By Scott W. Atlas, John R. Birge, Ralph L Keeney and Alexander Lipton, Opinion Contributors — 05/25/20 08:00 AM EDT 886 The views expressed by contributors are their own and not the view of The Hill 12,263
Our governmental COVID-19 mitigation policy of broad societal lockdown focuses on containing the spread of the disease at all costs, instead of “flattening the curve” and preventing hospital overcrowding. Although well-intentioned, the lockdown was imposed without consideration of its consequences beyond those directly from the pandemic.
The policies have created the greatest global economic disruption in history, with trillions of dollars of lost economic output. These financial losses have been falsely portrayed as purely economic. To the contrary, using numerous National Institutes of Health Public Access publications, Centers for Disease Control and Prevention (CDC) and Bureau of Labor Statistics data, and various actuarial tables, we calculate that these policies will cause devastating non-economic consequences that will total millions of accumulated years of life lost in the United States, far beyond what the virus itself has caused.
Pandemics have afflicted humankind throughout history. They devastated the Roman and Byzantine empires, Medieval Europe, China and India, and they continue to the present day despite medical progress. null
The past century has witnessed three pandemics with at least 100,000 U.S. fatalities: The “Spanish Flu,” 1918-1919, with between 20 million and 50 million fatalities worldwide, including 675,000 in the U.S.; the “Asian Flu,” 1957-1958, with about 1.1 million deaths worldwide, 116,000 of those in the U.S.; and the “Hong Kong Flu,” 1968-1972, with about 1 million people worldwide, including 100,000 in the U.S. So far, the current pandemic has produced almost 100,000 U.S. deaths, but the reaction of a near-complete economic shutdown is unprecedented.
The lost economic output in the U.S. alone is estimated to be 5 percent of GDP, or $1.1 trillion for every month of the economic shutdown. This lost income results in lost lives as the stresses of unemploymentand providing basic needs increase the incidence of suicide, alcohol or drug abuse, and stress-induced illnesses. These effects are particularly severe on the lower-income populace, as they are more likely to lose their jobs, and mortality rates are much higher for lower-income individuals.
Statistically, every $10 million to $24 million lost in U.S. incomes results in one additional death. One portion of this effect is through unemployment, which leads to an average increase in mortality of at least 60 percent. That translates into 7,200 lives lost per month among the 36 million newly unemployed Americans, over 40 percent of whom are not expected to regain their jobs. In addition, many small business owners are near financial collapse, creating lost wealth that results in mortality increases of 50 percent. With an average estimate of one additional lost life per $17 million income loss, that would translate to 65,000 lives lost in the U.S. for each month because of the economic shutdown.
In addition to lives lost because of lost income, lives also are lost due to delayed or foregone health care imposed by the shutdown and the fear it creates among patients. From personal communications with neurosurgery colleagues, about half of their patients have not appeared for treatment of disease which, left untreated, risks brain hemorrhage, paralysis or death.
Here are the examples of missed health care on which we base our calculations: Emergency stroke evaluations are down 40 percent. Of the 650,000 cancer patients receiving chemotherapy in the United States, an estimated half are missing their treatments. Of the 150,000 new cancer cases typically discovered each month in the U.S., most – as elsewhere in the world – are not being diagnosed, and two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population. Nearly 85 percent fewer living-donor transplants are occurring now, compared to the same period last year. In addition, more than half of childhood vaccinations are not being performed, setting up the potential of a massive future health disaster.
The implications of treatment delays for situations other than COVID-19 result in 8,000 U.S. deaths per month of the shutdown, or about 120,000 years of remaining life. Missed strokes contribute an additional loss of 100,000 years of life for each month; late cancer diagnoses lose 250,000 years of remaining life for each month; missing living-donor transplants, another 5,000 years of life per month — and, if even 10 percent of vaccinations are not done, the result is an additional 24,000 years of life lost each month.
