photo by Jakub Orisek courtesy of pixabay.com
A close friend of the family is in the hospital with COVID-19. I was depressed by the news as I knew he was at very high risk due to multiple medical conditions. He was working for farm labor contractors, transporting injured workers to medical offices and translating for them. He has been a close friend of our family for thirty years.
He was admitted to the hospital last week and started on remdesivir. He has gone downhill over the last few days and had more than one stroke. He is now on a ventilator. I fear that he will not survive. If he does live through this, he will never be the same. His wife is completely wiped out by this turn of events. She had symptoms of the virus– cough and fever– but recovered quickly. This is the way it usually happens: women are not as severely affected as men.
Our worst problem in this difficult situation is that we are unable to go to his bedside or even to communicate with his doctors. We don’t know if there is an advance directive in place as to his treatment, and we have no way to find out. Our lack of contact with him and his medical team has left us without any way to influence his care or to have any personal interaction with him.
It is one thing to learn about the challenges faced by other people– people I don’t know– when confronted by illness with COVID-19. It is quite another, intensely frustrating and painful, to have personal contact with friends and relatives who have the illness. The only thing that could be worse is to be personally sick with the virus and to be struggling to breathe, with coughing and chest pain. So far, I have been extremely fortunate not to have this experience. I wouldn’t wish it on my worst enemy.
Coronavirus studies by Engin Akyurt via pixabay.com
Statnews.com reported on June 16 that a study found dexamethasone (6 mg once a day, oral or intravenous) improved survival in severe COVID-19: “‘Dexamethasone is the first drug to be shown to improve survival in COVID-19,’ Peter Horby, one of the lead investigators of the study and a professor in the Nuffield Department of Medicine at the University of Oxford, said in a statement.”
From the statnews report:
The study randomly assigned 2,104 patients to receive six milligrams of dexamethasone once a day, by mouth or intravenous injection. These were compared to 4,321 patients assigned to receive usual care alone.
In patients who needed to be on a ventilator, dexamethasone reduced the death rate by 35%, meaning that doctors would prevent one death by treating eight ventilated patients. In those who needed oxygen but were not ventilated, the death rate was reduced 20%, meaning doctors would need to treat 25 patients to save one life. Both results were statistically significant.
There was no benefit in patients who didn’t require any oxygen. The researchers running the study, called RECOVERY, decided to stop enrolling patients on dexamethasone on June 8 because they believed they had enough data to get a clear result.
Dexamethasone is a cheap, generic steroid (a drug that reduces inflammation) that has been widely available for a long time. Its effective doses and side effects are well understood, and it has been used for many indications. These characteristics make it an ideal drug to implement wide use. Its effects in other diseases make these positive results easily understood and expected.
Once a patient has been put on a ventilator for severe COVID-19 with respiratory failure, their chances for survival are poor. In other diseases, a 50/50 chance of survival on a ventilator was expected, but with COVID-19, as few as 12% of patients have survived. This is because lung inflammation leads to a cascade of edema, fluid filling of air spaces, and breakdown of lung membranes. Once inflammation and breakdown is fully established, survival is poor.
The only other way to get around the problem is with extra-corporeal membrane oxygenation (ECMO), a complex technique that is available only at a few regional medical centers. Ideally, treatment of COVID-19 should prevent patients from deteriorating to the point where they need to be on a ventilator, but no such treatment has been available.
Putting patients who appear to be at risk of going downhill based on their dropping blood oxygen saturation would reduce the risk of having to use a ventilator. Early treatment with dexamethasone, along with remdesivir, may prevent this.
William Barr (stolen off internet, probably copyrighted)
I included this picture, not because Billy Barr is the cause of all these problems, or even because he is making our response more difficult. No, I included it because that shit-eating grin is a symptom of what is wrong with our government.
