From the President

COVID-19 Statistics and Facts:
Meaningful or a Means of Manipulation?
Kristin S. Held, M.D.
What Does the COVID Data Mean?
The COVID-19 case counts, hospitalization numbers, anddeath counts are meaningless in their current fluid form. Theirmalleability primarily serves those who seek to distort reality.
The morphable numbers are reported, then manipulated
by federal, state, county, city, and hospital authorities andagencies. The manipulation is driven by power and moneyand fueled by fearmongering, panic stoking, and promise ofmonetary and political gain. All this is bought and paid forunder the guise of trying to save the world from the COVID-19
pandemic.
We must ask the appropriate questions and demandanswers, which must then be verified. We must answer thequestion of what happened in Texas, Florida, and current “hotspot states” around Jun 14-16. Something did, according to
the statistics. Did redefining what constitutes a COVID-19
case, hospitalization, or death change the numbers? Did
federal financial aid to hospitals change admitting thresholds
and practices? Did the withdrawal of the Emergency Use
Authorization (EUA) for hydroxychloroquine (HCQ) by the
U.S. Food and Drug Administration (FDA) alter outpatient
treatment, resulting in a surge of COVID-19 hospitalizations
and deaths? Was it the riots? Or what?
The Council of State and Territorial Epidemiologists (CSTE)
adopted new definitions of COVID-19 cases and COVID-related
deaths in April that were quickly adopted by the Centers
for Disease Control and Prevention (CDC).1 The states werethen encouraged to adopt the new definitions, as the Texas
Department of State Health Services (DSHS) did on May 11.2
The adoption and implementation of these definitions
makes a huge difference in the counting of new COVID-19
cases and deaths. In Texas, the May 18, 2020, Collin County
Commissioners meeting is one of the best discussions of theeffect of the definitions I have encountered. Listen from the
15:27 to the 59-minute mark on the recording for yourself.3
Collin County Judge Chris Hill and commissioners
beautifully analyzed what was about to happen and evendiscussed the necessity of warning Collin County residents
that the number of COVID-19 cases and COVID-related deaths
were about to go up because of the new definitions. My cityand county, San Antonio in Bexar County, adopted the new
definitions and state: “COVID-19 cases include both confirmed
and probable cases” on the COVID-19 San Antonio Dashboards
and Data, which I recorded with a screen shot on July 12. The
CDC/CSTE new definition of COVID-19 cases can result in 17“probable” cases from just one PCR-positive patient. COVIDrelated deaths can include anyone who has COVID-19 listed on
the death certificate as one of the causes of death. It doesn’t
have to be the first or second cause, and no COVID-19 testingis required. During the exact time frame in which these new
definitions would have been adopted and implemented, the
new COVID cases and COVID death counts started going up in
Bexar County.
What is going on in each of the 254 counties in Texas as70

well as each of the 50 states? It is impossible to know without
checking the definitions that each is using.
While the definitions of COVID-19 cases and deaths
were being expanded by the CSTE, CDC, and state healthdepartments, efforts to collect and track this epidemiological
data were being increased. On May 13, using federal
dollars, Texas Governor Greg Abbott signed a $295.3 million
27-month contract with MTX Group, a New York-born andnewly Texas-based company tasked with contact tracingof Texans who meet the definition of a COVID-19 case. The
Texas DSHS is administering the contract. Seventeen states
started using technology from this same group around thissame time, including Georgia, Florida, New Mexico, New
York, Massachusetts, Oklahoma, New Hampshire, Vermont,and Illinois. MTX has a $250 million contract with New Yorkplus a second for $46 million for New York City alone. Texas
lawmakers questioned a “hastily-awarded” $295 million
emergency contract to expand the Texas contact-tracing
network.4
Many of these states are now deemed “hot spots” because
of increasing numbers of reported cases. The COVID-19
contact tracing efforts include tracking and tracing Texans
using thousands of contact tracers and personal phone
apps. By June 3, Texas lawmakers were calling to end
the contact-tracing program, which they called “a grossinvasion of personal liberty and privacy” and insisted thatrecently surfaced evidence that Das Nobel, CEO of MTX, lied
about having a “Doctorate of Management, Organizational
Development, and Leadership” on his LinkedIn profile was
grounds to end the contract.5 Five Texas lawmakers also sued
Governor Abbott over the $295 million coronavirus contacttracing contract.6
Concurrently, the American Medical Association (AMA)
was working with the CDC and CSTE on electronic casereporting (eCR) to “transform the way we do business” incollecting patient data from physicians and labs. They proudly
proclaimed the data mining does not require extra clicks,
but reduces burden, because “it’s in the background…soas the data and information is being recorded through thenormal healthcare visit process, it’s there, and then eCR justallows it to move from health care into public health. It’s likeplugging in the EHR to public health.” They advertise that eCR
fulfills clinicians’ reporting requirements, automatically sends
required information to all appropriate public health agencies,
and allows expansion to all reportable conditions.7
AMA’s daily COVID-19 update, Jun 4, features a video
and transcript of the eCR collaborative. This comprises the
Public Health Informatics Office at the Center for Surveillance,
Epidemiology and Laboratory Services within the CDC in
Atlanta; AMA’s director of science, medicine and publichealth; and the CSTE in Atlanta.8 The eCR is an initiative thathas come together with CSTE, the Association of Public Health
Laboratories, CDC, and AMA to focus on COVID-19 reporting
using electronic case reporting infrastructure that’s in place,to develop an eCR app that can be used by EHR vendors that
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Fall 2020

didn’t have eCR capability, and to allow data flow between
patient care and public health. The CDC spokesperson
claims to have been able to move COVID eCR rapidly, having“onboarded in the last month, around 2000 facilities thatcome to us from around 17 organizations, and we’ve seen
over 460,000 case reports electronically flow through this andreceived in 32 different public health jurisdictions for use.”