These unintended consequences of missed health care amount to more than 500,000 lost years of life per month, not including all the other known skipped care.
If we only consider unemployment-related fatalities from the economic shutdown, that would total at least an additional 7,200 lives per month. Assuming these deaths occur proportionally across the ages of current U.S. mortality data, and equally among men and women, this amounts to more than 200,000 lost years of life for each month of the economic shutdown.
In comparison, COVID-19 fatalities have fallen disproportionately on the elderly, particularly in nursing homes, and those with co-morbidities. Based on the expected remaining lifetimes of these COVID-19 patients, and given that 40 percent of deaths are in nursing homes, the disease has been responsible for 800,000 lost years of life so far. Considering only the losses of life from missed health care and unemployment due solely to the lockdown policy, we conservatively estimate that the national lockdown is responsible for at least 700,000 lost years of life every month, or about 1.5 million so far — already far surpassing the COVID-19 total.
Policymakers combatting the effects of COVID-19 must recognize and consider the full impact of their decisions. They need to be aware of the devastating effects in terms of lost life from shutting down significant parts of the economy. The belated acknowledgement by policy leaders of irreparable harms from the lockdown is not nearly enough. They need to emphatically and widely inform the public of these serious consequences and reassure them of their concern for all human life by strongly articulating the rationale for reopening society. https://ebd4fc279229bb5cc4164421271babeb.safeframe.googlesyndication.com/safeframe/1-0-37/html/container.html
To end the loss of life from the economic lockdown, businesses as well as K-12 schools, public transportation, parks and beaches should smartly reopen with enhanced hygiene and science-based protection warnings for any in the high-risk population. For most of the country, that reopening should occur now, without any unnecessary fear-based restrictions, many of which repeat the error of disregarding the evidence. By following a thoughtful analysis that finally recognizes all available actions and their consequences, we can save millions of years of American life.
When the next pandemic inevitably arises, we need to remember these lessons and follow policies that consider the lives of all Americans from the outset.
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Researchers say the new models show how even small differences in timing could have prevented the worst exponential growth of coronavirus cases. Author: TEGNA Published: 5:39 AM EDT May 21, 2020
New modeling shows that if the U.S. adopted coronavirus social distancing measures one week earlier in March, the country could have saved nearly 36,000 additional lives from COVID-19. Researchers say its a sign of how quickly the virus can spread when no measures are in place.
On March 16, President Donald Trump announced guidelines from the White House coronavirus task force aimed at slowing the spread of the virus. He asked Americans to avoid discretionary travel, avoid gathering in large groups and encouraged schools to teach remotely.
Columbia researchers say that had such measures been enacted on March 8, the number of total deaths, as of May 3, could have dropped by nearly 36,000. If the restrictions had gone into effect March 1, the researchers projected that the number of deaths could be 54,000 less, as of May 3.
The team estimated that in New York City alone, the number of coronavirus deaths reported on May 3 could have dropped by nearly 15,000 to just 2,838. The researchers’ findings have yet to be peer-reviewed and were shared online to the preprint site medrxiv.
Landmark study claims virus didn’t come from animals in Wuhan market
China’s claims that the pandemic emerged from a wild animal market in Wuhan last December have been challenged by a landmark scientific study.
The Mail on Sunday can reveal that analysis of the coronavirus by specialist biologists suggests that all available data shows it was taken into the market by someone already carrying the disease.
The article goes on to state the following:
They also say they were ‘surprised’ to find the virus was ‘already pre-adapted to human transmission’, contrasting it to another coronavirus that evolved rapidly as it spread around the planet in a previous epidemic.
“The publicly available genetic data does not point to cross-species transmission of the virus at the market,” said Alina Chan, a molecular biologist, and Shing Zhan, an evolutionary biologist, according to the report.
“The possibility that a non-genetically engineered precursor could have…
Superspreading events involving SARS-CoV-2, the virus that causes COVID-19, have been reported.
