flip flop sandals by Peggy Choucair courtesy of pixabay.com
First reports by the Financial Times today (April 23) of a remdesivir placebo-controlled trial in China say it was a “flop”. Virtually the same percentage of mortality was found– 13% vs. 14%– with 158 on remdesivir and 79 on a placebo; 18 were withdrawn due to side effects in the active group and an unspecified number (in the FT story) withdrawn from the placebo arm for side effects (this sounds absurd, but is expected in such a trial, in which even the doctors giving the pill don’t know whether it’s a placebo or the real thing).
Fierce Biotech ran a story on the same study and reached somewhat different conclusions. First, “Patients in both study arms experienced side effects at roughly the same rate (about 65%), but more patients on remdesivir stopped treatment early because of side effects compared with placebo (12% versus 5.1%).” Make of that what you will. Second, Gilead’s chief medical officer said, “The study was terminated early due to low enrollment, and, as a result, it was underpowered to enable statistically meaningful conclusions.”
Third, patients were treated as late as twelve days after onset of symptoms. This is too long; most infection treatments don’t help unless they are started early. For example, Tamiflu, which is available by prescription for influenza, says in its prescribing information (wording required by the FDA) that the drug must be started within 48 hours to have a significant beneficial effect in shortening the illness. This restriction makes sense, because the influenza virus (like most viruses) replicates rapidly in the early phases of disease; by the time symptoms are evident, the body has already started to react to the infection and replication rates are already dropping. To have any effect, the drug must interfere in the rapid replication phase and be started as soon as symptoms begin.
All of this does not say that remdesivir will work, even if it is started early. But this warning suggests that we should beware of studies that are done of people who don’t start taking the medicine until they are already in the recovery (and body reaction) phase of the disease.
Currently, the National Institute for Allergy and Infectious Diseases is conducting a study of remdesivir in COVID-19, and Gilead is conducting additional placebo-controlled (phase III) studies as well. Only time will tell whether remdesivir is beneficial. In the meantime, the stock-buying public is getting a crash course in medicine.
Wuhan by Eric Manzi courtesy of pixabay.com
Bloomberg Businessweek reported a story about the re-opening of Wuhan on April 22, but of even more interest was this statement from the virus lab at the center of conspiracy theories about the outbreak of COVID-19 there:
Yuan Zhiming, director of the Wuhan National Biosafety Laboratory, hit back at those promoting theories that the virus had escaped from the facility and caused the outbreak in the central Chinese city. “There is absolutely no way that the virus originated from our institute,” Yuan said in an interview Saturday with the state-run China Global Television Network.
Yuan rejected theories that the yet-to-be identified “Patient Zero” for Covid-19 had contact with the institute, saying none of its employees, retirees or student researchers were known to be infected. He said U.S. Senator Tom Cotton, an Arkansas Republican, and Washington Post journalists were among those “deliberately leading people” to mistrust the facility and its “P4” top-level-security pathogen lab.
You could accuse Mr Yuan of lying, but that’s a pretty comprehensive denial– “none” of its workers “were known to be infected”…
The post I was going to write– about the precautions being taken in Hubei, capital of Wuhan– was a little overshadowed by that story.
What are they doing in Wuhan now that they’ve received permission from the Chinese government to come out of lockdown? First, everyone has a cellphone, and they have their status updated regularly: red for infected or likely infected, yellow for contacts, and green for no known contact. Second, when going to work, entering the mall, or going into a public building, everyone has their temperature taken, and anything over 37.3° Celsius (99.1° Fahrenheit) is investigated. Merely visiting a building or apartment where someone else is later found to have been infected will change your status from green to yellow. Apartment compounds can prevent anyone from leaving if an infected person is found within.
A Bloomberg reporter visited the Lenovo factory, where tablet computers are made, and discovered everything has changed. The lunchroom, for instance, is partitioned into individual eating spots with tall plastic barriers. Everyone who has returned to work has already been tested with the antigen nasal swab and an antibody blood draw. Robots are deployed wherever possible to transport supplies. Elevators are closed– everyone has to use the stairs.
The outbreak in Hubei was said to have peaked in mid-February, and according to the government, there are almost no new infections in the area. The surveillance state has gained even more power since the pandemic struck. Every movement, from taking the subway to going to the grocery store, is monitored. Despite the official claim that there is no more virus, people are not going to department stores, malls, or restaurants, and the subway is quiet. Cars are more popular than ever, because they provide individual transportation free of direct interactions with other people.
The government’s effort to control the outbreak in Wuhan was enormous: over 40,000 doctors were imported from other areas of China to help out and to replace others who had fallen ill (or died) from COVID-19. People suspected of being infected were quarantined in hotels and temporary, specially-constructed buildings until they were cleared. Large factories were repurposed to make ventilators and personal protective equipment on government command.
