Showing posts sorted by date for query COVID. Sort by relevance Show all posts
Showing posts sorted by date for query COVID. Sort by relevance Show all posts

Saturday, August 1, 2026

The MAGA GOP Against Anthony Fauci, MD...


 

The Lie

The Facts

Lie 1: "Fauci lied about masks."

The Claim: repeatedly asserts Fauci intentionally lied to the public to manipulate them or that his changing guidance proved he was deceptive.

In March 2020 (the early weeks of the pandemic), public health officials—including Fauci—advised the general public against buying N95 surgical masks to prevent a severe shortage for front-line healthcare workers, given the initial belief that COVID-19 spread primarily through large droplets and surfaces. As airborne transmission and asymptomatic spread became clear in April 2020, guidance shifted to universal cloth mask-wearing. Scientific adaptation to new data was re-framed by critics as a malicious "lie."

Lie 2: "Fauci created/funded COVID-19 in Wuhan."

The Claim:  Repeated claims state that Fauci personally authorized "gain-of-function" research at the Wuhan Institute of Virology that directly created the SARS-CoV-2 virus.

While the National Institutes of Health (NIH) did fund grants to EcoHealth Alliance for bat coronavirus research in China, independent scientific panels, the NIH, and intelligence reviews clarified that the specific bat coronaviruses studied under those sub-grants were genetically distinct from SARS-CoV-2 and could not have evolved into the pandemic virus. The political rhetoric, however, repeats the "Fauci created the virus" line to frame a public servant as a criminal perpetrator.  Some circles suggest there was homicidal intent.

Lie 3: "Fauci personally forced lockdowns and school closures."

The Claim: characterizes lockdowns, school closures, and business restrictions as unilateral mandates handed down personally by "Dictator Fauci."

Under the U.S. federal system, public health mandates (closing schools, restricting indoor dining, stay-at-home orders) were legally enacted by state governors and local public health departments—not federal advisory scientists. Fauci served as an advisor whose task force issued recommendations, but he lacked any statutory executive power to pass laws or order closures. See Supplementary 7 (below).

Lie 4:  "Fauci lied when he said vaccines stop 100% of transmission."

The Claim: Asserts that public health officials promised the original COVID-19 vaccines would permanently block all infection and transmission, calling subsequent variant breakthrough cases "proof of a lie."

Clinical trials in late 2020 measured efficacy against symptomatic disease (which was ~95% for original strains). While early real-world data showed significant reduction in transmission against original variants, the emergence of mutated variants (like Delta and Omicron) eroded protection against infection while maintaining strong protection against severe illness and death. The shift in viral evolution was reframed as a deliberate institutional falsehood.

Lie 5: “Fauci made millions of dollars directly off the COVID-19 pandemic.”

The Claim:  made millions through secret royalty checks paid by pharmaceutical companies for COVID-19 vaccines. The claim frames him not as an independent public health scientist, but as a compromised figure using federal authority to enrich himself and corporate allies.  In this hearing there was a comments that he was “enriching himself through the use of federal employees.”  There has also been a longstanding complaint that Dr. Fauci is the “highest paid federal employee and he makes more than the President.”  That is true but it is full disclosure and according to federal regulations.

-Dr. Fauci holds no patents and receives no royalties related to any COVID-19 vaccines or treatments (including the Pfizer, Moderna, or Johnson & Johnson vaccines).

-FOIA disclosures obtained by watchdog groups showed that the NIH and its scientists received third-party royalties for older, pre-pandemic medical innovations (such as early HIV/AIDS research from decades prior). However, sensationalist headlines falsely claimed that these past, unrelated payments were "COVID-19 vaccine profits."

-Dr. Fauci has repeatedly stated—dating back to interviews with the Associated Press and BMJ in 2004/2005—that he attempted to refuse statutory royalty payments from earlier research (such as an interleukin-2 treatment developed for HIV/AIDS) because he felt it posed a potential conflict of interest.  Because federal law required the agency to issue the funds, Fauci pledged to donate 100% of his royalty payments to charity.

-Federal Salary: As the former Director of the National Institute of Allergy and Infectious Diseases (NIAID) and Chief Medical Advisor, Dr. Fauci was one of the highest-paid federal civil servants, earning a fixed annual government salary (~$480,000 before his retirement in late 2022). This salary was set by federal civil service pay scales, completely independent of vaccine sales or corporate profits.

- Public Filings: Under the Ethics in Government Act, Fauci’s financial disclosures—including his investments, stock holdings, and outside income—are subject to strict federal conflict-of-interest audits and are a matter of public record. His filings show no stock holdings in individual pharmaceutical companies; his personal investments are held in broad mutual funds, municipal bonds, and standard retirement accounts.  His income is subject to strict federal conflict-of-interest audits and is a matter of public record. His filings show no stock holdings in individual pharmaceutical companies; his personal investments are held in broad mutual funds, municipal bonds, and standard retirement accounts.