What is added by this report?
Following a 2.5-hour choir practice attended by 61 persons, including a symptomatic index patient, 32 confirmed and 20 probable secondary COVID-19 cases occurred (attack rate = 53.3% to 86.7%); three patients were hospitalized, and two died. Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing.
What are the implications for public health practice?
The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission.
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On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir’s member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2–5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.
Investigation and Findings
The choir, which included 122 members, met for a 2.5-hour practice every Tuesday evening through March 10. On March 15, the choir director e-mailed the group members to inform them that on March 11 or 12 at least six members had developed fever and that two members had been tested for SARS-CoV-2 and were awaiting results. On March 16, test results for three members were positive for SARS-CoV-2 and were reported to two respective local health jurisdictions, without indication of a common source of exposure. On March 17, the choir director sent a second e-mail stating that 24 members reported that they had developed influenza-like symptoms since March 11, and at least one had received test results positive for SARS-CoV-2. The email emphasized the importance of social distancing and awareness of symptoms suggestive of COVID-19. These two emails led many members to self-isolate or quarantine before a delegated member of the choir notified SCPH on March 17.
All 122 members were interviewed by telephone either during initial investigation of the cluster (March 18–20; 115 members) or a follow-up interview (April 7–10; 117); most persons participated in both interviews. Interviews focused on attendance at practices on March 3 and March 10, as well as attendance at any other events with members during March, other potential exposures, and symptoms of COVID-19. SCPH used Council of State and Territorial Epidemiologists case definitions to classify confirmed and probable cases of COVID-19 (6). Persons who did not have symptoms at the initial interview were instructed to quarantine for 14 days from the last practice they had attended. The odds of becoming ill after attending each practice were computed to ascertain the likelihood of a point-source exposure event.
No choir member reported having had symptoms at the March 3 practice. One person at the March 10 practice had cold-like symptoms beginning March 7. This person, who had also attended the March 3 practice, had a positive laboratory result for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR) testing.
In total, 78 members attended the March 3 practice, and 61 attended the March 10 practice (Table 1). Overall, 51 (65.4%) of the March 3 practice attendees became ill; all but one of these persons also attended the March 10 practice. Among 60 attendees at the March 10 practice (excluding the patient who became ill March 7, who also attended), 52 (86.7%) choir members subsequently became ill. Some members exclusively attended one practice; among 21 members who only attended March 3, one became ill and was not tested (4.8%), and among three members who only attended March 10, two became ill (66.7%), with one COVID-19 case being laboratory-confirmed.
Because illness onset for 49 (92.5%) patients began during March 11–15 (Figure), a point-source exposure event seemed likely. The median interval from the March 3 practice to symptom onset was 10 days (range = 4–19 days), and from the March 10 practice to symptom onset was 3 days (range = 1–12 days). The odds of becoming ill after the March 3 practice were 17.0 times higher for practice attendees than for those who did not attend (95% confidence interval [CI] = 5.5–52.8), and after the March 10 practice, the odds were 125.7 times greater (95% CI = 31.7–498.9). The clustering of symptom onsets, odds of becoming ill according to practice attendance, and known presence of a symptomatic contagious case at the March 10 practice strongly suggest that date as the more likely point-source exposure event. Therefore, that practice was the focus of the rest of the investigation. Probable cases were defined as persons who attended the March 10 practice and developed clinically compatible COVID-19 symptoms, as defined by Council of State and Territorial Epidemiologists (6). The choir member who was ill beginning March 7 was considered the index patient.