They discuss plans to eventually insert treatment guidelines
and isolation guidelines for COVID-19 as well.
Testing, reporting, and tracing are big-money industries
with potential for overreach, over-reporting, and error
resulting in loss of liberty and livelihood for Americans. Allof this money is coming from taxpayers, and none has gone
toward actual treatment. From information technology (IT)vendors and data brokers to the AMA, which profits as an“implement, comply, and coding” arm of the Department of
Health and Human Services (HHS), there are monetary andpower incentives to increase testing, tracing, and reporting of
COVID-19.
Why would someone want to inflate case counts, and what
are the risks and benefits of doing so? As reported in Modern
Healthcare, HHS was to send $10 billion in round two of relief
grants to COVID-19 hot spots: “Hospitals that had more than
161 COVID-19 admissions between January 1 and June 10
will be paid $50,000 for each COVID-19 admission. HHS asked
hospitals to start submitting COVID-19 admission data on
June 8.”9
Hospitals that use the new CDC definition stand to makemillions of dollars. The first round of HHS grants was $12
billion and paid $76,975 per admission to hospitals that had
more than 100 COVID-19 admissions from Jan 1 throughApr 1. Obviously, states hit early got huge sums of money.
Illinois received $740 million; New York, $684 million; andPennsylvania, $655 million. Additionally, Medicaid will pay out$15 billion in relief funds. Hospitals must apply by August, so
the more cases the better the return. Remember, this is on topof the extra money commercial insurers pay and the extra 20
percent Medicare pays to hospitals for patients hospitalized“with COVID-19.” The hospitals reporting the most cases get
the most money.
Because of expanding the definition of a new COVID-19
case to include exposure to a COVID-positive patient and a selfreported fever, lowering admission thresholds, and requiring
testing on every admission, it is easy to code a hospital
admission as “with COVID.” A colleague reported to me that
her scheduled Caesarian section patient was asymptomatic
but tested positive on the required admission COVID test, so
she too became a hospitalization “with COVID.” The army ofhospital billers and coders is no doubt hard at work scouring
EMRs and community contact-tracing data to find any links
that could raise their bounty. This may also explain why theaverage hospital stay for COVID-19 was around 1.4 days lasttime I checked—just long enough to go beyond a 24-hour
emergency room observation status to count as an actual
hospital admission.
Doctors, nurses, and patient-care staff do not get thismoney. In fact, many of my fellow physicians received pay cuts
as great as 20 percent while being asked to step up and carefor the increasing number of admissions, and many nurses
and other members of our patient-care teams were in fact
fired or furloughed because of financial devastation resulting
from the initial premature and prolonged shutdowns.
Hospital beds and operating rooms sat empty as aconsequence of governors’ executive orders banning all nonJournal of American Physicians and Surgeons Volume 25 Number 3

Fall 2020

urgent care. The premise was to reserve bed capacity for the
anticipated COVID-19 surge. The result was near financial
ruin for hospitals at the very time they were charged withpreparing for a pandemic. The state governments’ bans on
non-urgent care had the opposite of the desired effect. Rather
than increasing capacity, Texas lost staffed hospital beds. Thus,
when our COVID-19 wave came, 3 months after the governor’s
executive order declaring a disaster, we were less prepared,
with fewer staffed beds and more financial stress. Now wehave fewer doctors and staff members, who are overworked
and underpaid, to care for more patients. This is compoundedby the new public health problem created by the bans andshutdown; all the non-COVID patients who delayed or weredenied care during the near 2-month ban on treating them
are all now in desperate need of care, and they are sicker. The
hospitals now have more COVID patients, more non-COVID
patients, and fewer staffed beds.