-In February 2021, Tel Aviv University awarded Dr. Fauci the Dan David Prize for lifetime achievement in public health and his leadership during the HIV/AIDS and COVID-19 crises.  After tax withholdings and administrative fees, the direct deposit received by Fauci totaled $899,960.  The National Institutes of Health (NIH) ethics office has long-standing regulations (5 C.F.R. § 2635.204(g)) that allow federal researchers and doctors to accept bona fide, prestigious awards for scientific achievement from non-profit or educational institutions, provided the award is approved by an agency ethics officer.  Before accepting the Dan David Prize (and other academic honors throughout his 50-year career), Fauci submitted the award for official NIH ethics review, which formally authorized him to accept the cash prize.


I saw the various clips but don’t have to watch the entire debacle.  It was the usual exercise in rhetoric as I watched the US slide farther and farther from reality.  After all this was a debate about the COVID pandemic that officially ran from March 11, 2020 to May 5, 2023.  It has been over for more than 3 years.  The argument can easily be made there are more pressing public health and safety problems at this point ( foodborne illness outbreaks, vaccine preventable disease outbreaks (measles, pertussis), toxicology emergencies (lead poisoning), wildfires, that are direct  products of the policies of this administration and currently endanger thousands of Americans. 

In addition, the elimination of Medicaid and SNAP benefits endanger millions more.  Medicaid is the nation's largest payer of mental health and substance use disorder care, and the primary funding vehicle for addressing Social Determinants of Health (SDOH) (housing, food security, and transportation).  Medicaid is also the single largest payer of maternity care in the US covering 40% of all births. In the midst of those problems the HHS Secretary has decided that he knows something about mental health and has decided he knows more about what medications and treatments people with those disorders need to take.  So why is the pandemic being relitigated while this administration is ironically making American unhealthy again?

The most straightforward answer is because they can.  Trump and his allies have tapped in to strong anti-science, anti-knowledge, and anti-expert biases in the US and used them to their advantage.  They routinely scapegoat and vilify anyone who they consider to be an enemy or outsider and that is a very low bar.  To end up in the enemy camp – all you have to do is disagree with them.  Disagreement is easy when they have produced so many ideological decisions that have no rational basis.  The list of those irrational decisions can fill volumes at this point.  I will focus on the dynamics of the Fauci hearing.   

This hearing was clearly a set up by Paul, and Fauci made that point in his opening statement – specifically that Paul had an unhealthy obsession with him and had threatened to jail him. This is apparently because of Paul’s conspiracy theory that the COVID virus (SARS-CoV-2) was a virus modified in a Chinese lab and accidentally released.  He claims that Fauci knew something about this despite Fauci’s diary entry of 2021 documenting that the latest genetic information made manufacture in a lab an impossibility. The remainder of the hearing was essentially Fauci taking the Fifth Amendment against self-incrimination.  Anyone who knows how the government works would be foolish to start any discussion in such a biased proceeding. That is especially true in the case of Fauci who has a pardon from former President Biden. In this setting it is easy to suggest perjury incidents and file those charges in the absence of any real evidence for the original charge.

At least some of the impetus for these hearings was the personal diary of Dr. Fauci.  Paul apparently was given this access by HHS Secretary Kennedy who discovered it on their servers.  At this point I do not know if it was Dr. Fauci’s naiveté about recording personal notes on a government server or something else.  I do know that it is common sense that diaries are not written for public disclosure.  To publish this as Paul has done shows that it is all part of a general smear campaign and an attempt to suggest that the things nobody says out loud are really “lies”. 

Like almost all of the current governments tactics this all comes down to rhetoric at several levels.  The first is just the usual scapegoating and rage-bating.  Fauci is an intellectual, an elite, etc.  He is not like the rest of us but he likes to tell us all what to do.  This is our chance to rise up and throw him in jail.  Of course, the rage baiting caused more problems than that for Dr. Fauci and his family.  He has been threatened with harm and many of those threats were considered serious.  He had a government security detail from 2022 until it was terminated by Trump on January 24, 2025. It has not prevented further public threats in some cases by public figures who have no idea who Dr. Fauci is or what he has accomplished.  They are generally focused on one of the lies in the above table.

I thought about adding a section here on the academic references to the various rhetorical devices used by autocrats and fascists.  But I will keep it simple.  Trump and his administration use them all to distort reality, provoke anger in his base, and further divide the country.  One of his advisors was very clear about it and called it “flooding the zone.”  There is plenty written about that process in academic references, but you can see how it works in real time just by watching the news every day. Trump promotes the lie that the 2020 election was “stolen” and none of his cabinet nominees will answer that question in Congressional hearings.  Suddenly we have unconstitutional interference with local elections and pending federal legislation that will eliminate tens of thousands of eligible voters.

The pattern is clear.  Initiate a divisive issue, never admit it is false or involves any wrongdoing, and keep repeating it.  Ignore the fallout even if that includes casualties on the streets of Minnesota or in an unnecessary war.  Blame everyone else and never acknowledge mistakes even when they are obvious to everyone else. Academic references about logical fallacies are unnecessary in these scenarios. This is where the lies about Anthony Fauci come from.  When he was coming up with solutions to the horror of the pandemic, Trump and his cohort were suggesting bleach, ivermectin, and hydroxychloroquine – all completely ineffective and in some cases dangerous.  In fact with the “pile on” effect from this hearing one of those cabinet members took to social media to claim he had stockpiles of hydroxychloroquine that would have saved thousands of people.  That is another completely inaccurate claim.     