The reason we are having so many problems responding to the triple crisis is that our federal government is not taking decisive action to deal with it. For example, there is no federal government database or tally of how many people are testing positive for novel coronavirus each day, how many are dying, nor how many in each state are being tested. At the same time, there is no use of the Defense Procurement Act to obtain tests or testing supplies, nor for personal protective equipment, for ventilators, or for anything at all. The only use of the Defense Procurement Act so far is to (supposedly) force meat-packing plants to stay open. Even then, the plants can’t stay open if too many workers are sick. The president threatened to use the Act to force car companies to produce ventilators, but it backed down when the companies made concessions. There is no daily coronavirus briefing– not since the president’s staff warned him that it was making him look stupid, and not since he is trying to hide the fact that the pandemic is still raging.
The whole country has been convulsed by demonstrations against police brutality– which have been met with more police brutality. In the face of the pandemic, protestors are being assaulted by tear gas, pepper balls (containing the active ingredient found in hot peppers, only at much higher concentrations), and rubber bullets. The tear gas makes people cough and vomit, not the sort of thing you want when some of them inevitably have active cases of novel coronavirus, even if they are not symptomatic at the moment. Then the demonstrators, most of whom were wearing masks, are being arrested, having their masks torn off while their hands are cuffed behind their backs, and thrown into crowded, unventilated jail cells. A more dangerous place to be in the face of this pandemic could hardly be imagined.
There was even a video-documented case where a policeman tore off the mask of a protestor (who wasn’t being obstreperous) and sprayed her in the face with pepper spray. This may not be as shocking as a policeman suffocating a man who allegedly passed a counterfeit $20 bill to death with his knee on the arrestee’s neck (for eight minutes and forty-six seconds) or another policeman shooting a fleeing drunk driver in the back and calmly picking up his spent shell casings while the suspect lay dying on the street. That may be more shocking than the policeman who shoved a 75-year-old man backwards and watched him stumble and fall, hitting his head on the sidewalk– which followed with the man bleeding from his ear (a sure sign of a basilar skull fracture, for which he was placed in intensive care.) That may not be as shocking as the presidential tweet “questioning” whether the old man was trying to block police communications with his cell phone (which is technically impossible) and “questioning” whether the old man was an “antifa” agitator (when in fact, the old man was a long-time Catholic pacifist who literally wouldn’t hurt a fly.)
None of that is shocking enough. What is shocking enough is the only real policy response of the president: he refuses to “even consider” taking the names of Confederate generals (who after all, were racist, traitorous losers who were responsible for killing many loyal Union soldiers) off of Army, Navy, and Air Force installations. The only excuse for refusing to “even consider” this long-overdue action is to pander to the 39% of the country who are racist, traitorous losers and who plan to vote for him come November.
Where is the organized policy? No-where to be seen. Where is the “leading by example” in response to the advice of all the experts on infectious disease? Missing in action. Where is the “unifying force” that brings our country together? Absent altogether.
Instead, the president is using the pandemic as an excuse to continue and intensify his anti-immigrant policy to the detriment of our economy, even seeking to actively exclude people we need to harvest our crops– people who already have legal worker visas. He is using the pandemic as an excuse to eliminate regulations protecting fisheries from total collapse. He is using the pandemic as an excuse to suspend all inspections of meat-packing plants and eliminate all regulations limiting methane emissions from pipelines. All this and more is being done because people’s attentions are distracted by economic collapse, pandemic spreading, and widespread demonstrations and rioting.
It is no wonder that people are burning down the Wendy’s drive-through where a drunken driver was shot in the back for resisting arrest. It is no wonder that people are smashing windows and looting cellphones from Apple stores (where they immediately turn into bricks as soon as they lose the wifi signals that keep them operating.) The police are too busy trying to intimidate demonstrators to protect vulnerable stores.
It is easy to see why people are angry and fed up with what is going on right now. Unemployed people are not getting their unemployment benefits because the systems are overloaded, and now they are threatened with being kicked off the rolls if they refuse to return to dangerous work.
