The Clinicians Got Their Nose Whipped?

(Rise Up The World Internists)

Taufiq Muhibbuddin Waly, M.D., Internist

I got an article from an orthopedic surgeon (Yogi Prabowo, M.D., Orthopedist). He said about his dissatisfaction of the handling of the COVID-19 pandemic outbreak in the world, especially in Indonesia. According to him, the main cause was the weakness of the clinicians’ skills in overcoming the epidemic. The contents of the letter are as follows: [1]

If we compare it to a football match, then the minimum score is 3-0 for the Epidemiologists to beat the clinician (doctor) in the Covid-19 Countermeasures Cup Championship.

Now let’s look at the three goals. The first goal was scored by epidemiologists, in terms of explaining the “pathogenesis and pattern” of spreading, which suggests that this virus spreads from animals to humans and then the spread will increase according to the calculation of the numerical model of epidemiologists and mathematicians that the results are quite scary and succeed in spreading fear and panic on society.

Meanwhile, the clinicians were “forced” to follow the rhythm of the epidemiologists and forget about their scientific studies that have been learned in medical school, namely basic virology and pathology (pathogenesis) which can explain how viruses are transmitted.

We still remember when the Avian Flu outbreak hit Indonesia, Siti Fadilah Supari and the Eijkman institution managed to deny that viruses transmitted from animals can also be transmitted from human to human because they have different receptors. And virus mutation is not that easy because it requires process and intervention.

Epidemiologists numerical prediction appears to be so frightening, it makes clinicians “forget” or do not believe that there is another factor that influences the spread of the virus, namely Immunology. Epidemiologists cannot explain the phenomenon, there was one person who was very infectious (super spreader) entered a church in South Korea or on the Diamond Princess cruise ship and then infected tens or hundreds of other people. Meanwhile, the assistant of one of the ministers affected by Covid-19 is in good health even though he accompanied him almost all the time.

Clinicians should be able to answer the phenomenon of the emergence of this new virus, because the corona virus (SARS-CoV-2) is not the first to appear, but was preceded by other Corona viruses such as SARS-Cov (Severe Acute Respiratory Syndrome-related Coronavirus) which emerged in 2002, and the MERS (Middle East Repiratory Syndrome) virus or Camel Flu in 2012. So this past experience can be used as a reference in dealing with Covid-19. However, it seems that almost the entire world is stuttering against this Covid-19 so that it has spread throughout the world to become a Pandemic. Even regarding the method of transmission of this virus, there is still a lot of controversy between the spread through droplets or aerosols (air) even though in the end everyone agrees that droplets can turn into aerosols with certain treatments.

Another controversy is regarding the speed of spread geographically. The increase in the number of sufferers in tropical countries such as Southeast Asian countries is not as fast as in subtropical countries such as China, Europe and America. Moreover, another controversy is that epidemiologists have succeeded in coercing clinicians to support and strongly suggest the implementation of the lockdown policy or lockdowns to prevent the entry and exit of people into the area.

This policy has indeed been seen to be successfully implemented in Wuhan as the epicenter of the spread of the virus, with a marked decrease in Covid-19 cases in Wuhan. But it still failed to prevent the spread of Covid-19 in other countries around the world.

Meanwhile, another picture can be seen in Southeast Asia, such as in Malaysia, when the number of cases reached 500, it decided to apply a lockdown for 2 weeks, and the number of Covid-19 cases continued to increase to reach 4,000 in mid-April (the highest in ASEAN). Likewise in the Philippines, which extended the lockdown until the end of April because it had not seen significant results in reducing the rate of increase of Covid-19

The second goal was scored by epidemiologists, who managed to force clinicians not to use the science of disease diagnosis, just like what have been learned all these times. Clinicians are directed to treat it not based on a clinical diagnosis such as pneumonia (pneumonia) and so on. But must use “Epidemiologist-style Public Health Diagnosis, namely OTG (Asymptomatic), ODP (Person Under Supervision), PDP (Patience Under Supervision) and Confirmed COVID (+). Even patients whose initial diagnosis was not Covid-19, for example cancer patients, could suddenly change their verdict to Covid-19 due to meeting the existing criteria. As a result, it creates a feeling of fear and anxiety among the health workers who handle it.