 In the final analysis. It all comes down to whether or not you are a rational person.  You may feel encapsulated by a Democrat or Republican label.  That clearly does not insulate you from unnecessary wars, the erosion of civil rights, the dismantling of the public health infrastructure, a deteriorating climate and environment, a worsening health care system, diversion of most economic resources to the wealthy, enabling convicted criminals and fraudsters to commit further crimes and trying to reimburse them for jail time, and using government resources to attack innocent American citizens.  It does not insulate you from the fact that we have an administration that has appointed people to serve in the cabinet who have no qualifications.  None of this passes muster as politics as usual much less rational decision-making.

So – be a rational person.  Respond to facts and not rhetoric. Notice when there is an appeal to your emotion rather than your decision-making. Recognize the obvious fallacies when you see them – like the frequent name-calling and witch hunts

Get the USA back on track again…

 

George Dawson, MD, DFAPA 

 

 

Supplementary 1:  The American Public Health Association (APHA) has come out on social media in support of Dr. Fauci.  Several medical organizations have done this in the past related to COVID and HIV controversies. It is time that every physician organization does the same thing and does it now.  I have been an elected official in physician organizations and there is always a “big-tent” concern.  In this case that would mean supporting Dr. Fauci would alienate any dues paying Republicans. As I hope to have pointed out in the above post – this is larger than political labels.  In the above table you can choose to be in column 1 or column 2.  Column 2 is the rational choice.  

Supplementary 2:  If you want to see how some of these lies played out in real time - I have a post here that recorded some of what football star Aaron Rodgers  had to say about Dr. Fauci back in 2024.  Mercifully the video has been taken down but the lies and distortions are still all there.  He goes even further suggesting that both the HIV and COVID pandemics were created to respond to only specific drugs and enrich Dr. Fauci and Pharma.  I am not saying that Rodgers is lying but he certainly is repeating them almost exactly as outlined in the above table.  The information to refute his assertions was widely available at the time and in the case of HIV for decades earlier. 

Supplementary 3:  Commentators on this issue always soft pedal any direct confrontation of the lie.  For exam on Lie #2 - Fauci funded the creation of the pathological COVID virus (already walked back by Sen. Paul to GOF and not the pandemic virus) it is common to hear:  "Well I don't agree with that but I do disagree with the way the pandemic was handled."  First off what part do you disagree with?  Fauci's job was keeping up with the research and trying to change guidance on the fly while hospitals were overwhelmed and tens of thousands of people were dying. Anyone in that situation is going to make what they consider to be the most conservative recommendation to save the most people.  Secondly, by making that hedging statement you are endorsing Lie #3.  Fauci did not personally close down anything.  That was all local officials.  

Supplementary 4:  I have a great interest in airborne viruses.  Because of that interest I documented the transition in thinking about COVID transmission from droplet nuclei to airborne on this blog.  The date was April 8, 2020.  This confirms row 1 in the table. 

Supplementary 5:  Highly recommend the nonpartisan Annenberg Foundation's FactCheck.org to fact check anything this party or administration has to say about Dr. Fauci or the COVID pandemic.

Supplementary 6:  Since I posted this around noon on August 1, 2026 I have heard the following in the media:

"Fauci is responsible for 8 or 9 millions deaths."

"Fauci is worse than Joseph Mengele."

And from a national comedian: "Of course Fauci lied about gain of function."

No he did not.  All of these statements confirm what is said in the body of my post and will probably be repeated every day if you are paying attention.  To be a rational person you have to be intentional.  All of these inaccurate statements cannot be brushed off or in the case of comedians - laughed at.  Pick a column and stay there.

8/2/2026:  Day 2 of the Fauci hysteria.  Many people have taken to social media to reinforce the message of the MAGA Republicans today portraying Fauci as a megalomaniac and blaming him for everything from vaccination side effects to their kid having to wear a dirty mask to school for 8 days in a row.  One of the worst examples I have seen was an excerpt posted about a meeting with a CIA official that supposedly informed him of a lab leak and suggesting he covered this up.  It is clear from the diary entry that he considered both the information and informant unreliable and actually suspicious.  This same author likened the situation to finding out Dick Cheney wrote in his diary that he knew there were no weapons of mass destruction in Iraq.  The huge problem with that comparison is not only what was recorded at the time (unreliable source) - but that genetic analysis of the virus showed it was not produced in a lab.  The real comparison here is from law enforcement and that is:  1:  eyewitnesses are unreliable and this informant would not even qualify as an eyewitness.  According to rules of evidence this is hearsay.  2:  In court - hearsay is not evidence, but genetic analysis is.  

And then there was this interview of RFK, Jr by CCN's Dana Bash.  It was full of misinformation including some of the misrepresentations in the table above.  Ashish Jha, MD provides a bit of commentary at the end and has the stunning disclosure that he now believes the pandemic virus was a lab leak.  I have searched everywhere for what he is basing that opinion on and so far have found nothing.  No matter what side of the issue you are on - all of this agitation does absolutely nothing to address either future outbreaks or the outbreaks that are occurring right now.  