Yes, thank and pray for our critical-care doctors, nurses,
and teams. They are doing more with less under great stress,
but they are doing phenomenally good work. Death rates in
Texas, for example, are remarkably low in spite of the new
definition of COVID-related death. As discussed earlier, being
coded as a COVID-related death does not require a COVID test
but does come with a big payout for the hospitals. Definitions
matter.
Another sad consequence of the inflated numbers isthat we are losing freedoms and destroying our state andcountry. Our re-openings are based on these numbers. We
have lost our ability to congregate in groups of 10 or more;
go to church, school, weddings, funerals, sporting events,
concerts; go anywhere without a mask; or hug our parents,
grandparents, children, grandchildren, and the lonely. In
Texas, there are Hospital Trauma Service Areas where larger
counties with state and county hospitals take transfers fromcounties and rural hospitals less equipped. Bexar County
covers for 22 counties. Our case reports did not separate out
who was a Bexar County resident and who was from anothercounty or country—we are a 2.5-hour drive from Mexico.
Ironically, while Bexar County is taking care of all the sickest
patients transferred in, we are penalized because of increasing
COVID-19 hospitalizations and deaths; simultaneously, thecounties that sent the patients to us, record fewer COVID-19
admissions and deaths and remain open with greater freedom
and liberty. San Antonio is not allowing us to gather in groups
of more than 10. Meetings and events are being canceled.
Some are being rescheduled to other counties that we cover.
This inflicts severe economic and psychological damage on
our community.
This is not just a result of perverse financial incentives, but
this is clearly also a political fight. San Antonio has a liberal
Democrat mayor and Bexar County has a liberal Democrat
county judge. Their approach is totalitarian. Their goal is for
Democrats to win on Nov 3. Perhaps they are willing to draw
this siege out to achieve personal political goals. Already school
openings have been delayed based on manipulated numbers.
Other counties being punished, such as Harris County and
Dallas County, also have county hospitals and Democrat local
leaders. Look at their numbers, definitions, and counting andreporting methods—and their loss of liberty.
A Better Response
Our response has been all wrong. We must stop repeating
our mistakes and instead learn from them. Imagine if the $37
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billion dollars HHS is now sending to hospitals had been spent
instead hiring and training doctors, nurses, and medical teams,
building out COVID hospitals and rehabilitation units for postCOVID care, and preparing outpatient facilities and operatingrooms to care for non-COVID patients. This money would
have been better spent helping urgent care clinics, outpatient
clinics, and rural clinics strengthen their patients’ immune
systems with vitamin D3, vitamin C, zinc, exercise, weight loss,
and control of their blood pressure, diabetes, and asthma.
Imagine preparing our nursing homes and long-term carefacilities. Imagine offering residents the choice of participationin outpatient studies of low-dose hydroxychloroquine (HCQ)
and zinc that have proven effective when administered early insafe doses around the world, or other affordable, repurposed
treatments such as ivermectin and nebulized budesonide.
Frontline medical workers and high-risk patients could havebeen offered the same safe, potentially life-saving choices
as prophylaxis. Imagine having 84 percent fewer hospital
admissions to deal with, along with more doctors and staffed
beds. “Shoulda, woulda, coulda” doesn’t matter now, but let’s
learn from our mistakes. Let’s demand that our numbers bemeaningful, not means of manipulation.
I have not discussed here the contemptible intellectual
dishonesty, scientific fraud, and falsification of data that has
been used to sabotage outpatient use of hydroxychloroqine
and zinc in order to profit large drug and vaccine makers,
such as Gilead Science, which makes remdesivir. The trillionsof dollars, billions of lives, and immeasurable conflicts ofinterest tying the CDC, FDA, National Institutes of Health, and
Dr. Anthony Fauci’s National Institute of Allergy and Infectious
Disease (NIAID) into one giant tangled web are beyond thescope of this article. You must research this on your own.
Did the FDA Contribute to the Rise in Cases?
Concerning the question of what happened Jun 14-16,
does the rise in COVID-19 cases in any way tie back to the
FDA’s removing the Emergency Use Authorization (EUA) for
HCQ from the Strategic National Stockpile for COVID-19 on
Jun 15? False data from a questionable company, Surgisphere,
was exposed by brave citizen scientists and investigators,
resulting in retractions of articles that sabotaged the use of
HCQ for COVID-19. Lancet and the New England Journal of
Medicine retracted two articles based on this falsified data, but
not before the World Health Organization (WHO) halted major
studies of HCQ based on the fake science.
Mathematical analysis suggests that this has indeed
contributed to increased COVID cases and death. Who bears
responsibility for such evil? Needless to say, in spite of 35 years
at NIAID and more than $20 billion in the last 4 years alone,
Dr. Fauci failed us. We were not prepared, and preparedness
was his charge. He can no longer be trusted. Former President
Ronald Reagan famously said, “Trust, but verify.” I’m sorry tosay, the only thing we can trust is that most of those in chargeof this pandemic from Dr. Fauci on down cannot be trusted.