Epidemiologist-style diagnosis gives “Uncertainty” amidst the lack of availability of diagnostic tools then has an impact on “Anxiety” which also affects decision making in treatment. This can lead to inefficiencies and ineffectiveness in treatment.

Clinicians, in fact, should stick to the principles of diagnosis and try to clarify the exact diagnosis. Without forgetting efforts to prevent the transmission of Covid-19 by continuing to strive for zoning or cohorts in the form of sorting out patients who are at risk.

Disaster triage also needs to be done to improve the quality of treatment, by classifying the severity of Covid-19 and sending it to the appropriate health facility based on its facilities and capabilities. Another thing that clinicians can do to reduce mortality is to treat Covid-19 patients in a multidisciplinary manner because Covid-19 patients can be accompanied by other diseases.

The third goal, in the next minute the clinician conceded again. Clinicians are once again “forced” to do more tracing on Covid-19 patients and people around them rather than focusing on treating the patients themselves. Even comorbid patients are also at high risk resulting in increased mortality.

Even for the collection of Covid-19 treatment financing from the government, it is required to fill in a PE (Epidemiological Investigation) form. The collaboration between epidemiologists and clinicians should be put in better rhythm, each in accordance with the portion and their place. Will these clinicians immediately rise from their downturn and together with epidemiologists move forward against a common enemy, namely Covid-19.

It can be seen from the article that he wrote, his resentment towards clinicians, saying that clinicians have been controlled by an epidemiologist. Like a buffalo stuck on its nose. In a soccer game, according to him, the clinician team had lost 0-3 against the epidemiologist team.

   Let’s analyze these goals, based on what he wrote down

1. The first goal

Clinicians only agree with the large number of COVID-19 morbidity and mortality rates that are claimed by epidemiologists. Clinicians should evaluate the pathogenesis of COVID-19. Are the morbidity and mortality rates really due to COVID-19 or not. But clinicians don’t do that. They just agree with anything said by the epidemiologist. This has the effect of the epidemiologist team succeeded in getting the clinician to ask the government to carry out tracing, lockdown, and even vaccinate all of its people.

2. Second goal

A team of epidemiologists is stepping up their attacks, saying a new, more dangerous mutation of the virus has emerged. The eleven clinicians increasingly stuttered. It even weakens its defenses by ignoring brain skills and learning outcomes of 5-6 years in internal medicine (internist).

The presence of pneumonic view on x-rays has always been tried to be associated with the epidemiologist, namely PDP and ODP. Even without any symptoms, a clinician can diagnose it as an OTG.

3. The third goal

The third goal that occurred was due to the extraordinary panic of the clinician team after the 2 goals created by the epidemiologist team. Tracing, tracing and tracing should always be the first thing to perform in a patient with any diagnosis, if the throat swab is positive. This includes tracing people around him who are suspected of being COVID-19. So that it can result in neglection of handling of these patients if they have dangerous comorbids.

Analysis about the lost:

Many clinicians do not like what orthopedist Yogi Prabowo has said. In fact, they said that his writing could divide specialist doctors. Because COVID-19 is a new disease. But for me it is a good input. The problem is whether this is so. If so, clinicians should improve themselves. If what he said was wrong, then where is the wrong statement?

In my opinion, this article only shows how worried he is about the COVID-19 problem. Not a desire to divide between specialists. He saw that clinicians did not show their knowledge in contributing to their thoughts in dealing with the COVID-19 pandemic. The clinician just follows what the epidemiologist says.

In my opinion too, the internist is the commander of the clinician. Or the captain of the team of clinicians. That’s why orthopedist Yogi Prabowo’s writing is essentially aimed at internists. And as a senior internist (24 years of experience as an internist) it is my duty to comment on the article.

Our internists are trained not to be subject to laboratories and X-rays. It is only as a tool for us in making a diagnosis. We are subject to anamnesis, and a physical examination that we do. The pathogenesis of a disease is fundamental to us. Brain skills that are based on extensive reading are our weapons.