 Supplementary 7:  A reminder of what actually happened and what the timeline was (see Lie #3).  States clearly ended emergency declarations before the dates declared by Trump HHS Secretary Azar,  Trump himself, and Biden ending it early.  Dr. Fauci was not in that loop.  Red states did it before Blue states and there was a mortality gap due to COVID with red states having a higher mortality. 

Feature

Federal Emergency Declarations

State Emergency Declarations

Primary Purpose

Funding, regulatory flexibility, and administrative waivers.

Direct police power over public movement, business operations, and health rules.

Scope

Unlocked federal funds (FEMA, CARES Act), allowed FDA Emergency Use Authorizations (EUAs), expanded telehealth, and provided extra Medicaid matching funds.

Enforced stay-at-home orders, indoor mask mandates, business closures/capacity limits, and school rules.

Jurisdiction

Did not have the legal power to issue nationwide lockdowns, close private businesses, or mandate masks for the general public.

Had direct legal authority under state constitutions to issue and enforce mandates.

 

The Two Federal Declarations

The federal government established blanket, nationwide emergency statuses covering all 50 states:

  1. Public Health Emergency (PHE): Declared by HHS Secretary Alex Azar on January 31, 2020 under Section 319 of the Public Health Service Act. It officially ended on May 11, 2023 (6 days after the World Health Organization declared an end to the pandemic on May 5, 2023).
  2. National Emergency: Declared by President Donald Trump on March 13, 2020 (retroactive to March 1) under the National Emergencies Act and Stafford Act. President Biden signed a bipartisan congressional resolution ending it slightly early on April 10, 2023.


State Actions:


Florida:

 April 30, 2020 (Stay-at-Home Order Ends):

DeSantis issued a 30-day "Safer at Home" order on April 1, 2020. He allowed it to expire on April 30, 2020, initiating Phase 1 of state reopening on May 4.

 September 25, 2020 (Lifting Business Limits & Banning Mask Fines):

DeSantis moved Florida directly into Phase 3 reopening. This order:

Removed all state-level capacity limits on restaurants, bars, and businesses.

 Prohibited local municipalities from enforcing mask rules or public health orders with fines or penalties, effectively gutting local mask mandates.

 May 3, 2021 (Invalidating All Local Mandates):

DeSantis signed Senate Bill 2006 and issued an immediate executive order that canceled all remaining emergency orders and mask mandates passed by cities or counties statewide.

 June 26, 2021 (State of Emergency Expires):

DeSantis allowed Florida's official statewide COVID-19 State of Emergency to lapse without renewal.

 July 30, 2021 (School Mask Mandates Prohibited):

As schools prepared to reopen for the fall, DeSantis issued an executive order banning local school boards from requiring students to wear masks.

 States That Ended Emergency Declarations Before Florida

  • Michigan (October 12, 2020):

The Michigan Supreme Court ruled in October 2020 that Governor Gretchen Whitmer lacked the legal authority to maintain executive emergency powers without legislative approval, effectively striking down the state of emergency early.

  • Wisconsin (March 31, 2021):

The Wisconsin Supreme Court struck down Governor Tony Evers’ emergency declaration, ruling he violated state law by repeatedly extending 60-day emergency orders without legislative consent.

  • Alaska (April 30, 2021):

Governor Mike Dunleavy allowed the legislature's extended public health emergency declaration to lapse on April 30, shifting the state into an administrative recovery phase.

  • North Dakota (April 30, 2021):

Governor Doug Burgum officially rescinded North Dakota’s executive order declaring a state of emergency at the end of April.

  • Oklahoma (May 4, 2021):

Governor Kevin Stitt issued an executive order terminating Oklahoma’s state of emergency in early May, citing falling cases and wide vaccine availability.

 

References:

1:  Rasmussen A.  RFK Jr is Asking to Be Proven Wrong Again So Here Are 40 Examples From Just One CNN Interview.  August 4, 2026:  https://rasmussenretorts.substack.com/p/rfk-jr-is-asking-to-be-proven-wrong

If you read one reference this is the one I recommend.  Dr. Rasmussen is a working academic virologist who knows more about these issues than anyone in the Trump administration or their affiliated media networks.  

2:  Gounder C.  Underlying Conditions https://www.celinegounder.com/

Dr. Gounder is an infectious disease specialist and epidemiologist and on this blog she exhaustively looks at the claims being made by politicians and whether or not they are accurate.  That include 3 parts on the Fauci hearing but also RFK's autism claims and the recent problems with food safety.  You should not be too shocked by the results.  

3:  Robertson L.  The Wuhan Lab and the Gain-of-Function Disagreement.   FactCheck.org.  Posted on May 21, 2021 | Updated on July 1, 2021  https://www.factcheck.org/2021/05/the-wuhan-lab-and-the-gain-of-function-disagreement/

4:  Robertson J, MacDonald J.  Fauci and Paul, Round 2.   FactCheck.org Posted on August 11, 2023 | Updated on August 23, 2024  Posted on July 22, 2021 | Updated on August 19, 2021 https://www.factcheck.org/2021/07/scicheck-fauci-and-paul-round-2/

There’s no evidence that Fauci lied to Congress, as Paul asserted in the July 20 hearing, given that the NIH unequivocally backs up Fauci’s statement that the grant-backed research “was judged by qualified staff up and down the chain as not being gain-of-function.”