The critical questions must be asked by us, and their answers
must be pursued and verified by us. Definitions, semantics,
data, and statistics matter. There are a few good men andwomen out there. It is up to us to identify them and help them
help us.
Sadly, as exemplified by the attack on America’s Frontline
Doctors, physicians who speak out against this corruption
are denigrated, censored, threatened, and fired. As more
physicians become employees, they fear reprisal for speaking
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out in truth. AAPS is the only organization that has had
physicians’ backs and defended those who are threatenedwith loss of licensure by their state’s medical board, fired bytheir hospital or private equity group, or worse. The rest oforganized medicine is part of the problem and complicit in
the take. COVID-19 is the 2020 weapon of mass destruction;
this is bioterrorism resulting in financial terrorism, economic
devastation, and loss of Americans’ life and liberty. Even
our annual AAPS meeting cannot be held in person due togovernment-imposed restrictions on public gatherings.
The virus is bad, but the collateral damage from the failed
response is worse. Everyone from Dr. Fauci to the media
and half of our own profession wants to shut us down, but
we must stand strong for our patients and posterity; it is we
who must save the world or die trying. AAPS is the last best
hope. Somehow, we must find a way to let all physicians andpatients know we are here for them.
Kristin S. Held, M.D., practices ophthalmology in San Antonio, Texas, andserves as president of AAPS.

REFERENCES
1. CSTE Interim Position Statement: COVID-19 Case Definition
and Addition to the NNC List. Council of State and Territorial
Epidemiologists (CSTE); Apr 9, 2020. Available at: https://www.google.
com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEw
iDxoLNso_rAhXNWc0KHXHACdIQFjABegQIBhAB&url=https%3A%2
F%2Fwww.cste.org%2Fnews%2F500750%2FCSTE-Interim-PositionStatement-COVID-19-Case-Definition-and-Addition-to-the-NNC-List.
htm&usg=AOvVaw1I0vd18o8g8JSx_Qjp-lRe. Accessed Aug 10, 2020.
2. Hellerstedt J. DSHS Surveillance Case Definitions for 2019 Novel
Coronavirus Disease (COVID-19)—Revised; May 11, 2020. Available at:https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiDxoLNso_rAhXNWc0KHXHACdIQFjAMegQIAxAB&ur
l=http%3A%2F%2Fwww.medinacountytexas.org%2Fupload%2Fpage%2F9856%2Fdocs%2FDSHS-COVID19CaseDefinitionandInvestigationPrioritizationGuidance.pdf&usg=AOvVaw2wXpYFtBMLMMLAWB_CcflX.
Accessed Aug 10, 2020.
3. Collin County Commissioners Court; May 18, 2020. Available at: https://t.
co/HMkdmYaDEE?amp=1. Accessed Aug 11, 2020.
4. Root J, Blackman J. Lawmakers question $295 million emergency deal toexpand Texas contact tracing network. Houston Chronicle, May 19, 2020.
Available at: https://www.houstonchronicle.com/politics/texas/article/
Lawmakers-question-295M-emergency-deal-to-expand-15281974.php.
Accessed Aug 10, 2020.
5. Friend D. GOP state lawmakers call on Governor Abbott to end contact
tracing program. The Texan, Jun 3, 2020. Available at: https://thetexan.news/
gop-state-lawmakers-call-on-governor-abbott-to-end-contact-tracingprogram/. Accessed Aug 10, 2020.
6. Hall K. 5 Texas lawmakers sue state over $295 million coronavirus contacttracing contract. Austin American Statesman, Aug 6, 2020. Available at:https://www.msn.com/en-us/news/us/5-texas-lawmakers-sue-state-over24295-million-coronavirus-contact-tracing-contract/ar-BB17BWyg. Accessed
Aug 10, 2020.
7. eCR now: COVID-19 electronic case reporting for healthcare providers
improve outbreak response with real time data flow. CDC; Updated Jul 22,
2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/downloads/
hcp/eCR-Now-Electronic-Case-Reporting-for-healthcare-providers.pdf.
Accessed Aug 10, 2020.
8. AMA COVID-19 daily video update: Why it’s essential to improve datacollection and reporting; Jun 4, 2020. Available at: https://www.ama-assn.
org/delivering-care/public-health/ama-covid-19-daily-video-update-why-its-essential-improve-data. Accessed Aug 11, 2020.
9. Cohrs R. HHS to send $10 billion in round two of relief grants to COVID-19
hot spots. Modern Healthcare, Jul 17, 2020. Available at: https://www.
modernhealthcare.com/finance/hhs-send-10-billion-round-two-reliefgrants-covid-19-hot-spots. Accessed Aug 10, 2020.
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Fall 2020