On that basis, our team of internists should not be beaten easily by the epidemiologist team. However, it must be admitted that at first we stuttered at the rapid attack of the epidemiologist team. Only 1.5 months after Wuhan was locked down (January 23rd, 2020), on March 9th, 2020 COVID-19 had spread to 109 countries. [2] With a fairly high mortality rate (above 2%), namely 3.48%. [2] And in May 2020 the epidemiologists showed terrifying data for all citizens of the United States and the world. 100,000 citizens of the United States have died from COVID-19. [3] Even more so, the New York Times newspaper in May wrote the names of 100,000 Americans who were said to have died from COVID-19 on the front page of its newspaper. [4]

We as a team of internists, were totally at a loss to endure the swift and devastating total football assault of the epidemiologist team. The attacks are strongly supported by the mainstream media in the US and around the world. We want to survive by studying the pathogenesis of the disease. But most of the data we get comes from the intellectuals of Chinese doctors. Because of that, we as an internist team worldwide, learn the pathogenesis of COVID-19, which was created by the Chinese doctors.

And those Chinese doctors taught us that COVID-19 is creating a cytokine storm. Because the receptor of the SARS-COV-2 virus is ACE 2, which is found on the surface of the cell membrane of the body’s organs. Where the reality shows that ACE 2 is present on the surface of the cell membrane in almost all organs of the body. Thus all diseases can be caused by COVID-19 (the thousand facies disiases). [5-6] Their research shows the discovery of the SARS-COV-2 virus in feces, brain fluid, and lungs as well as the discovery of hemostatic disorders which are said as a result of COVID-19, such as: DIC, increased fibrinogen, increased ferritin, etc. all add to our belief of the correctness of the Chinese doctors’ theory of cytokine storms. WHO also (the supreme teacher) confirmed the pathogenesis of these Chinese doctors. The opinion of the great teacher (WHO) is also followed by all doctors worldwide, both clinicians and non-clinicians. Including doctors who specialize in epidemiology.

We, the internist team, actually want a critical discussion with the opinion of that supreme teacher. But prof. Antony Fauci. as the great professor at the Faculty of Medicine Harvard (ranked 1st in all of the medical faculty worldwide) agrees with the opinion of the WHO teacher. Thus it is difficult for the great masters of this world to contradict Antony Fauci. What’s more, he is the editor of the text book, the handbook for internists worldwide; “Harrison Principle of Internal Medicine”. With the submission of the captain of the world internist team, which is held by Antony Fauci, in the matter of pathogenesis, then the brain skills that exist in the international internist team in the matter of COVID-19 are then always based on the pathogenesis and pathophysiology of the cytokine storm theory. In such circumstances, goal after goal in the goal of an internist team will easily happen.

On the basis of the theory of cytokine storms, we as a team of internists are forced to remain silent or agree to the morbidity and mortality rates stated by the epidemiologist team (first goal). We agree that the mutation of the virus from SARS-COV-2 will cause the COVID-19 problem to become even more dangerous (second goal). The fear of cytokine storms and new virus mutations has led to epidemiological diagnoses such as ODP, PDP, and even OTG to form the basis of our diagnosis. We looked for any features of pneumonia or GGO. We even dare to diagnose COVID-19 with just an X-ray image like that. Even when the throat swab is negative or has not been checked. The pulmonary specialist has been the captain of the team of clinicians since the COVID-19 pandemic. Because internal medicine specialists or internists do not use their brain skills to their full potential.

And in the end we agree that the main concern in this COVID-19 problem is tracing. Even when the cost will be the delays in handling of comorbid diseases of the patient (third goal). In fact, we just agree with the treatments given to COVID-19. However, these medications may not necessarily be needed by the patient. Even they may be dangerous.[6] We are told to always be aware of the presence of cytokine storms, at all times. That’s why we do throat swabs on any patient, such as cancer, heart failure, kidney problems, bronchial asthma, and so on. Thus in the diagnosis of COVID-19, we need to add the critearia of patients with positive throat swabs (third goal). However a positive throat swab does not necessarily mean that SARS-COV-2 is alive in that patient.

In order to avoid death from cytokine storms in patients infected with COVID-19, the number of infected people must be reduced. So that we agree with the vaccination. There is no need for a more in-depth assessment of the benefits of vaccination. [7-8]

From the article above, as an internist or part of the team of clinicians, I admit the 3-0 defeat. And from the article above, the main cause of the defeat was due to the submission of the eleven clinicians to the theory of the COVID-19 cytokine storm.

