2020. Information about specific times and locations for early voting are available at the Democratic headquarters or at the Harrison County Elections Office at 415 East Burleson Street.

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Community and Economic Director Wes Morrison resigns from city

[Marshall, Texas, October 1, 2020]

Last week Marshall’s community and economic director Wes Morrison sent in his resignation letter for his position with the city.

Morrison’s last day with the city will be Oct. 13, and city spokesperson Stormy Nickerson said that a posting for the job position was posted on the city’s website on Tuesday this week.

“We wish Mr. Morrison well in his future,” Nickerson said.

Morrison said that the decision to leave the city was not easy for him, but that he knows it is the best decision for his career and his future.

“Marshall will always be my hometown, I am thankful that I had the opportunity to be a part of accomplishing some great things that moved the city forward over the past six years,” Morrison said.

According to his letter of resignation, Morrison will be accepting a position in another community that is seeing exceptional growth.

“I feel that it is the best time for me to move on to the next chapter,” Morrison said. “I look forward to coming back to visit and watching Marshall continue to prosper.”

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State Senate Candidate, District 1, Audrey Spanko, in Marshall

State Senate Candidate, District 1, Audrey Spanko, kicks off 16-County District 1 Road Trip at Harrison County Democratic headquarters in Marshall on October 1

State Senate Candidate, District 1, Audrey Spanko, kicks off 16-County District 1 Road Trip at Harrison County Democratic headquarters in Marshall on October 1 Audrey Spanko, Democratic State Senate Candidate, District 1, will kick off her “Texas Senate District 1 Road Trip” at the Harrison County Democratic Headquarters, located at 213 West Austin Street in downtown Marshall, on Thursday, October 1 at 1:00pm—3:00pm.

Ms. Spanko is the Democratic Senate candidate running against Republican incumbent State Senator Bryan Hughes and the event in Marshall is the kick-off event in a road trip will be making to the 16 counties in District 1, in the next 12 days to encourage people to register to vote before the October 5 deadline and to encourage voters to vote early when the polls open in Texas on October 13.

The event in Marshall is designed to provide members of our local community to have an opportunity to meet the candidate and for Ms. Spanko to answer any questions that community members might have about the issues facing East Texas.

Audrey Spanko is a licensed social worker and advocate. She is from Mineola and has two degrees in social work from the University of Texas. For roughly a decade, she has worked for nonprofits helping families seeking medical care and basic needs support, and from 2016-2019 she worked in child abuse prevention for the Department of Family and Protective Services. While finishing classes for her masters degree, she served as an advocacy intern during the 2019 Texas legislative session. It was this experience and all that she witnessed while working as a social worker in Texas that inspired her to run for Texas State Senate.

The event is also designed to provide a continued opportunity for citizens of Harrison County who are not yet registered to vote to register before the voter registration deadline.

“We’ve had a very successful voter registration campaign in Harrison County and we’re continuing to encourage community members who are not yet registered to get registered to vote before the registration deadline on Monday, October 5,” shared Maxine Golightly, chairman of the Harrison County Democratic Party. “It’s important that people make sure they are registered so they can vote in this critical election.”

The event will be held in the backyard of the Democratic headquarters at 213 West Austin so that people can enjoy the gorgeous fall weather and to provide for social distancing. The Harrison County Democratic Headquarters is open every Monday, Wednesday, Thursday, and Friday from 11am—2:00pm.

Volunteers staff the headquarters for those wishing to register to vote, as well as those wishing to obtain campaign signs, along with information about the early voting schedule in Harrison County, the Democratic candidates, and the issues facing East Texans and Americans. If these times are not convenient, persons are encouraged to call Maxine Golightly at (903) 908- 0521 or Christina Anderson at (903) 938-8373 to make an appointment and they or another volunteer will arrange to meet the person at the headquarters at an appointed time.

Due to the ongoing COVID-19 pandemic and the Democratic Party wishing to take all measures to help stop the spread of the coronavirus, the Democratic headquarters follows all Centers for Disease Control and Prevention guidelines for social-distancing and wearing masks. If a person does not have a mask and wishes to visit the headquarters, a mask will gladly be provided.

The Harrison County Democratic Party will host another “Meet the Candidate and Voter Registration” event on Saturday, October 3 at 2:00pm-4:00pm in the backyard of the Harrison County Democratic headquarters, featuring Judge Staci Williams, who grew up in Marshall and is a candidate for the Texas Supreme Court. More information about that event will be provided in a separate news release.

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CORONAVIRUS INFO PROVIDED BY DR. JIM HARRIS – 9/29/2020

September 29, 2020

Harrison County reports 1 new case Monday while
Gregg had 16 and Smith 46. (J. Harris: Are we creeping upward again?)

FROM A HOUSTON INTERNIST: “Imagine being the December dead chump with no mask when your friends are getting their vaccine in January..”

Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe
The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.
COVID-SNIFFING DOGS SARS-CoV-2 testing would likely be less scary or uncomfortable if it was conducted by puppies. Perhaps that is part of the motivation behind Finland’s new plan to deploy “coronavirus-sniffing dogs” at the Helsinki Airport. The airport is conducting a pilot project that uses specially-trained dogs to detect SARS-CoV-2 infection in passengers based on their scent. Dogs have been used in a similar manner to detect other infections or diseases that cause a distinct odor in patients, including cancer and Clostridium difficile, sometimes before the onset of symptoms. Samples are taken by swabbing passengers’ necks and then delivered to the dogs in a separate room. One researcher from the University of Helsinki indicated that the dogs can approach 100% sensitivity and can detect infection up to 5 days before the onset of symptoms. A similar program was also recently implemented in the Dubai International Airport. The use of dogs to detect SARS-CoV-2 has not been sufficiently assessed in scientific studies, so passengers identified by the dogs will be administered a more traditional test to confirm infection. Further research is needed to demonstrate the accuracy of this surveillance method, but it could provide rapid assessment capability, particularly for high-traffic areas like airports.

Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis (JAMA Pediatrics) In this systematic review and meta-analysis including 32 studies, children and adolescents younger than 20 years had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults 20 years and older; this finding was most marked in those younger than 10 to 14 years. Data were insufficient to conclude whether transmission of SARS-CoV-2 by children is lower than by adults. Preliminary evidence suggests that children have a lower susceptibility to SARS-CoV-2 infection compared with adults, but the role that children and adolescents play in transmission of this virus remains unclear.

Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study
” …fewer than 10% of the US population has seroconverted as of July, 2020, and herd immunity remains out of reach, as has been the conclusion from large international surveys from the UK44 and Spain,1 where intense outbreaks of COVID-19 occurred during the spring and summer of 2020…..However recurring monthly testing of remainder plasma of randomly selected sets of people—as is practically feasible in patients receiving dialysis—can serve as a representative surveillance system in the USA…(J. Harris: This Lancet article has a readable and comprehensive “Conclusion” portion that is worth the read.)

New document reveals scope and structure of Operation Warp Speed and underscores vast military involvement
(J. Harris: Please let me know if you are able to follow their flow sheet.)

My friend’s bakery burned down last night. Now his business is toast.

If toast always lands butter-side down and cats always land on
their feet, what happens if you strap toast on the back of a cat?
~ Steven Wright