The March 10 choir rehearsal lasted from 6:30 to 9:00 p.m. Several members arrived early to set up chairs in a large multipurpose room. Chairs were arranged in six rows of 20 chairs each, spaced 6–10 inches apart with a center aisle dividing left and right stages. Most choir members sat in their usual rehearsal seats. Sixty-one of the 122 members attended that evening, leaving some members sitting next to empty seats. Attendees practiced together for 40 minutes, then split into two smaller groups for an additional 50-minute practice, with one of the groups moving to a smaller room. At that time, members in the larger room moved to seats next to one another, and members in the smaller room sat next to one another on benches. Attendees then had a 15-minute break, during which cookies and oranges were available at the back of the large room, although many members reported not eating the snacks. The group then reconvened for a final 45-minute session in their original seats. At the end of practice, each member returned their own chair, and in the process congregated around the chair racks. Most attendees left the practice immediately after it concluded. No one reported physical contact between attendees. SCPH assembled a seating chart of the all-choir portion of the March 10 practice (not reported here because of concerns about patient privacy).
Among the 61 choir members who attended the March 10 practice, the median age was 69 years (range = 31–83 years); 84% were women. Median age of those who became ill was 69 years, and 85% of cases occurred in women. Excluding the laboratory-confirmed index patient, 52 (86.7%) of 60 attendees became ill; 32 (61.5%) of these cases were confirmed by RT-PCR testing and 20 (38.5%) persons were considered to have probable infections. These figures correspond to secondary attack rates of 53.3% and 86.7% among confirmed and all cases, respectively. Attendees developed symptoms 1 to 12 days after the practice (median = 3 days). The first SARS-CoV-2 test was performed on March 13. The last person was tested on March 26.
Three of the 53 patients were hospitalized (5.7%), including two who died (3.8%). The mean interval from illness onset to hospitalization was 12 days. The intervals from onset to death were 14 and 15 days for the two patients who died.
SCPH collected information about patient signs and symptoms from patient interviews and hospital records (Table 2). Among persons with confirmed infections, the most common signs and symptoms reported at illness onset and at any time during the course of illness were cough (54.5% and 90.9%, respectively), fever (45.5%, 75.8%), myalgia (27.3%, 75.0%), and headache (21.2%, 60.6%). Several patients later developed gastrointestinal symptoms, including diarrhea (18.8%), nausea (9.4%), and abdominal cramps or pain (6.3%). One person experienced only loss of smell and taste. The most severe complications reported were viral pneumonia (18.2%) and severe hypoxemic respiratory failure (9.1%).
Among the recognized risk factors for severe illness, the most common was age, with 75.5% of patients aged ≥65 years. Most patients (67.9%) did not report any underlying medical conditions, 9.4% had one underlying medical condition, and 22.6% had two or more underlying medical conditions. All three hospitalized patients had two or more underlying medical conditions.
Public Health Response
SCPH provided March 10 practice attendees with isolation and quarantine instructions by telephone, email, and postal mail. Contacts of patients were traced and notified of isolation and quarantine guidelines. At initial contact, 15 attendees were quarantined, five of whom developed symptoms during quarantine and notified SCPH.
Before detection of this cluster on March 17, Skagit County had reported seven confirmed COVID-19 cases (5.4 cases per 100,000 population). At the time, SCPH informed residents that likely more community transmission had occurred than indicated by the low case counts.* On March 21, SCPH issued a press release to describe the outbreak and raise awareness about community transmission.† The press release emphasized the highly contagious nature of COVID-19 and the importance of following social distancing guidelines to control the spread of the virus.
Multiple reports have documented events involving superspreading of COVID-19 (2–5); however, few have documented a community-based point-source exposure (5). This cluster of 52 secondary cases of COVID-19 presents a unique opportunity for understanding SARS-CoV-2 transmission following a likely point-source exposure event. Persons infected with SARS-CoV-2 are most infectious from 2 days before through 7 days after symptom onset (7). The index patient developed symptoms on March 7, which could have placed the patient within this infectious period during the March 10 practice. Choir members who developed symptoms on March 11 (three) and March 12 (seven) attended both the March 3 and March 10 practices and thus could have been infected earlier and might have been infectious in the 2 days preceding symptom onset (i.e., as early as March 9). The attack rate in this group (53.3% and 86.7% among confirmed cases and all cases, respectively) was higher than that seen in other clusters, and the March 10 practice could be considered a superspreading event (3,4). The median incubation period of COVID-19 is estimated to be 5.1 days (8). The median interval from exposure during the March 10 practice to onset of illness was 3 days, indicating a more rapid onset.