Black and brown people are suffering from lack of health insurance and at the same time being killed by the virus because of their fragile health status. Black and brown people are being felled disproportionately by the virus at the same time they have either lost their jobs or been forced to work exposed to the virus in “essential” positions– they have good reason to be angry that they are being harassed and shot disproportionately by police.
There is no justice, and as long as there is no justice, there will be no peace.
Samatha (calm) and vipassana (insight): two aims of Buddhist meditation. Also, What is Meditation?
Gandhara Buddha circa 1900 years ago, courtesy of wikimedia commons
The twin aims of meditation, in Buddhist practice, are calming the mind and attaining insight. From Wikipedia:
- Samatha, calm abiding, which steadies, composes, unifies and concentrates the mind;
- Vipassanā, insight, which enables one to see, explore and discern “formations” (conditioned phenomena based on the five aggregates).[5]
Meditation is a practice which predates Buddhism and probably also Hinduism– it has been recognized since at least 1500 BCE, or 3500 years ago, in Vedantic Hinduism. The practice of meditation is recognized in all major religions, including Sufism (an Islamic tradition), Christian “Hesychasm” (from the Eastern Orthodox), and Judaism (in the Kabbalah.) The term defies precise definition: (Wikipedia) “A 2009 study [in the Journal of Psychology of Religion and Spirituality] noted a ‘persistent lack of consensus in the literature’ and a ‘seeming intractability of defining meditation’.”
In meditation, a person sits, lies down, or even simply stands still. It is also possible to meditate while walking or while performing a simple, repetitive task. You attend to one thing or nothing and concentrate the mind. You do not try to do anything at all (at least nothing that you’re not already doing.) One common technique is to concentrate on breathing slowly, in and out; in through the nose (employing the inherent air-filtering capacities of the nostrils and nasal cavities) and out through the mouth (relaxing the diaphragm, allowing it to move upwards and letting the chest collapse.)
A commonly used technique is to concentrate on a single word or phrase. This technique, most used in Tibetan Buddhism, often includes the phrase “Om mani padme hum.” This means, according to Wikipedia (among many other things): “The first word Aum/Om is a sacred syllable in various Indian religions. The word Mani means “jewel” or “bead”, Padme is the “lotus flower” (the Buddhist sacred flower), and Hum represents the spirit of enlightenment.” In Tibet, this phrase is everywhere painted onto hillsides, carved into rocks, or written on prayer flags and prayer wheels.
Meditation also can begin with emptying the mind. One would not try too hard; anything that enters the mind while meditating should be remarked upon then discarded, as if “moving on.” It is important not to try, because trying involves effort, and the effort itself interferes with relaxation. Calm is achieved in part through simply relaxing. Once the mind is emptied in this way, single thoughts that arise can be more easily dealt with. One can acknowledge that a thought is a symptom of the mind’s clinging to the senses, and classify a thought as to whether it means one is obsessing about something in particular. Why would this thought come up now?
Meditation is broadly classified into two forms: open and directed. In directed meditation, one focuses on something or concentrates on a single thought. In open meditation, one simply monitors all thoughts that enter the mind, dismissing them one by one and returning to an empty, mindful/mindless state. You might say that open meditation steadies and calms you, while directed meditation allows you to achieve insight. You can use both forms, either sequentially or all at once.
When one meditates, the brain often enters a state easily recognized on the EEG (electroencephalogram, a recording of the brain’s electrical activity obtained with electrodes attached to the scalp.) A rhythm called the alpha rhythm appears, a slow 8-12 beats per second wave. This differs from the rhythm seen when one is thinking about something, when there are no visible waves. According to brainworksneurotheraphy.com, “Alpha brainwaves are dominant during quietly flowing thoughts, and in some meditative states. Alpha is ‘the power of now’, being here, in the present. Alpha is the resting state for the brain. Alpha waves aid overall mental coordination, calmness, alertness, mind/body integration and learning.”
