I have updated, expanded, and corrected portions of, this 30 October 2024 “memo” on the Antibiotics Hypothesis as it related to New York City’s spring 2020 death spike. This was not and is not intended to be a full treatment of the question but a record of some of my thinking, then and now (12 March 2026).
Question: Did sudden withdrawal of antibiotics as a treatment for pneumonia/respiratory illness contribute to the New York City spring 2020 death spike?
Available data and the timeline of events do not, in my opinion, support the hypothesis that failing to use or prescribe antibiotics in the hospital or outpatient was a significant contributor to the NYC death spike. This tentative conclusion does not equate to denying that people died as result of various “kinds” of pneumonia in spring 2020, or to accepting that some portion of deaths in New York City hospitals that attribute respiratory disease or COVID-19 as underlying cause were people with resolvable pneumonia upon admission, regardless of whether pneumonia was their only or primary ailment/condition.
King et al (2020) show 37% and 10% increases for azithromycin prescriptions dispensed in New York State in March and April 2020 compared with the three-year baseline. From the study: “…in March 2020, the number of patients dispensed azithromycin prescriptions exceeded the historical average in 11 states (Supplemental Table 2): New York (37% higher in 2020 than 2017–2019 average), New Jersey (32%), Florida (16%), Oklahoma (7%), Louisiana (6%), Georgia (5%), Alabama (5%), Texas (3%), Mississippi (3%), Arkansas (2%), and Idaho (1%). In April 2020, the number of patients dispensed azithromycin prescriptions was lower than the historical average in all states except New York and New Jersey, where 2020 numbers exceeded historical averages by 10%.” (p. 655)
Cummings et al (2020) reported that almost 90% of “critically ill” COVID-19 patients in an academic hospital system in New York City during a two-week period in spring 2020 received antibiotics.1 Patients in the study were admitted between March 1 and April 1 and were “diagnosed with laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure.” The authors state: “As the incidence of bacterial superinfection in our setting was unknown early in the outbreak, antibacterial agents were administered empirically to nearly all critically ill patients (229 [89%] of 257). Antibiotics were de-escalated based on pertinent culture data at the discretion of treating clinicians in collaboration with infectious diseases consultants.” In other words, patients admitted with severe respiratory illness were treated with antibiotics, along with other “interventions,” suggesting that illness progression or death in the cohort can’t necessarily be pinned on the lack of antibiotics.
Data obtained via public records request for the daily number of blood cultures (BCs) taken in New York City’s public hospitals (n=11) show a ~50% base-to-peak increase in BCs taken after 15 Days to Slow the Spread was declared.
Whether and how that relates to antibiotics disbursement is unclear. The February dip in BC orders is notable, and slightly discrepant with daily deaths in February, but without data from prior years it is hard to say whether the decrease is normal; my request for 2017-2019 data was denied.
The peak in BC orders taken preceding the peak in deaths (all causes) by roughly two weeks suggests decisions about whether to use antibiotics were made. BC orders taken then dropped below baseline while deaths returned to normal, which is unexpected. My request for daily or weekly doses of all antibiotics administered to all patients from 1/1/2017 – 12/31/2022 was denied.
In “Whodunnit?” colleagues and I explained the “delayed treatment” hypothesis: officials and guidance encouraging people with COVID-like symptoms2 to remain at home may have led some individuals with respiratory infections to postpone medical care, allowing bacterial pneumonia to progress before treatment and increasing the likelihood of ARDS once hospitalized. Timing makes this explanation difficult to apply to the front end of New York City’s death spike event, which was incredibly fast.
Not only the cohort in Cummings et al but COVID-designated patients in other NYC cohort studies (e.g., Richardson et al., 2020; Goyal et al., 2020, Parish et al., 2021) were apparently admitted before widespread public messaging to avoid hospitals, or in the earliest part of “15 days to slow the spread.” Seeing as the progression from respiratory infection to severe bacterial pneumonia and ARDS typically requires several days, the calendar leaves little room for a large population of patients with untreated pneumonia to have delayed care long enough to progress to critical illness before hospital admission.
The belief that people presented to the emergency room in need of antibiotics, were denied prescriptions, and then got worse at home and died there or in the hospital would require additional data and individual record review to substantiate.3 To a certain extent, that storyline (which has been promoted since 2020) benefits purveyors of the ‘official narrative’ by directing attention away from what was done toward what ‘wasn’t’.
The more likely scenario involves patients already in the hospital being transferred to ICUs or, if already in the ICU, tested and reclassified as COVID patients. Nursing home residents with respiratory illness or mild pneumonia (along with other ailments) manifesting in earlier weeks may have been sent to hospitals, where they were tested for SARS-CoV-2 and subjected to a range of “treatments” and protocols — some of which varied by hospital or system as part of various “trials” and experiments, including those carried out by military personnel sent into facilities.
As acknowledged and/or explained here, here, and here, ventilators were advertised and marshaled as “weapons” in a war against an (alleged) silent-spreading coronavirus. The machines, the process of intubation, and the drugs used to place and keep patients on the machines are in themselves enough to kill, either quickly or more gradually. Once protocols were activated, some patients (aka, “damaged ships”) were ripe, if not “marked,” for sinking.
I’ve speculated a systematic transfer of care home residents into hospitals in early 2020, before and during the emergency period, but my efforts to test this hypothesis were stymied. To the extent that hospital patients or nursing home residents were denied antibiotics or other care in the weeks or months preceding the pandemic declaration, and their deaths either prolonged or digitally “pushed forward,” the Antibiotics Hypothesis could make sense.
Otherwise, insofar as medications go, there is better support for mass euthanasia of existing and admitted hospital patients than there is for sudden withdrawal of antibiotics as a driver of the 26,000-27,000 “excess” figurre New York City reports for spring 2020.
Adding On:
We made the following observation in Fighting Goliath, Chapter 18:
“Note that midazolam was stockpiled [698] by the US Army as a mass casualty medical countermeasure; 675,000 multi-dose vials were approved for the strategic national stockpile to be used as an anti-seizure medication for people exposed to chemicals that cause prolonged seizures, in combat, domestically or from an intentional attack. Apparently, this was in response to exposure to chemicals and not biological threats.” (p. 254)
This anticipated use fits well with my oft-stated hypothesis that the federal government not only implemented a chemical-attack drill in New York City, but quite literally simulated such an attack using real patients – and did not need spreading or sprayed biological/chemical agents to do so.
Notes
- In my original memo, I incorrectly attributed this statistic to the wrong study and have corrected it for this revision, besides elaborating the findings. ↩︎
- Which are indistinguishable from symptoms associated with colds and influenza-like illnesses ↩︎
- This belief is also not well-supported by time-series data of various kinds, including deaths by setting of death, 911 calls, ambulance dispatches, and ED visits and is contradicted by the orders given to paramedics (EMTs and FDNY) and cardiac arrest data. (See here). ↩︎
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