In a May 19 statement, NIH Director Dr. Francis S. Collins said that “neither NIH nor NIAID have ever approved any grant that would have supported ‘gain-of-function’ research on coronaviruses that would have increased their transmissibility or lethality for humans.”  “

5:  Jaramillio C, and Yandell K.  RFK Jr.’s COVID-19 Deceptions.  FactCheck.org Posted on August 11, 2023 | Updated on August 23, 2024  https://www.factcheck.org/2023/08/scicheck-rfk-jr-s-covid-19-deceptions/

6:  Kaiser J.  Under fire from Republican senators, Fauci takes the Fifth at COVID-19 hearing.  Science July 29, 2026:  https://www.science.org/content/article/under-fire-republican-senators-fauci-takes-fifth-covid-19-hearing

7:  American Society of Microbiology Letter in Support of Dr. Fauci.  July 28, 2026:  https://asm.org/articles/policy/2026/july/asm-letter-to-senate-committee-in-support-of-fauci

8:  The Bethesda Declaration: A Call for NIH and HHS Leadership to Deliver on Promises of Academic Freedom and Scientific Excellence:  https://www.standupforscience.net/bethesda-declaration

9:  Yamey G, Titanji B K. Fauci’s Senate hearing riled up the MAGA base—but at the cost of damaging public health BMJ 2026; 394 :e100529 doi:10.1136/bmj-2026-100529  https://www.bmj.com/content/394/bmj-2026-100529


 



Sunday, February 15, 2026

Community Acquired Pneumonia - and How To Avoid it

 


Disclaimer:  Like all posts on this blog this is intended for educational and commentary purposes and is not medical advice in any form.  All medical decisions need to be made in collaboration with your personal physician who knows your history.  For reasons stated below - vaccination information and recommendations are also less clear than they have ever been due largely to political influences that can also affect physicians.

 

This a strategic post about pneumonia.  By strategic I mean I hope to clarify what it is and how to prevent it.  This is not about diagnosing and treating it.  Most people reading this blog either don’t need to know that or know a lot more than me about it. Instead, I hope to address three things – misinformation about it, barriers in the modern healthcare system to acute care, and how to prevent it.

My focus will be on community acquired pneumonia (CAP).  It is a term I am very familiar with dating back 40 years to med school and my medical internship. As an intern I carried around my copy of Sanford’s antimicrobial therapy and the relevant section of Phantom Notes which was basically an outline of the leading Internal Medicine text at the time.  Thirty percent of the people I admitted to the hospital had some kind of pulmonary problem.  Depending on who you read chronic obstructive pulmonary disease (COPD) is as high as the third leading cause of death worldwide.  Exacerbations of COPD were very common reasons for hospital and ICU admission. 

CAP by definition is acquired in the community and not in a hospital setting.  It can be cause by a range of microorganisms and host factors.  It can also develop in people with no known risk factors. Conventional wisdom used to be that the lung was sterile territory but now we know that it contains a low biomass microbiome consisting of bacterial, viral, and fungal elements that are there via microaspiration of mouth contents.  Local physiological changes can occur to change the microbiome, or pathogens can be inhaled that establish primary infections (1).   Certain lung diseases like COPD and asthma can also lead to selective proliferation of elements of the microbiome. 

The ability of the lung to repair itself after injury or infection is controversial. Some research suggested that the lung was permanently changed by infection.  One example would be the association of asthma with previous rhinovirus infection. More recent work suggests there is room for optimism if the regenerative capacity of the lung can be activated (2).  

My motivation for this post was a clinical trial I read in the New England Journal of Medicine.  It was about treating CAP in East Africa.  The research question was whether adding glucocorticoids to antibiotic treatment as usual would improve outcomes.  That study quotes the mortality of CAP as 25-30%. The study was conducted in Kenya.  2,180 study patients were randomized to standard care versus glucocorticoids.  All patients were admitted to a hospital and CAP was defined as “the presence of at least two of the following signs and symptoms for less than 14 days: cough, fever, dyspnea, hemoptysis, chest pain, or crackles on chest examination.”  Imaging was not a criterion for study entrance because it was not available in many settings.  They were started on the protocol within 48 hours of admission. Glucocorticoids were provided for free as one of five glucocorticoids in bioequivalent doses for a total of 10 days (including after discharge) in addition to standard care (6 mg of dexamethasone, 160 mg of hydrocortisone, 30 mg of methylprednisolone, 50 mg of prednisolone, or 50 mg of prednisone).  Standard care was antibiotic therapy per World Health Organization (WHO) guidelines (beta lactam and macrolide antibiotics). Exclusion criteria are available in the paper.

30-day mortality was the primary endpoint in an intent-to-treat analysis.  To get to the treatment population a total of 46,224 patients were screened.  Of the 2,180 patients mortality was 530 (24.3%) at 30 days.  246 of 1089 (22.6%) were in the glucocorticoid group and 284 of 1091 (26.0%) in the glucocorticoid group.  That translates to a hazard ratio of 0.84.  The authors explain the limitations (comorbid illnesses – HIV, hypertension) and advantages (large N, lower media age) of their study.  That seems like a slight reduction in mortality for the intervention, but the authors point out that several other studies had better results up to a 50% reduction in mortality with glucocorticoids and it is a low tech readily available intervention.