No-one was allowed to enter or leave Wuhan for three months; the first trains with departees left on April 8. Some people had been there on vacation and were stranded there the entire time.
Restrictions on people’s movement like that would be impossible to implement in a society like the United States. Voluntary compliance with isolation recommendations is the best we could do. The other things are do-able: temperature checks, physical distancing, cellphone apps with aggressive contact tracing, virus tests for everyone coming out of isolation. The only thing we can’t do is have mandatory quarantines for people even suspected of having contact with those infected. Quarantines, under US law, are limited to those with active, contagious lethal diseases– like smallpox or Ebola.
I think that enough people would voluntarily isolate themselves to have nearly the same effect as they had in China– especially if the US government were honest with its people and told them everything that is known about the virus, as well as all of our uncertainties and unanswered questions. Is it too much to ask for government people to tell us the truth? Probably, when our president refuses even to release his income tax returns.
sleeping panda by Cimberley courtesy of pixabay.com
Politico reported today (April 24) that the Bank of China bankrolled a nearly $1 billion refinancing deal on a property in which [redacted] has a 30% stake– one of His most expensive pieces of real estate– in 2012, via a $211 million, ten-year loan that formed part of the package. Sadly for Him, He is only a minority stakeholder in this real estate– so he has no control over the policies there and can’t put His name on the buildings.
Since He has been criticized for his weak, late response to the coronavirus crisis earlier this year, He has gone negative on China. At first, he was full of praise for Xi Jinping, the head of the Chinese state. Now he is blaming them for “covering up” the spread of the virus from its epicenter in Wuhan province. In point of fact, by early January the Chinese government was allowing its scientists to report on key facts about the virus: its complete genetic sequence, a critical bit of information that informed efforts to create tests for, and drugs against, the virus. Without actually saying so, the Chinese admitted that there was human-to-human spread. The Chinese warned the rest of the world that the virus would be highly contagious.
There were things the Chinese government did that could be seen as a “cover-up”: they wouldn’t allow foreign experts from WHO into the country for several weeks. They implicitly concealed the probable spread of the virus to four times the number of people who were officially reported. They have taken other steps that, in retrospect, appear to be counter-propaganda: after American sources claimed that the virus was either deliberately or accidentally released from a major virology lab in Hubei, Wuhan, a Chinese government source put out a theory that American soldiers had delivered the virus to Wuhan in late 2019 during a military exercise.
There has been, to be sure, a major propaganda war between the US and China, with the new virus a focal point for attacks from both sides. For example, I recently received in the mail a “newspaper” (unsolicited) from an American organization that was at least five double-sided, newspaper-sized pages with a layout closely resembling a conventional newspaper. The entire “news” content of the paper consisted of scurrilous attacks on China, starting with the assertion that “the Chinese Communist Party” was responsible for deliberately infecting US citizens and sending them back here to spread the virus. The content went downhill from there, and every single article consisted of a propaganda attack on China, particularly the Chinese Communist Party. There were no ads except for offers to subscribe. I was shocked, shocked I tell you, to find that the Americans (at least the Republican Party) are spending good money to spread disinformation among the credulous rural voters in Devin Nunes’ (the “farmer”) congressional district.
This paper is produced by the “Epoch Times”, which claims to be a non-profit organization and uses this claim to get a discount on postage. The whole back page consisted of an ad offering a subscription and a request to share “CCPVirusTruth.com” “with at least 5 friends”. In large print, scare headlines announced that this paper is “A Factual and Honest Newspaper” and “LIES KILL, TRUTH SAVES”– “HELP ALL AMERICANS SEE THROUGH THE CCP’s COVERUP”. The headline on the front read, “How the Chinese Communist Party Endangered the World”. Every single article in this already yellowing paper repeated another aspect of the propaganda claims central to Fox “News” and [redacted]’s attacks on China.
One article went so far as to claim that “21 million fewer Cellphone Users in China May Suggest a High Death Toll”. The implication that over 20 million people in China have died from the novel coronavirus is staggering, not to mention incredible.
This type of propaganda is paid for by secret donations to Political Action Committees (PACs) tied to the Republican Party by like-minded individuals. It is only one example of the monies spent to distract from, distort, and deny the facts on the ground. These are attempts to instill fear and anger in the hearts of naive rural people.
Certainly the novel coronavirus originated in Wuhan, certainly local Communist Party officials initially attempted to cover up the existence of a new form of viral pneumonia. But the authorities completely reversed themselves when higher-ups realized that a truly dangerous situation was at hand. At first, a doctor was called into a police station and admonished for reporting (by the pre-authorized mechanism for reporting new diseases) cases of viral pneumonia that didn’t fit established patterns.