Choir practice attendees had multiple opportunities for droplet transmission from close contact or fomite transmission (9), and the act of singing itself might have contributed to SARS-CoV-2 transmission. Aerosol emission during speech has been correlated with loudness of vocalization, and certain persons, who release an order of magnitude more particles than their peers, have been referred to as superemitters and have been hypothesized to contribute to superspeading events (1). Members had an intense and prolonged exposure, singing while sitting 6–10 inches from one another, possibly emitting aerosols.
The findings in this report are subject to at least two limitations. First, the seating chart was not reported because of concerns about patient privacy. However, with attack rates of 53.3% and 86.7% among confirmed and all cases, respectively, and one hour of the practice occurring outside of the seating arrangement, the seating chart does not add substantive additional information. Second, the 19 choir members classified as having probable cases did not seek testing to confirm their illness. One person classified as having probable COVID-19 did seek testing 10 days after symptom onset and received a negative test result. It is possible that persons designated as having probable cases had another illness.
This outbreak of COVID-19 with a high secondary attack rate indicates that SARS-CoV-2 might be highly transmissible in certain settings, including group singing events. This underscores the importance of physical distancing, including maintaining at least 6 feet between persons, avoiding group gatherings and crowded places, and wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain during this pandemic. The choir mitigated further spread by quickly communicating to its members and notifying SCPH of a cluster of cases on March 18. When first contacted by SCPH during March 18–20, nearly all persons who attended the practice reported they were already self-isolating or quarantining. Current CDC recommendations, including maintaining physical distancing of at least 6 feet and wearing cloth face coverings if this is not feasible, washing hands often, covering coughs and sneezes, staying home when ill, and frequently cleaning and disinfecting high-touch surfaces remain critical to reducing transmission. Additional information is available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.
Patients described in this report; health care personnel who cared for them; Skagit County Public Health staff members and leaders, particularly the Communicable Disease investigators; Washington State Department of Health.
1Skagit County Public Health, Mount Vernon, Washington.
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TABLE 1. Number of choir members with and without COVID-19–compatible symptoms (N = 122)* and members’ choir practice attendance† — Skagit County, Washington, March 3 and 10, 2020
Attendance No. (row %) March 3 practice March 10 practice Total Symptomatic Asymptomatic Total Symptomatic Asymptomatic Attended 78 51 (65.4) 27 (34.6) 61 53§ (86.9) 8 (13.1) Did not attend 40 4 (10.0) 36 (90.0) 61 3 (4.9) 58 (95.1) Attendance information missing 4 1 (25.0) 3 (75.0) 0 0 (—) 0 (—) Attended only one practice 21 1 (4.8) 20 (95.2) 3 2 (66.7) 1 (33.3)
Abbreviation: COVID-19 = coronavirus disease 2019. * No choir members were symptomatic at the March 3 practice. † Thirty-seven choir members attended neither practice; two developed symptoms, and 35 remained asymptomatic. § Includes index patient; if the index patient excluded, 52 secondary cases occurred among the other 60 attendees (attack rate = 86.7%).
FIGURE. Confirmed* and probable† cases of COVID-19 associated with two choir practices, by date of symptom onset (N = 53) — Skagit County, Washington, March 2020
Abbreviation: COVID-19 = coronavirus disease 19. * Including the index patient.
Suggested citation for this article: Hamner L, Dubbel P, Capron I, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:606–610. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e6.
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The health official responsible for overseeing nursing homes in Pennsylvania — where nearly 70 percent of the state’s coronavirus-related deaths have occurred — moved her elderly mother out of one of the facilities as deaths skyrocketed, a report said.
