By Dr. Anthony Policastro

No one has to point out how divided our country is. Some people are throwing around the term “We the People” as if they represent all 330 million citizens. The Greeks would term that hubris.

The next part of the line following those words is “of the United States in order to form a more perfect union.” We are clearly not “united.” We are far from having a “perfect union.”

In the past I have written about my management philosophy as an Air Force Commanding Officer. I called it the C-9 Philosophy. It referred to 9 characteristics that were necessary in order to accomplish things. If I were to grade our country on those 9 characteristics right now, we would get a failing grade.

Those characteristics are:

Commitment – This means that the final goal must be in the forefront of everything we do. There is a perception that only people who wear MAGA hats are interested in having a great country. That’s not true. We all want to be part of what is the greatest country in the world. We sometimes lose sight of that fact. We think some people want that and others do not.

Competence – We all have different skills. Only by combining everyone’s strongest skills can we make the right things happen. When we do not recognize that, we will work at cross purposes.

Confidence – This is the can-do attitude that allows us to accomplish more than we could ever realize. We currently have the attitude that if the opposing group is in power, nothing will be accomplished. As long as we have that attitude, then indeed nothing will get accomplished.

Congeniality – We can agree to disagree. That is healthy. It is also productive. However, we have taken to demonizing people who do not have the same beliefs that we do. That leads to an inability to work together.

Compassion – This term is often used in medicine. That is why it is at the center of my philosophy. I defined it as being a true professional in the face of adversity. Partisan politics is the direct antithesis of a country’s compassion. George Washington even said that in his farewell address over 200 years ago.

Communication – This is always at the heart of the matter. Most of my people could not remember all 9 of the C’s. However, everyone knew what C-6 was. That’s because most of our problems were due to poor communication. The explosion of social media has allowed anyone with any thought to tell the world that thought. That is the case no matter how untrue it is. What is worse is that people then believe it. It makes me glad I never set up a Facebook page.

Cooperation – Nothing gets accomplished if our heels are dug in. All we do is point fingers. That is something to be ashamed of.

Compromise – This word appears to not be in our vocabulary. I told Bryant Richardson that I was totally confused by the COVID support bill discussion. Democrats wanted unemployment benefits to be $600. Republicans wanted them to be $400. Neither side understood that $500 was a reasonable compromise. So they compromised by not having any agreement. That meant people got nothing.

Camaraderie – This is the sense of belonging. It comes when everything else is working well. We should all be proud of being Americans. Instead we act like some of us are and some of us aren’t.

If I ran my Air Force hospitals the way we currently run the country, we would have accomplished nothing. We would not have been selected as one of the top 10 percent of Air Force Hospitals for all six of the years we were eligible.

We currently have a country. However, it looks more like the States of America than it does the United States of America.


The numbers for total cases for November have increased. However, the increase appears to be somewhat stable. Prior to November 11th, we exceeded 136,000 new cases in a day 16 times in about 6 months. Since Nov. 11th, we have had between 141,000 and 204,000 cases every day except one. So it appears that we have increased but somewhat leveled out at that higher number.

Last week Delaware doubled its number of cases. The last doubling took 87 days. This time it was 103 days. So it was slightly longer this time.

Sussex County has looked similar to the national statistics. Prior to November we rarely had more than 100 new cases per day. Now we are seeing several days per week with more than 100 new cases.

The United States has long had the lead in total number of cases and total number of deaths. Most of that lead is due to the large population. Our death rate in terms of deaths per million has also always been poor. From May until November, we had the 9th highest death rate of the 195 countries in the world. There were multiple factors for that. A big one has been the unwillingness of many people to treat the disease seriously.

That has led us to new heights. This month we passed both Brazil and Chile in death rate. We now have the 7th highest death rate in the world. We are quickly gaining on the United Kingdom and Argentina, so we may have the 5th highest death rate in the world by the end of the year. I am not sure this is something in which we really want to be a world leader.

