“Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever… It is worthy of comment that three of the greatest benefits conferred on mankind… have been in connection with the fevers: The introduction of cinchona , the discovery of vaccination, and the announcement of the principle of asepsis.” – William Osler, lecture to the American Medical Association on “The Study of the Fevers of the South,” 1896.

Cinchona refers to the plant that provides the anti-malarial drugs quinine, chloroquine, hydoroxychloroquine, or just “hydroxy” as Donald Trump referred to it when debate raged about its effectiveness in treating SARS-Cov-2 infections.

Although “fever” may have diminished in the 20th century as the greatest enemy of mankind—with mankind’s industrial civilization becoming a new enemy—cinchona is still working miracles and stirring controversy 124 years later. Unfortunately for those who reflexively oppose everything uttered by Donald Trump, there is clear evidence that the prophylactic and cure that can end the pandemic is a treatment protocol involving zinc, vitamin D, hydroxychloroquine, and zithromycine, given in the right amounts in the early stages of infection.

In a powerful and angry speech on July 27, 2020, Dr. Stella Immanuel described her use of the treatment with 350 high-risk patients in Texas, none of whom died. (Hear her speak here, from 5:25~, transcript here). The video was banned by YouTube and Facebook on the day it first appeared, and any mention of it on Facebook was labelled as false information because it allegedly spread lies about effective treatment of Covid-19. That is the state of free speech in the age of privately owned social media.

Dr. Immanuel gives an endorsement of everything I’ve been reporting on this blog in recent months about the chloroquine controversy in France. The views of Dr. Immanuel and the doctors in her group have actually been mainstream and acceptable in France for the past month ever since a leading virologist, Didier Raoult, testified in the French legislature about the effectiveness of the chloroquine treatment protocol for Covid-19. For very peculiar reasons the message is being censored fiercely in the English-speaking world.

Articles critical of Dr. Immanuel appeared immediately after her speech, as if prepared in advance. In addition to her role as a doctor, she is alleged to be active in a church where she has spoken publicly about diseases being caused by evil spirits. Regardless of what one thinks of her religious and political beliefs, if she is right on this issue, her beliefs and opinions on other matters are irrelevant. Most importantly, the issue of cencorship should be a concern to anyone who cares about free speech rights. Do you believe in free speech for those who say things you oppose, or are you against free speech?

Dr. Immanuel’s critics were also quick to pounce on the fact that she is Nigerian, saying she’s the latest “Nigerian scammer.” None of these critics discussed the substance of her argument, or the fact that it was repeated by other doctors in the group who are white speakers of American English. The facts ignored by critics are:

  1. doctors in many countries have noted the positive effects of chloroquine in Covid-19 treatment, in combination with zinc, vitamin D and zithromycine.
  2. research published fifteen years ago described the positive effect of chloroquine in treating SARS-Cov-1 (M.J. Vincent, E. Bergeron, S. Benjannet, et al. “Chloroquine is a potent inhibitor of SARS coronavirus infection and spread,” Virology Journal 2, 69, 2005.),
  3. the research that attempted to disprove the effectiveness of the treatment was designed to make sure it would fail—researchers administered chloroquine too late in the progress of infection, without the antibiotic, zinc and vitamin D, at too high a dose or for too long, and to patients with heart conditions that should have excluded them from treatment, and
  4. the recent articles in The Lancet and The New England Journal of Medicine that claimed chloroquine was not effective—which social media fact checkers are still using to make their judgments—were retracted shortly after publication.

This preamble may seem unconnected to the following discussion of various causes of death in first world nations, but I want readers to keep in mind that the number of deaths caused by Covid-19 might have been much lower if the chloroquine treatment protocol had not been suppressed. Perhaps it is all fake news and the reality is that there are hundreds of financially secure, highly educated, politically conservative doctors running around the country telling deadly lies and giving false hope about a cure for Covid-19. They must be doing it just for the wicked fun of it. The authorities who suppressed this treatment must hope so. Otherwise, they would be liable for hundreds of thousands of cases of negligent death and the financial losses of millions of individuals whose lives were disrupted by the reaction to the pandemic.

Dr. Stella Immanuel speaks at a press conference in Washington DC on July 27, 2020
“Media reports of crises in other countries—often without critical analysis of their relevance for Canada—can exacerbate fears and may have overly influenced policy decisions. If we tested for influenza every winter as we have done for coronavirus, we would have similar daily reports of cases and deaths, nursing home outbreaks, and stretched capacity of hospitals. Unlike for COVID-19, there would be several reports of influenza deaths in children. Has a precedent now been set for lockdowns every flu season?” – Joel Kettner, associate professor, Department of Community Health Sciences, University of Manitoba, former chief public health officer, Province of Manitoba, “A New Normal, or New Abnormal? Change in Direction Needed on COVID-19 Response,” CBC News, July 28, 2020.