Pennsylvania Health Secretary Dr. Rachel Levine said Tuesday that her 95-year-old mother requested to be moved out of a personal care home, a local ABC affiliate reported.
“My mother requested, and my sister and I as her children complied to move her to another location during the COVID-19 outbreak,” Levine said, according to ABC27.
“My mother is 95 years old. She is very intelligent and more than competent to make her own decisions,” she added.
After criticism from some state lawmakers for the move, Levine argued she’s working to ensure the health and safety of all state residents, according to the report.
In March, Levine ordered long-term care facilities in the state to continue to accept coronavirus patients who had been discharged from hospitals but who were unable to return to their homes, the Bucks County Courier Times reported.
Of the state’s 3,806 coronavirus deaths, 2,611 had occurred in nursing homes and long-term care facilities, according to ABC27.
The MGM plan released Tuesday offered a first look at how Atlantic City casinos plan to operate to protect both employees and guests from the coronavirus.
The new rules include:
— Daily temperature checks for all employees, as well as screening measures to determine whether they have infection symptoms and where they are in contact with those who have been infected, such as someone in their household or someone they care for.
— Guests who think they may have been exposed will be “strongly encouraged” to stay at home and not travel.
— All employees must wear masks, and all guests will be encouraged to do so in public areas. The casino will hand out free masks to guests.
— Workers will be trained on proper cleaning procedures and other steps to protect against the virus.
— Employees who handle food, clean public areas and enter guest rooms must wear gloves. Other workers also may required to wear personal protective equipment.
— Guests still will be able to order beverages but not food on the casino floor, and can remove their masks to drink.
— Frequent cleaning and disinfecting of slot machines, tables and kiosks.
— Stations for handwashing and hand sanitizing in high-traffic areas.
— A six-foot social distancing policy will be followed whenever possible, with signs and floor guides to help separate patrons. In areas where the distancing policy cannot be followed, plexiglass barriers will be installed or employees will be given eye protection.
— Poker rooms may not reopen when the rest of the casino does, depending on guidance from state officials and medical experts.
— Plexiglass barriers throughout the casino and lobbies.
— Medical personnel on staff to respond in case a guest or employee tests positive for COVID-19. Exposed areas will be sanitized and efforts will be made for contact tracing, notifying those who may have been in contact with the individual.
— Limits on how many people can share an elevator cab.
— Allowing guests to check in to their hotel rooms digitally without having contact with anyone at the front desk.
— Digital menus and text notifications when tables are ready, eliminating the need to wait in line.
It remains to be seen if the steps are sufficient to win the approval of Unite Here, the union that represents 10,600 Atlantic City workers. Their plan called for having the state gaming commission ensure that the casinos were taking the necessary steps to protect employees and guests.
The union said that the six-foot distance between customers needed to be followed at slot machines and table games, dice and chips needed to be frequently sanitized, buffets needed to be suspended and spas and pools needed to close temporarily.
“It’s good that the company is talking about it, but we need them to work in partnership with frontline workers to come up with a full plan to protect guest and workers,” said Mayra Gonzalez, a line server at Borgata and a member of Unite Here.
"There is but one straight course, and that is to seek truth and pursue it steadily" – George Washington letter to Edmund Randolph — 1795. We live in a “post-truth” world. According to the dictionary, “post-truth” means, “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.” Simply put, we now live in a culture that seems to value experience and emotion more than truth. Truth will never go away no matter how hard one might wish. Going beyond the MSM idealogical opinion/bias and their low information tabloid reality show news with a distractional superficial focus on entertainment, sensationalism, emotionalism and activist reporting – this blogs goal is to, in some small way, put a plug in the broken dam of truth and save as many as possible from the consequences—temporal and eternal. "The further a society drifts from truth, the more it will hate those who speak it." – George Orwell “There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.” ― Soren Kierkegaard