The University of Nebraska Medical Center in Omaha prepared for the current wave of sick patients. They now have a total of 10 COVID-19 units in the hospital. Three of those 10 units care for the sickest patients. Some of those patients die every day. There is a fourth unit that only provides comfort care to those patients who are beyond saving. They are all going to die. It is like a hospice unit in the hospital.

A drug from Regeneron was used to treat President Trump. It was also used for Ben Carson’s COVID-19 infection. The drug is a combination of two drugs called casirivimab and imdevimab. It has now received emergency use authorization.

The drug is difficult to make so will not be readily available for most people to use. Some people will object to its use on religious grounds. The original source of the drug was tissue from an aborted fetus.

As my regular readers know, I have been on the MMR bandwagon for months.  An October study in the American Journal of Medicine had the following recommendation: “Clinicians who are caring for such high-risk patients should consider the benefit/cost ratios of MMR vaccination to justify use of this simple, low-risk intervention to reduce COVID-19 disease, especially until a specific vaccine is approved.”

Then on Nov. 20th the journal for the American Society of Microbiology announced a study that looked at MMR antibody levels. They compared antibody levels to seriousness of COVID-19 infection. The study showed that the higher the mumps antibody level the less severe the COVID-19 symptoms. The number of patients studied was small. However, the research continues to pile up.

Johnson and Johnson is behind Pfizer and Moderna in its vaccine research. They do not expect to have approval until some time in February at the earliest. Their vaccine is a single dose vaccine. That is different than the two doses other manufacturers require.

AstraZeneca vaccine studies show that its vaccine has about a 70 percent effectiveness with two low doses. However, it goes up to 90 percent if the second dose is higher. They also had a labeling issue so some people got a different dose than what was labeled. It is cheaper and easier to manufacture and distribute. That means that it will be important for the world’s poorer countries.

When I was in the Air Force, the immunization requirements were different than civilian requirements. One of the necessary vaccines was typhoid. It was required every three years. I always got mine on Friday. That was because I knew that the next day I would have a high fever and be unable to get out of bed.

Apparently, the early reports from COVID-vaccine trials is that many of the individuals had a similar experience. They had fever, fatigue, weakness and muscle aches for about 24 hours. The expectation was that vaccine recipients should expect to spend the day after the vaccine in bed. That also means it is wise for spouses to not get the vaccine at the same time.

It does appear that the Coronavac has fewer of these side effects. That is not a surprise since it is more of a traditional vaccine. Antibody levels after Coronavac are not as high as they are with patients who have recovered from infection. They are also not as high as the protein based vaccines. However, there is no evidence that the higher the antibody, the greater the protection.

One vaccine question that is not yet answered is related to children. Trials to this point have been on adults. Children often have more severe immunization reactions. Children tend to have mild infection with COVID-19. So the first question is whether the vaccine or actual infection poses a higher risk. The second question is whether herd immunity will require children getting the vaccine. The answers to these questions are still months away.

Louisiana looked at its contract tracing figures to see where the COVID-19 outbreaks were coming from. They had a total of 469 outbreaks. The outbreaks accounted for 3,540 cases.

Interestingly industrial settings accounted for the highest number of outbreaks at  about 16 percent of the total. Restaurants were second at about 12 percent. Religious services were third at about 10 percent. Another 10 percent occurred from bars. Retail settings accounted for about 8 percent. These five accounted for just over 50 percent of the total cases.

Food processing plants and casinos had fewer outbreaks. However, the number of people infected per outbreak was higher.

For food processing plants, there were about 27 infections per outbreak. For casinos there were about 23 infections per outbreak. None of the other areas had more than 11 patients per outbreak.

A few weeks ago, I mentioned that President Trump had been taking melatonin before he was hospitalized. A recent study looked at melatonin specifically. It found that it was beneficial to some degree in preventing infection. It seemed to be more so in the African American population. However, even though it is an over-the-counter medication, it should be taken with a doctor’s advice.