In fact, I have reminded the players of the clinician team to be careful with epidemiologist claims related to the large number of COVID-19 deaths. All patients who have passed their life expectancy cannot be said to have died due to COVID-19. [3, 6] His death was due to his own chronic illness. Therefore, the deaths of the US people due to COVID-19 in May 2020 were not 104,542 people. But only 42,194 people. [3] Meanwhile, the world population’s death due to COVID-19 is not 3.23%. but only 1.13%. [6] Or equal to the level of the common cold. It could even be lower than that, if the cytokine storm theory is not used as a reference.

Unfortunately, my appeal to the clinician team players to be careful about the epidemiologist’s team’s claims was ignored. Belief in the cytokine storm theory was the reason why my appeal was ignored. No doctor or medical organization dares to refute the opinion of WHO as the supreme teacher on the problem of pathogenesis. No one dares to say there might not be a cytokine storm. But what happened was a sicokin (Chinese slang word for cytokine) storm.

With the submission of the captains of the world-class internist team, led by Antony Fauci et al, the belief in the occurrence of a cytokine storm in the world’s mainstream internists and their clinician team is very strong. However, I have written caution against the claims of cytokine storms that Chinese doctors are saying. [5] Even after internists around the world have researched a lot about the cytokine storm and agreed with what Chinese doctors said, I made a more powerful article by investigating dozens of international journals, to find out how exactly the pathogenesis of COVID-19 really is. [6]

From the results of this investigation, I found that the target cells of the SARS-COV-2 virus, the cause of COVID-19, is not the same as the SARS-COV-1 virus that causes SARS and MERS-CoV causes MERS. The target cells of SARS-COV-2 are goblet cells in the upper airway. Meanwhile, the target cells from SARS-COV-1 and MERS-COV were in the lower respiratory tract. Namely on the pneumocyst-2 cells, which are directly adjacent to the alveoli. [6] With SARS-COV-2, it is difficult to inflict damage to the alveoli or cause pneumonia. Another case with SARS-COV-1 or MERS-COV. There is no need to be afraid of new virus mutations. Because the target cells remain in the upper airway. Unless the new virus mutation changes its target cells to lower airway cells. When that happens, SARS-COV-2 has changed to SARS-COV-1 or MERS-COV. Or not COVID-19 anymore.

From investigations on international journals, it was also found that the target cells of SARS-CoV-2 were not cells that had ACE-2 on the surface of their cell membranes. The ACE-2 enzyme only facilitates the entry of the SARS-CoV-2 virus into our organ cells.

Thus there is nothing to be afraid of if someone is infected with COVID-19, by way of droplet infection. Even in people with old age. Because research shows that people who are HIV positive, and who do not receive regular treatment for HIV, can survive the attack of COVID-19. [9] We should not worry of etting SARS-COV-2 in the lungs or in the blood or gastrointestinal tract and brain glands. Because the numbers are very small and these viruses will easily be destroyed by our Natural Killer cells. It is different if we directly inject SARS-COV-2 into the blood, for example, vaccination. The dead virus or the protein part of the virus can directly enter the cells of organs that have ACE-2 on the surface of their cell membranes (heart, lungs, kidneys, brain, skin, digestive system, and blood vessels). And it can provide a dangerous intracellular reaction to our immune response. Hazardous reactions which may occur acutely or chronically. Immunity obtained from vaccination cannot prevent infection or re-infection of SARS-CoV-2 in our throat that occurs as a result of droplet infection. Because what plays a role there is our immunity from the upper respiratory tract (MALT / NALT). Immunity due to vaccination, can only fight SARS-CoV-2 in the blood, if the vaccine that is being injected is a good vaccine. Unfortunately, of the top 10 WHO vaccines, not even one can be considered as adequate. (8)

Further explaining that the target cells of the SARS-COV-2 virus are in the upper respiratory tract, so the likelihood of developing a cytokine storm is small. The presence of a lot of cytokines was released, as reported by the researchers, Chinese doctors because SARS-COV-2 was injected directly into the body of mice.[6] Not because through droplet infections. Nor did the Chinese researchers show the large number of immune complexes dispersed in the blood and the increased activity of the complement. Yet without these two things, it is difficult for a cytokine storm to occur.