The practice of meditation has been the subject of scientific research for quite some time. It is attractive especially because it would seem to provide some therapeutic effects for pain, depression, anxiety, drug addiction, antisocial behavior, etc. However, research has not been able to clearly establish whether the benefits of meditation can be separated from the social activities associated with teaching the practice. Nonetheless, it seems to provide some pain relief and, in a 2017 systematic review it was found to help “improve positive prosocial emotions and behaviors.” (Luberto, Christina M.; Shinday, Nina; Song, Rhayun; Philpotts, Lisa L.; Park, Elyse R.; Fricchione, Gregory L.; Yeh, Gloria Y. (2017): “A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors”. Mindfulness. 9 (3): 708–24. doi:10.1007/s12671-017-0841-8. PMC 6081743. PMID 30100929).
There are also potential negative effects of meditation. In one criticism, the practice is felt to enhance narcissism– this is true but also highly reductive or simplistic. Meditating in a deconstructive fashion (for example) may result in anxiety, fear, depersonalization, or distorted perceptions. “Unwholesome or frightening visions” are also mentioned as to be expected, in a Theravada Buddhism practical manual on vipassana meditation (Vörös, Sebastjan (2016). “Sitting with the Demons – Mindfulness, Suffering, and Existential Transformation”. Asian Studies. 4 (2): 59–83. doi:10.4312/as.2016.4.2.59-83).
Nonetheless, meditation is a highly effective means of, at least temporarily, obtaining calmness and even insight. See also the Wikipedia article on “meditation” for considerable details on the history and prevalence of meditation in various religions and for therapeutic purposes. From a traditional point of view, see “What is Meditation” by Shiva Shakti Yoga.
sars-cov-2 virions (complete virus) in EM by NIAID (via Medscape.com)
A Scripps Research post dated June 12 describes a mutation called D614G in the novel coronavirus that has come to dominate new infections. The mutation, changes a glycine residue to an aspartic acid residue in the spike protein and stabilizes the spike by making it more flexible. This leads to a 4-5X increase in the number of functional spikes on each virus particle (virion) which improves the virus’ ability to bind to and infect human cells. The research behind this finding is described in the paper “The D614G mutation in the SARS-CoV-2 spike protein reduces S1 shedding and increases infectivity” published by Scripps as a pre-print (before peer review.)
The research was done with a harmless coronavirus ( Maloney murine leukemia virus (MLV)-based pseudoviruses (PVs)) engineered to express the same spike protein as the pathogenic virus. The mutation does not appear to reduce the effectiveness of neutralizing antibodies raised against the SARS-COV-2 virus during natural infection, so there is probably no difficulty with vaccines that are currently being developed.
The mutation does not appear to increase severity of infection. The mutated virus has come to dominate new infections, probably because it is much more efficient at spreading. According to the Scripps Research post, “It is still unknown whether this small mutation affects the severity of symptoms of infected people, or increases mortality, the scientists say. While ICU data from New York and elsewhere reports a preponderance of the new D614G variant, much more data, ideally under controlled studies, are needed…”
The novel coronavirus will continue to mutate. This mutation appears to increase the efficiency of transmission but apparently without making it more severe. Future changes in the virus genome will have unanticipated effects, but they are unlikely to change the basic strategy for preventing transmission: mask wearing, physical distancing (six feet where possible), and frequent hand-washing or sanitizing before and after being in public.