In looking at the side effects of glucocorticoids   Pulmonary tuberculosis and hyperglycemia were the most common adverse effects in the glucocorticoid treated group.  Pulmonary tuberculosis and acute kidney injury were the most common adverse effects in the standard care group. 

The striking part of this study for me are the mortality figures. Although the researchers emphasized throughout their study that this was a pragmatic trial in a healthcare system with fewer resources – the estimated mortality for community acquired pneumonia in the United States is 6% at 30 days for hospitalized patients but that increases to 34% at 30 days for patients who do not initially improve initially (4).  There are treatment guidelines for primary care physicians about who can or cannot be treated on an ambulatory basis.  Age is a risk factor for increased incidence of pneumonia with the rate increasing from 248 (all adults) to 634 (ages 65 to 79) to 16,430 per 100,000 after the age of 80 (5).  Pre-existing COPD increases the risk of hospitalization 9-fold.

There are characteristic patterns of pneumonia by pathogen based on the immune response.  Bacterial infections elicit an infiltration of neutrophils into the alveolar space in a pattern of lobar or bronchopneumonia that results in an exudate of dead cells and phagocytes in the alveolar space.  Viral infections cause an interstitial pattern of inflammation with lymphocytic cell infiltrates.  Identification of the pathogen is largely done on a clinical basis due to difficulty identifying the pathogens.  Indirect methods can be used like determining acute and convalescent phase antibodies to specific viruses. Both types of infection compromise normal physiology and can lead to hypoxia and in the case of bacteria secondary infections - like meningitis.      

Recent sporadic and annual viral pandemics have created a confluence of factors at the hospital that are best avoided.  The first is the use of broad-spectrum antibiotics.  Since a significant portion of people admitted with viral pneumonia develop hospital acquired secondary bacterial infections – antibiotics are given prophylactically to prevent that complication.  Increasing exposure to increasingly potent antibiotics leads to multiple drug-resistant bacteria.  The best pathway is to avoid getting the respiratory infection in the first place. 

The absolute best way to avoid is vaccinations.  Vaccinations are currently available for influenza, COVID-19 (Sars-CoV-2), respiratory syncytial virus (RSV), and Streptococcus pneumoniae (pneumococcal pneumonia and meningitis).  They have all been tested and offer relative protection (rather than absolute) against serious illness, hospitalization, and death, especially for adults 65+ years of age.  Vaccinations have become a mixed bag of accessibility.  On the one hand you can get them from pharmacies and that is a recent development.  On the other hand we have an elected government that has appointed a well known antivaccination promoter as the head of Health and Human Services – Robert F. Kennedy, Jr.  So far there have been restrictions on the COVID vaccination to people who are 65+ or have an underlying health condition.  Since the administration is apparently making health decision based on politics and ideology many states and professional organizations are publishing their own guidelines.  As an example here is a list of respiratory virus vaccination guidelines from the American Academy of Family Practice (AAFP).  The CDC still has pneumococcal vaccination recommendations for children less than the age of 5 and adults over the age of 50.

The University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) program has a good brief on the vaccine controversy and chaos introduced by the Trump administration and the lack of scientific origins at this link.

Apart from vaccinations risk factor modification should be considered.  If you were born and raised in American culture – it is important to realize that you have been socialized to expect to get sick in the wintertime.  I did not realize that until I was getting sick 2-3 times a year on the inpatient unit where I worked.  They were viral illnesses that took 2-3 weeks to recover from.  The building was made in an era where preservation of heat was the primary design goal.  There was minimal circulation of clean air or filtration.  My suggestions to improve the air quality were ignored.  The mini-epidemics were made worse by admitting people who were ill with respiratory viruses and not using any precautions to prevent the spread of those viruses.  The new personal time off (PTO) policies that make no distinction between vacation and sick days also lead to increased exposure to sick employees who would rather work sick than use PTO days for sick time.  Since the COVID pandemic even outpatient clinics ask questions every time they see you to minimize staff exposure to respiratory viruses.

Masks work.  They must be N95 masks and fit correctly but there is no doubt that they work.  These days it is common to see political arguments and in the extreme ridicule heaped on people who use them. Large scale uncontrolled studies are often cited as evidence that they are a weak intervention.  These studies are almost all self report with no measures of actual adherence to masking.  The best studies are done in a lab that look at filtering virus sized particles and there is no doubt they are equal to that test.  

Risk factor modification is probably important.  Cardiopulmonary diseases are significant risk factors for pneumonia – so maintaining the best possible treatment for those conditions is important.  Weight control and activity level are also important.  There is at least one study showing that 65+ year olds who maintain high activity levels have better immunity than those who do not.  The specific dose of exercise for that effect is unknown currently. 

Expert advice on vaccine allergies is an important point.  I have personal history of an anaphylactic reaction to anti-rabies duck embryo vaccine in 1975.  For the next 30 years I did not get a single vaccine against influenza because it was egg based.  I had innumerable episodes of viral illness that was probably influenza and decided to see an immunologist to see if I could be desensitized to eggs so I could get the flu vaccine.  When he confirmed that I could eat eggs without a problem he said that I would probably not have any problems with the vaccine.  He was correct and I have not missed an annual dose since.

