Mary C. Vrtis, Ph.D., MSN, RN, OCN, NEA-BC, FCN

August 15, 2025

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Use of Primary Sources and Archived Statistical Data for Secondary Analysis

The authors have gone to great lengths to use primary resources, when at all possible. Data was frequently converted into graphs and/ or visual aids to help the reader understand the importance of the point. References with hyperlinks are supplied for the primary sources, however, some of this information from U.S. government websites was archived and possibly totally removed in 2025 due to presidential executive orders. The entire Centers for Disease Control and Prevention (CDC) website was revamped, and some information is no longer tracked following the end of the public health emergency and historical COVID-19 databases are no longer available.

During the three years of the pandemic, we regularly downloaded and stored data from the CDC website (https://CDC.gov) and other data locations for secondary analysis. As demonstrated in figure 1, it was often necessary to combine statistical data that was collected by multiple government agencies to better estimate the real morbidity and mortality toll on nurses and other healthcare providers.  

For example, figure 1 shows cumulative totals of COVID-19 infections in healthcare workers who were not employed in nursing home facilities from CDC with data from Health and Human Services (HHS) and the Centers for Medicare and Medicaid Service (CMS) for healthcare staff employed in skilled nursing homes from January 2020 to June 24, 2023.

The combined data was still flawed as death data and COVID-19 infections for staff members employed in nursing homes were not tabulated or reported to any agency until after mid-May, whereas the highest numbers of deaths throughout the country occurred in March and April of 2020. We could not find any data at all on staff illnesses and deaths for providers employed in home health, private duty, assisted living facilities, dialysis units, group homes, primary care or specialist offices, or free-standing outpatient clinics. In addition, personal communications with nurses and other clinicians who lived through the worst of the pandemic included discussions of how staff members and travel agency nurses who were expected to work a shift were found dead in their residences. The counts that do exist were clearly incomplete.

References

Unfortunately, the historical hyperlinks we cited in narratives, reference lists, and on figures to facilitate location of historical statistics may no longer work. We have tried to provide as much information as possible that would allow other researchers the opportunity to locate the source material this author used. In some instances, the archived information was located but this was a very time-consuming process, and it was not feasible to spend the hours necessary to locate removed or archived information on everything.

An Example of Information that Has Been Removed from Government Websites

On August 21, 2021, at 7:57 am (time zone not specified), the U.S. Food and Drug Administration (FDA) posted the “You are not a horse. You are not a cow” graphic on Twitter (now X). The post was intended to educate people that Ivermectin, a drug used to kill parasitic worms in the gastrointestinal system of horses and cows, was not effective to treat or prevent COVID-19 infections. The FDA also initiated the campaign to warn people that use of the veterinary livestock formulations were dangerous as poison control centers were reporting an increase in calls. Ivermectin, was being promoted as a potential treatment and/ or preventive through social media sites.

As shown in figure 3, the “You are not a horse. You are not a cow” campaign was extremely effective and was, at the time, the most popular FDA post ever.  Followers increased by 11,000, 637%, in two days.

This 269-page, untitled file appears to be a remnant of the ivermectin controversy that was found in the FDA archives. As of August 15, 2025, the link to the .pdf format was the only archived document found: https://www.fda.gov/media/160265/download. The document contains emails about success of the promotion as well as emails related to communications between FDA employees and a variety of representatives of other organizations who were interested in promoting the human dose dewormer ivermectin as a COVID-19 treatment. Unfortunately, the response to tweets, retweets and posts on social media sites far exceeded visits to official government sites.

Secondary Sources and Fact Checking

Whenever it was necessary to use secondary sources, such as news media reports, extensive fact checking was conducted to assure accuracy of the information documented within the book chapters. When research studies or governmental hearings were reported in media and other documents, we located the published study.

In general, we did not include studies reported in pop-up predatory journals. It was not possible to assess the quality and accuracy of research studies that were on “pre-publication websites.” Though some of these were interesting, we did not cite them. Peer review by experts in the subject matter prior to acceptance by a journal does not guarantee a quality publication. However, the peer review process, which involves content review by experts in the field, usually weeds out the junk science. But not always.

We do wish to thank the mainstream medical and nursing journal companies who provided research papers related to COVID-19 as open access/ free access. It would not have been possible to dive as deep as we did without the free access.

For U.S. Senate or House of Representative hearings we used the official records as source material. We used official records, fact-checking websites, and/ or compared the information available from multiple, reliable investigative reporting sources. When possible, we listened to the original electronic media recordings to confirm the accuracy of statements documented in secondary sources. We verified the authenticity of direct quotes given at press briefings using archived written and electronic media. In general, we provided hyperlinks for references cited.

Conspiracy Theories and Myths

In reference to widely disseminated conspiracy theories, we were able to find many of the original source posts, tweets, and videos that started the conspiracy. We did NOT provide hyperlinks that could lead to further crowdsourced dissemination of an unfounded conspiracy theory or damaging misinformation.

We conducted numerous PubMed and Google Scholar searches during this research, and every attempt was made to stay objective, factual, and non-political. However, lives were lost as a direct result of serious mistakes, inaccurate statements, accidental misinformation, deliberate disinformation campaigns, and political discord. It is impossible to learn from this situation without thoroughly reviewing the facts.

We do not wish to ascribe blame to individuals, failures in a situation as bad as this did not occur because of a single individual. In most cases of conspiracy theories, financially and/ or politically motivated falsehoods were initiated by a single individual or bot farm. The disinformation was then amplified through retweets, “likes,” and forwards via social media, automated bots, and individual conspiracy believers. In well-documented cases, we did name names.