(image courtesy of pixabay.com and Gerd Altmann)
The Washington Post has a good graphic of state by state case and death counts on a daily basis for all US states on this page. You can examine the case counts and death counts as they go up and down on a daily basis. Some states are clearly having problems, while others are getting better. Some states have had more than one peak in case counts. Some states don’t have clear trends at all, either because the totals are too small (like North Dakota and Montana) or else there’s just no clear trend. Sometimes it looks as if the counts are fishy; in other places, they don’t count on weekends. This page is for the nerdily inclined.
photo courtesy of pixabay.com and Erika Wittlieb
This Jennifer Rubin op-ed in today’s Washington Post is priceless: “[redacted] [and his] reckless endangerment problem” or, as the URL has it, “… beset by cognitive dissonance over coronavirus”:
CNN reports: “Attendees of President [redacted]’s upcoming rally in Tulsa, Oklahoma, must agree not to sue the campaign if they contract coronavirus.” Attendees must RSVP to register for the event, and in [sic] that registration contains a boilerplate waiver that the attendees understand the “inherent risk of exposure to COVID-19 exists in any public place where people are present” (especially one where people refuse to wear masks!). They have to promise not to sue the Great Leader or his campaign if they acquire the virus. The takeaway here: [redacted] is happy to endanger his followers’ health, but not his own pocketbook. (It is far from clear that kind of waiver is legally sufficient when the conduct is “reckless” — an apt descriptor for [redacted]’s covid-denying rallies.)
There is a legal concept called “reckless endangerment” which holds that a person or company is liable both civilly and criminally if its conduct is “wrongful and reckless or wanton, and likely to produce death or grievous bodily harm to another person.” (Wikipedia) Liability waivers, under state law, do not defeat civil actions for reckless endangerment. For example, if you were driving and someone rear-ended you because they were driving too fast for conditions (usually “too fast” is defined as “they hit you in the first place”) then that is simple negligence. However, if you are doing 30 in a 30 mph zone and the person who hits you is going 90 mph, that is gross negligence or recklessness– that person had complete disregard for the safety of others. (This example is from the blog lowenthalabrams and applies in Pennsylvania, New York, and New Jersey.)
Now, if a company has a rally during the covid-19 pandemic and does not provide/require everyone to wear a mask, requires people to sit shoulder-to-shoulder, encourages attendance by over 10,000 people, and encourages everyone to shout and scream for two or more hours, does that not constitute “reckless endangerment” and does that not overcome a liability waiver if an attendee develops covid-19 and dies? Just asking.
It doesn’t help that the president refused to hold his convention and coronation in North Carolina because the governor insisted on precautions like mask-wearing and social-distancing. Apparently, he couldn’t stand the idea of people listening to his speech while wearing masks and sitting six feet apart. Oh, the optics!
In other news, the president’s hotel and real estate business is tanking because of the pandemic. It couldn’t happen to a nicer guy.
echidna (hedgehog) image courtesy of pixabay.com
This article in the Washington Post from June 11 describes the machinations of a hedge fund investor who bought the rights to a drug developed by Emory University with $16 million in taxpayer funds in March. His company, Ridgeback Biotherapeutics, turned around and sold it to Merck for a big profit (the exact amount is not public) in two months, after he commissioned a human safety study– which he tried to get the US government to pay for. His company has lots of capital but no actual medical staff nor research infrastructure.
According to the article, “That wager paid off with extraordinary speed in May when, just two months after acquiring the antiviral therapy called EIDD-2801 from Emory, Ridgeback sold exclusive worldwide rights to drug giant Merck.” The hedge fund manager formed a company, Ridgeback Biotherapeutics, which purchased the rights to the drug from Emory on March 19. “Ridgeback launched a human safety trial of the drug in the United Kingdom and transferred rights to Merck in late May.” But first, the company tried to get hundreds of millions of dollars in government grants to develop the drug. The company was the subject of a whistleblower complaint by Rick Bright, former director of the Biomedical Advanced Research and Development Authority.
It seems that Ridgeback happened to find out that the drug had been thoroughly studied in preclinical work, found it to be available, and snapped it up for an undisclosed sum. It is unknown how the drug came to be on the market for purchase by Ridgeback nor how the owner learned that it would be a major advance for coronavirus therapeutics.