Look for respiratory infection season onset and peaks.  They are typically available through your state public health department and the CDC. When I notice it – I change my routine to shop at nonpeak hours and wear a mask in stores.  In addition to protection from the airborne transmission route hand washing is also important.  Shopping carts, door handles, and other high traffic areas are unavoidable areas for direct contact transmission. That may include being in a public bathroom any time somebody flushes a toilet.  Keep in mind that there are number of circulating common cold viruses that include 4 coronaviruses that can make you very ill.

What about barriers to care in the current healthcare non-system in the US?  There are many since businesses have taken over health care in the past 40 years.  Healthcare is rationed by both businesses and governments with only a very grudging nod to quality. The most obvious example is avoidance of the emergency department if you need it.  Anyone with previous experience knows about waits in emergency departments and delays in care.  People avoid paramedics and ambulances out of fear they will be billed for that service.  If you expect that you are ill beyond a typical cold and have additional warning signs like shortness of breath – seek help immediately.  I have given that advice to many people and it is included in the final paragraph of this AMA information sheet.   Keep in mind that pneumococcal infection can also cause meningitis which is even a more significant emergency and those symptoms can include a severe headache and neck stiffness.  Maintain a low threshold for checking these symptoms out with your primary care physician’s office during working hours and their call line after hours. But if that is not available or able to give you an answer call 911 and get a paramedic there in person to advise you and advocate for you getting timely care.  Even in our fragmented healthcare system you do not have to go it alone.  

Finally – you must realize that the infectious disease space has been infiltrated by many people who do not belong there.  They have mixed agendas involving politics and health and wellness profits.  In some cases, they are just promoting themselves.  This varies from a kernel of truth rhetoric (eg. “most people who get this virus do not die”) to outright lies (eg. “this vaccine has never been adequately tested”).  There are many points in between such as “He died of pneumonia not COVID”.  In outrageous cases they have attacked and threatened public health officials.  It is important to recognize who these people are and why they must be ignored to preserve your interest and that is your personal health. 

I attached a list of the main respiratory pathogen vaccinations as a supplementary below. The indications are taken directly from the FDA approved package insert that is in turn based on clinical trials for efficacy and safety. There are significant differences between the FDA approved indications and eligibility as determined by various organizations. There are also links to those graphics in the appended material. Note that for the COVID vaccinations especially the eligibility can vary based on age, susceptibility status, and what has been referred to as mutual decision making. In my opinion this is basically slow walking vaccine denial in as eligibility. Essentially all medical decisions are based on informed consent as mutual decision making. I did not get a single influenza vaccine for 30 years because of mutual decision making that was based on inadequate information. I asked an Internist about what he would recommend in the cased of COVID-19 vaccinations and he said: “Definitely recommend for over 65. Recommend for patients with multiple comorbidities. Recommend for healthy young adults if they were healthcare workers, teachers or in an occupation with lots of exposure to the public.” Why are the eligibility criteria not that simple?  As far as I can tell the answer is politics.

That is my overall strategy to avoid pneumonia.  It is most important as you age into categories where your risk doubles (65+ yrs old) and increases 25-fold (80+ yrs old).  I use these strategies myself and have found them to be very effective.  And remember the overall strategy is to avoid the physical virus or bacteria if at all possible and failing that make sure your immune system is activated by a vaccination to attack it if you are infected.

 

George Dawson, MD, DFAPA

 

References:

1: Li, R., Li, J. & Zhou, X. Lung microbiome: new insights into the pathogenesis of respiratory diseases. Sig Transduct Target Ther 9, 19 (2024). https://doi.org/10.1038/s41392-023-01722-y 

2:  Ainsworth C. Lung, heal thyself. Nature. 2026 Jan 29;649:S9 – S11.

3:  Lucinde RK, Gathuri H, Mwaniki P, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. N Engl J Med. 2025 Dec 4;393(22):2187-2197. doi: 10.1056/NEJMoa2507100. Epub 2025 Oct 29. PMID: 41159889; PMCID: PMC12659994.

4:  Peyrani P, Arnold FW, Bordon J, et al. Incidence and mortality of adults hospitalized with community-acquired pneumonia according to clinical course. Chest. 2020;157(1):34-41.    

5:  Jain S, Self WH, Wunderink RG, et al.; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427.


Graphic:

Pages from my trusty copy of Phantom Notes that I used on wards as a medical student.  I went back to check to see if community acquired pneumonia was a thing back then and it was not.  If you can read it they do discuss where it was acquired under Classification (D3).   According to PubMed that term was used just twice in 1981 - but became progressively more popular in the 1990s.


Note also that we have an expanded list of viral pathogens compared with 1981.

Phantom Notes Medicine 79-80 edition copyright Joe D. Glickman, Jr, MD All Rights Reserved.  