A few weeks ago I was discussing with a colleague whether it would be safe and fair to the students at our university in Japan to return to normal operations in the fall semester. He was very afraid of the new spike in reported cases in the United States and Japan, and he was worried that if the university reopens, the virus might go from students to him, and then to his elderly mother, who, unlike the young students, has a high chance of dying from it. I understand the concern, even though I can’t help but think to myself (I’m tired of arguing about it anymore with people who are determined to be frightened) that this risk has always existed with seasonal viral pandemics, and we always took that risk—even the people most at risk took that risk.

What he said next was something so ridiculous that I decided, for the sake of getting along, not to comment on. He repeated something he had heard in the American media recently about the number of Covid-19 deaths now being greater than all the American deaths in the Vietnam War. It was an utterly irrelevant comparison to make because 20th century American war casualties have always been far lower than the number of deaths that occur from other causes. Yet now for some peculiar reason we see people trying to move deaths from a natural disaster (and the pandemic is a natural disaster, despite all attempts to politicize it) into the category of war casualties—to equate it with the political decision to send human beings on a mission to kill other human beings.

I checked to see which media outlets had tried to make something out of the comparison of Covid-19 deaths with Vietnam War fatalities, and it was all the usual suspects: Washington Post, CNBC, Time, National Geographic etc. All compared Covid-19 deaths in the United States to the number of American soldiers who died in Vietnam, which they listed as 58,000. It is notable how, with the usual American narcissism, they overlooked the estimated 2,000,000 deaths of people in Southeast Asia caused by the French and American invasions between 1955 and 1975. I wonder if in socialist Vietnam there have been newspaper editorials remarking on the fact that deaths from Covid-19 are not even 0.0000005% of deaths during the American invasion—that is, they are zero, not even one versus the two million who died during the war.

The editorialist in The Washington Post was wise enough to note that the comparison was completely inappropriate, but he still described the war as a well-intentioned “blunder” and wrote, “U.S. leaders were accused of remaining in the war far too long.” The “papers of record” in the US never describe the Vietnam War as the war of aggression that it was, “the supreme international crime differing only from other war crimes in that it contains within itself the accumulated evil of the whole,” as the military tribunal for Nazi war crimes described it. The Vietnam War was justified under the flimsy pretense that US help had been requested by the South Vietnamese government, yet that government was itself a US-supported creation that never could have held power on its own.

In any case, if causes of mortality are going to be compared to war casualties in order to rouse people to action, why has there never been an outcry for months on end in all the media to no longer accept such high rates of death from heart disease or addictions, or several other causes of death which each year cause far more deaths than the Vietnam War? If drastic sacrifices were made and costly actions taken similar to what was done to fight the pandemic, surely 200,000 lives (a high estimate of the coronavirus death toll for 2020) could be saved. The table below shows that in the US, 782,000 people die each year from heart disease and addictions.

In fact, governments spend a great deal of money trying to reduce chronic illnesses and their root causes in the misery that comes from the socio-economic order. Some doctors have even blamed the poor response to the coronavirus on the fact that government health agencies are full of people specialized in chronic diseases but not in infectious diseases.

The trouble is that in spite of the resources thrown at the problem of chronic disease, systemic reform in capitalist countries is off the political agenda. The causes are thoroughly researched and understood, but nothing is done about them. The oligarchy has no interest in improving the lives of the oppressed in any meaningful way. The Democrats in Congress just voted to reject socialized health care, by a large majority.

According to the US Centers for Disease Control and Prevention (CDC), there were 2,813,503 registered deaths in the United States in 2017. The age-adjusted death rate, which accounts for the aging population, is 731.9 annual deaths per 100,000 people in the U.S., meaning 0.73% of the population dies every year.

Medical News Today states the following about causes of death in the United States:

Around 74% of all deaths in the United States occur as a result of 10 causes (heart disease, cancer, unintentional injuries, chronic lower respiratory disease, stroke and cerebrovascular diseases, alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease and suicide). Over the past 5 years [before 2017], the main causes of death in the U.S. have remained fairly consistent.

From Medical News Today and the American National Institutes of Health, I compiled the following list of fourteen causes of mortality in the United States, with statistics from 2017 (Medical News Today, rows 1-10) and 2018 (ANIH, rows 11-14) rounded to the nearest thousand. The total of all deaths was higher because not all causes are covered in this list. There is also some possible overlap between the two sources, but the statistics are informative nonetheless. I have chosen statistics from the United States because they are in English and they cover a very large population, but this sort of analysis and commentary could be done for any industrialized nation where governements have applied neoliberalism and austerity budgets in recent decades.