The hedge fund manager is Wayne Holman, and his wife is Wendy Holman. Wayne Holman has a medical education but his career lies elsewhere:
Wayne Holman, who holds a medical degree from New York University, is a hedge-fund manager with a long track record of investing in pharmaceutical stocks. He founded his fund Ridgeback Capital Management in 2006. Wendy Holman, chief executive of Ridgeback Biotherapeutics, is a former investment manager who was named to President Trump’s advisory council on HIV/AIDS in 2019.
Emory University received a $30 million grant five years ago to develop the drug, but spent just over half the money on preclinical research. EIDD-2801 is an orally administered drug which is active against Ebola and many other coronaviruses. It has a similar mechanism of action to remdesivir. I previously featured this drug in a blog post on May 31 and it is quite promising. Remdesivir was also developed with public money– $70 million according to the Washington Post article. The big question to taxpayers is: how much profit will GIlead and Merck garner from sales of these drugs, and how much will they cost to consumers? Those with public (“socialist”) feelings will want to know why taxpayers should pay for development of a drug that turns out to be a big moneymaker for private companies– shouldn’t the profits as well as the costs be socialized?
photo courtesy of pixabay.com
This article from business insider on June 8 describes a black market for a variant of remdesivir (the only drug with evidence for effectiveness against covid-19) to treat cats with a coronavirus that causes feline infectious peritonitis (FIP)– an otherwise fatal disease unique to cats. The drug, known as GS-441524, is made in China, and has been sold for more than a year through the facilitation of closed Facebook groups. It is not approved by the US government and sales for the purpose of treatment are technically illegal. Groups that facilitate the importation of this drug get around the law by advertising it as a nutritional supplement– which is unregulated.
According to business insider, “An academic who pioneered using the drug on cats says that a black market is the only option because pharma giant Gilead, which has the rights to GS, will not license it for use in cats.” The Facebook group doesn’t directly sell the drug; instead, it connects buyers and sellers as a middleman. These groups are also attempting to have the drug tested for purity, which is not guaranteed in drugs imported from China.
This American Veterinary Medical Association (AVMA) article from January describes the treatment, which requires a 12-week course of the drug. It says that the drug has transformed FIP from a universally fatal ailment to one with an 80% survival rate. The drug has been studied by Dr. Niels C. Pedersen, FIP researcher and professor emeritus at the University of California-Davis School of Veterinary Medicine with encouraging results.
The coronavirus which causes FIP is not infectious to humans but shares many characteristics with SARS-COV-2, including sensitivity to remdesivir.
Electron micrograph of SARS-COV-2 virions in vitro
Some 12% of COVID-19 patients have gastrointestinal (GI) symptoms: 7% have diarrhea, and 5% have nausea and vomiting. Fecal samples are positive for SARS-COV-2 in 41% of patients with positive nasopharyngeal antigen swabs. Fecal shedding continues for several days after release from hospital. Surveillance by samples taken from wastewater has revealed SARS-COV-2 antigen in municipal wastewater taken from many cities, often well before patients present with virus symptoms.
Testing by cell culture, however, reveals that antigen passed in stool is usually not infectious, probably because the virus has been disrupted by passage through the GI tract. Only 2 of 153 patients had live virus on electron microscopy in their stool. A significant number of patients had positive stool samples but negative respiratory samples. One patient had a positive rectal swab 18 days after symptom onset.
Roughly 18% of patients had elevated liver enzymes, either alanine aminotransferase (ALT) or aspartine aminotransferase (AST). The presence of GI symptoms and elevated liver enzymes appears to be associated with more severe infections. In addition, some studies that tested environmental samples found virus at higher levels in bathrooms and on toilets. All of the reported studies were observational and most came from China on or before March 20, 2020.
One obvious conclusion from this study is that infection control and prevention of nosocomial spread involves sanitation of toilet areas and frequent hand-washing for both patients and staff as well as civilians.
This information is taken from a meta-analysis of 23 peer-reviewed and six pre-print studies (out of 1484 altogether) on GI aspects of COVID-19 available on JAMA Network dated June 11 for free.