A Shocking Anecdote about Pneumococcus:

When I was an intern on neurology (1983) I was called down to the emergency department to assess a 70 year old woman for "agitation".   That was all they could tell me aside from the fact that her labs and exam were normal.  She was unresponsive, groaning softly and rolling from side to side on the bed.  I proceeded with my examination and found that she had a stiff neck and pus draining out of her left ear.  I called my two senior neurology residents and they came sprinting to the ED.  A quick gram stain of the pus showed gram positive cocci and we gave her 1 gram of IV chloramphenicol, did a lumbar puncture and transferred her to the Neurology ICU.  She subsequently developed ARDS and required transfer to the medical ICU for ventilatory support.  She was discharged a month later and was completely deaf as a result of pneumococcal meningitis.


Vaccines for Respiratory Tract Infections: Indications versus Eligibility:

 

Vaccine

Indication (From Package Insert)

Eligibility (From CDC)

Influenza

FLUARIX is a vaccine indicated for active immunization for the prevention

of disease caused by influenza A subtype viruses and type B virus contained

in the vaccine. FLUARIX is approved for use in persons aged 6 months and older. (1)

 - Fluzone High-Dose is a vaccine indicated for active immunization for the prevention of disease caused by influenza A subtype viruses and type B virus contained in the vaccine. (1) Fluzone High-Dose is approved for use in persons 65 years of age and older. (1)

Annual all adults

CDC Guidance

COVID

Moderna - SPIKEVAX is a vaccine indicated for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

SPIKEVAX is approved for use in individuals who are:

• 65 years of age and older, or

• 6 months through 64 years of age with at least one underlying condition that puts them at risk of severe outcomes from COVID-19

 

Pfizer - COMIRNATY is a vaccine indicated for active immunization to prevent

coronavirus disease 2019 (COVID-19) caused by severe acute respiratory

syndrome coronavirus 2 (SARS-CoV-2). (1)

COMIRNATY is approved for use in individuals who are:

 65 years of age and older, or

 5 years through 64 years of age with at least one underlying condition

that puts them at high risk for severe outcomes from COVID-19. (1)

Adults should discuss with their health care provider to see if this vaccine is right for them.

CDC Guidance

RSV

-Active immunization of pregnant individuals at 32 through 36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) and severe LRTD caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age. (1.1)

- Active immunization for the prevention of LRTD caused by RSV in individuals 60 years of age and older. (1.2)

-Active immunization for the prevention of LRTD caused by RSV in individuals 18 through 59 years of age who are at increased risk for LRTD caused by RSV

Adults 75+

Adults 50-74 at increased risk

CDC guidance

Pneumococcus

Pneumococcal Conjugate Vaccines (PCV)

 

PCV15 (Vaxneuvance): Protects against 15 types of pneumococcal bacteria.  is indicated for active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older.

 

PCV20 (Prevnar 20): Protects against 20 types of bacteria; it has largely replaced the older PCV13 (Prevnar 13). Prevnar 20 is a vaccine indicated for

• active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older. (1)

• active immunization for the prevention of otitis media caused by S. pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F in individuals 6 weeks through 5 years of age. (1)

• active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 18 years of age and older. (1)

The indication for the prevention of pneumonia caused by S.pneumoniae serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F in individuals 18 years of age and older is approved under accelerated approval based on immune responses as measured by opsonophagocytic activity (OPA) assay.

 

PCV21 (Capvaxive): A newer vaccine approved in 2024 for adults, protecting against 21 types, including several strains not covered by other vaccines. CAPVAXIVE™ is a vaccine indicated for:

• active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A,

11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B in individuals 18 years of age and older. (1)

• active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A,15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B in individuals 18 years of age and older. (1)

The indication for the prevention of pneumonia caused by S. pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B is approved under accelerated approval based on immune responses as measured

by opsonophagocytic activity (OPA).Continued approval for this indication may be contingent upon verification and description of clinical

benefit in a confirmatory trial. (1)

Pneumococcal Polysaccharide Vaccine (PPSV)

PPSV23 (Pneumovax 23)

PNEUMOVAX 23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F,14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F). (1.1)

PNEUMOVAX 23 is approved for use in persons 50 years of age or older

and persons aged ≥2 years who are at increased risk for pneumococcal disease. (1.1, 14.1)

Adults aged 50 or older according to CDC

 

 *High risk for severe outcomes:  For the comprehensive list of underlying medical conditions that place a person at risk for severe outcomes from COVID-19 see this CDC document: https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html

 FDA Vaccine, Blood, and Biologics Web Page:  https://www.fda.gov/vaccines-blood-biologics

 FDA Vaccines Licensed for Use in the United States:  https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states

CDC Vaccine Schedule with graphic:  https://www.cdc.gov/vaccines/imz-schedules/adult-easyread.html

COVID recommendation:  “Adults should talk to their health care provider to decide if this vaccine is right for them”.

 AAFP Adult Vaccination Schedule with graphic:  https://www.aafp.org/dam/AAFP/documents/patient_care/immunizations/2025%20adult%20Schedule_NOV.pdf

COVID recommendation:  “1 – 2 or more (age >65) does of the updated 2025-2026 vaccine”.

 Minnesota Department of Health Adult Vaccination Schedule with graphic: https://www.health.state.mn.us/people/immunize/resprecs.pdf

COVID recommendation:  “All adults especially 65+ (2 doses)”.