Fourteen causes of death in the United States, recent annual figures

1 heart disease 647,000
2 cancer 599,000
3 unintentional injuries 170,000
4 chronic lower respiratory disease 160,000
5 stroke/cerebrovascular 146,000
6 Alzheimers 121,000
7 diabetes 84,000
8 influenza and pneumonia 55,000
9 kidney disease 50,000
10 suicide 47,000
11 murder and manslaughter 16,214
12 opioid overdose 47,000
13 alcohol related 88,000
14 automobile collisions 33,000
TOTAL of 1-14 2,263,214

An obvious problem with the list is that each death has to be attributed to only one cause. Most deaths have multiple causes, and the attributed causes conceal ultimate causes such as childhood malnutrition, childhood trauma, environmental toxins, and poverty. Statisticians can tell us how many died of heart disease, but not how many died of broken heart and spirit.

The really interesting question about statististics for 2020 is how deaths attributed to SARS-Cov-2 will fit into the list above. Will the total number of deaths be higher or lower? Will rows 10 to 13 (deaths by crime and deaths of despair) increase due to the effects of the confinement and economic contraction? Will rows 3 and 14 (unintentional injuries and automobile collisions) decrease because people stayed home? Will rows 1, 2 (heart disease and cancer) and 4-9 (chronic lower respiratory disease, stroke/cerebrovascular, alzheimers, diabetes, influenza and pneumonia, kidney disease) decrease because some of the deaths usually attributed to those causes will be attributed to SARS-Cov-2? Will SARS-Cov-2 be correctly added to row 8 (influenza and pneumonia) or will it get its own category? Hospitals have been incentivized and pressured to write Covid-19 on death certificates. Consider the relatively small number of deaths in row 8 (influenza and pneumonia) which actually could be much higher every year because it is “the final blow” in many deaths caused by heart disease and cancer. Until 2020, doctors always sensibly indicated the chronic disease as the cause of death.

In the figures in rows 1, 2 and 4-9 there may be an increase in 2020 as a result of the pandemic because people delayed seeking medical treatment while they were afraid of being infected by the coronavirus. Perhaps these likely increases and decreases will cancel each other out.

With the number of deaths attributed to SARS-Cov-2 estimated to be 150,000 as of July, 2020, we could estimate that the total for the year is likely to be about 200,000, though the number may have peaked already. It is important to mention here too that many of these deaths were preventable. Government was slow to respond in the early weeks. The hydroxychloroquine treatment mentioned above was supressed. Patients were intubated too quickly, and the virus was carelessly (criminally) allowed to spread in seniors’ residences. However, assuming that we have to work with a figure of 200,000 deaths as the unavoidable outcome of the pandemic, it is only about 10% of annual deaths from all causes, and this number might just melt into the overall figures and become statistically meaningless, if other causes of death fluctuate to offset deaths from SARS-Cov-2 and the total deaths for 2020 are close to the figures for the previous years.

It seems reasonable to conclude that deciding upon the role of SARS-Cov-2 in deaths from all causes will involve a lot of guesswork and arbitrary categorization. The only truly useful number may be the total number of deaths, and if that number is not significantly more than the the figures for recent years, people will really wonder what all the social disruption was for. And if it is significantly higher, people will want to know if coronavirus infections were the cause or the social disruption was the cause. And the answer to these questions may stay locked in the proverbial black box. The disruption of 2020 will also continue to cause many non-lethal and lethal harms over several years. The harmful effects of bankruptcies, unemployment and disrupted education, won’t necessarily show up in next year’s mortality figures.

Yes, every individual who died a horrible death from this new viral infection represents a tragedy for the people involved, but people who plan public policy have to detach themselves from those tragedies and look at the overall picture and first do the least harm. The reaction to the pandemic is likely to increase deaths from causes 10-13 (deaths of despair), and increase or decrease deaths from causes 1, 2, and 4-9 (injuries and common chronic illnesses). Some will say that the reaction to the pandemic saved half a million lives (or any number they choose), but that is an unfalsifiable claim. What is more certain is, firstly, that the total number of deaths for 2020 is unlikely to be much different than the totals for recent years, and secondly, that fatal and non-fatal adverse consequences of the confinement and economic contraction will continue to rise and be more clearly understood as time goes by.

What will we do when the next frightening new virus appears in the world, or just the next influenza virus, which, through a careful public relations campaign, could also be used to paralyze millions of people with fear? Fully aware of the social disruption caused by the previous political decisions, the public may get wise and say, “No way, not all that again!” When that happens, we had better hope that we get lucky as we did this time with a virus that has only a 0.5% mortality rate. If we ever really do have to deal with a virus that has a 5% mortality rate, as SARS-Cov-2 was first described, then we will be living through one hell of a “boy who cried wolf” story.