However, severe pneumonia due to COVID-19 may occur in very old people, meaning that their immunity is lower than that of HIV patients. But still, the cytokines released should not be that much. A maximum of only the cytokine level that’s being released by SARS-COV-1 (SARS) and MERS-COV (MERS). If the cytokines released by SARS-COV-1 and MERS-COV could not be said of the existence of cytokine storm (even though there were more deaths), then it would be odd if the WHO as the supreme teacher agreed that COVID-19 was said to occur a cytokine storm.

   The conclusions of this paper are:

If what is written cannot be denied as the truth, and the clinicians squad use it in dealing with COVID-19, then the clinician team has won 10-0, over the epidemiologist team (because some say the highest level of football wins is 10-0 not 12-0 or 20-0). This 10-0 victory is due to the level of malignancy of COVID-19, which is the same as the common cold. There is no evidence of a cytokine storm. Thus, there is no need for tracing, lockdown, and vaccination. And there is no need to look for people infected with COVID-19. The clinician should focus only on the disease that the patient suffers from. There is no cause of death or COD from COVID 19. Bill Gates will not be able to cover that sunshine, even if he tries to.

Hopefully this paper can awaken the identity of clinicians, especially internists worldwide.

RISE UP INTERNISTS WORLDWIDE!!!

CC:

1. WHO

2. The International Society of Internal Medicine

3. World Medical Association

4. The World Association of Muslim Scholars (International Association of Muslim Scholars)

5. Indonesian Doctors Association (IDI)

6. Indonesian Internal Medicine Association (PAPDI)

7. Indonesian Association of Orthopedic Surgeons (PABOI)

8. Minister of Health of the Republic of Indonesia

9. Minister of Education and Culture of the Republic of Indonesia

10. Indonesian Muslim Intellectuals Association (ICMI)

Bibliography

  1. Epidemiologist Vs Clinicians: Failure in Treating Corona Pandemic, Yogi Prabowo, M.D, orthopedist. (http://bergelora.com/opini-wawancara/artikel/13499-epidemiolog-vs-klinisi-kegagalan-mengatasi-wabah-corona.html)
  2. Talk About CoVID-19, Raja Waly (https://renungan-tmudwal.com/bicara-covid-19/)
  3. The Death of 100,000 US People and The Horror of COVID-19 (The COVID-19 Pandemic has been Over), Taufiq Muhibbuddin Waly (http://dhf-revolutionafankelijkheid.net/the-death-of-100000-us-people-and-the-horror-of-covid-19-the-covid-19-pandemic-has-been-over/)
  4. American Doctors’ Role in Trump’s Defeat (Not Choosing Trump Is A Blunder For US Citizens), Taufiq Muhibbuddin Waly, M.D., Internist (http://dhf-revolutionafankelijkheid.net/american-doctors-role-in-trumps-defeat-not-choosing-trump-is-a-blunder-for-us-citizens/)
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  6. CoVID-19: GOD PUNISHES THE WORLD, OR THE WORLD PUNISHES ITSELF (A Discussion with International Journals), Taufiq Muhibbuddin Waly (http://dhf-revolutionafankelijkheid.net/artikel-55-covid-19-god-punishes-the-world-or-the-world-punishes-itself-a-discussion-with-international-journals/)
  7. Taufiq, M.D.: Sinovac Is the Funniest Vaccines out of 10 WHO’s Slapstick Vaccines! (https://www.law-justice.co/artikel/99290/dr-taufiq-sinovac-adalah-vaksin-terlucu-dari-10-vaksin-dagelan-who/)
  8. COVID-19 RELIGION, SLAPSTICK VACCINE AND HORROR VACCINE (Fight Against Colonization by COVID-19), Syarif, dr. Tgk. H. Taufiq bin Muhibbuddin bin Muhammad Waly bin Muhammad Salim bin Malin Palito, Sp.PD (http://dhf-revolutionafankelijkheid.net/artikel-59-covid-19-religion-slapstick-vaccine-and-horror-vaccine-fight-against-colonization-by-covid-19/)
  9. Cooper T, Woodward B, Alom S, Harky A. Coronavirus Disease 2019 (COVID‐19) Outcomes in HIV/AIDS Patients: A Systematic Review. HIV Med. 2020 July;21:567-577. doi:10.1111/hiv.12911