Two weeks later, his punishment was reversed and a formal apology was made to his family (after he died of the virus he warned about). The complete genetic sequence of the virus’ RNA was published in record time by the virological institute that is the subject of negative propaganda now. Its work was entirely confirmed by multiple outside labs in many other countries, and now forms the basis for many other sequences that show how the virus spread and mutated through-out the world.
The Republicans can complain that the Chinese government didn’t do a lot of things that would have been helpful to obtain complete transparency. But if their critics had not piled on with false conspiracy theories and anti-Asian ethnic slurs, perhaps they would not have felt so much pressure to counter with conspiracy theories of their own. At a time like this, when all of humankind is threatened by a new enemy, attacks against the very people who were trying their best to contain its spread are not helpful.
A final word about [redacted] and his obligations to a Chinese state bank: he has no business attacking Biden for being “soft on China” or claiming that his son Hunter profited from his connections to his father. The connections turned out to be a bust for Hunter Biden. He didn’t make any money from the failed deal with Chinese individuals who had business connections with the Chinese government. All he made was a headache for his father, who did not personally intervene to help him and is now being pilloried for having the same name as his son. That won’t stop the Republicans, of course. They are out to throw as much mud as they can against the wall in the hopes that some of it will stick.
Now is a perilous time for [redacted]. Objective citizens (independent voters, not registered with either major party) can see that He continues to fail in His response to the crisis, and they are reacting with disgust. His only plan is to double down on His attacks against American liberty and equality. He is increasing, quietly (while our attention is diverted by the crisis) His pernicious attempts to create more pollution and more global warming by repealing laws that were supposed to help reduce pollution and encourage our transition from fossil fuels to solar and wind energy.
You can expect to see more destruction of American institutions between now and the time Biden’s Democratic administration takes over in January 2021. His minions will continue to subvert the Voice of America by trying to install a head who will create a propaganda arm of his re-election campaign. He will continue to destroy protections for minority groups like LGBTQA people, full citizens who don’t deserve to be discriminated against by bigoted individuals. He will continue to hollow out our international obligations like the support of WHO and foreign aid to countries seriously affected by the new virus. In short, he will keep up the work he started in January 2017: an attempt to make America safe for plutocrats and billionaires, and dangerous for the lower 99% of our population.
flip flop sandals by Peggy Choucair courtesy of pixabay.com
First reports by the Financial Times today (April 23) of a remdesivir placebo-controlled trial in China say it was a “flop”. Virtually the same percentage of mortality was found– 13% vs. 14%– with 158 on remdesivir and 79 on a placebo; 18 were withdrawn due to side effects in the active group and an unspecified number (in the FT story) withdrawn from the placebo arm for side effects (this sounds absurd, but is expected in such a trial, in which even the doctors giving the pill don’t know whether it’s a placebo or the real thing).
Gilead’s stock dropped significantly after this story came out.
The FT story admits that the study was stopped prematurely due to low enrollment. We don’t know for sure what this means. Others are likely to weigh in with their own interpretations of this study as we will see over the next few days. Stay tuned.
photo courtesy of Gerd Altmann (geralt) via pixabay.com
According to the New York Times, New York Governor Andrew Cuomo announced that a preliminary survey or 3,000 people found 14% with antibodies to the new virus. Among 1300 residents of New York City, 21% were positive. The survey was conducted among people who were out shopping, meaning they were not essential workers (like grocery clerks or bus drivers) but not isolated at home. The rate of positive results would probably be higher among essential workers, but lower among people who have isolated themselves at home. The sample will be increased over the next few weeks, which will give a better picture of who has been infected over the entire population of New York State.
The test results suggest that 2.6 million people across New York State had been infected with the virus, although there are only 250,000 positive antigen tests on record– a disparity of ten times.
image by Lothar Dieterich courtesy of pixabay.com
Multiple news outlets (including the BBC) have warned that the pandemic will lead to increased famine, particularly in Africa, where an outbreak of locusts has decimated crops throughout eastern Africa and southern Asia. Yemen has the worst famine in decades from the locusts already.
David Beasley, head of the World Food Programme (WFP), made the following statements:
“We could be facing multiple famines of biblical proportions within a short few months,” he said. “The truth is we do not have time on our side.”
In a call to action, he added: “I do believe that with our expertise and our partnerships, we can bring together the teams and the programmes necessary to make certain the Covid-19 pandemic does not become a human and food crisis catastrophe.”
Mr. Beasley himself recently recovered from an attack of COVID-19. He also said, “Excuse me for speaking bluntly… One way or another, the world will pay for this.” He predicted that 30 million people could die from the famine, a hundred times the number of people who have died from COVID-19 so far. The WFP currently feeds more than 12 million people a month in Yemen.
At the same time, it was reported that 26 million Americans had succeeded in filing for unemployment in the past month. Famine could affect people right here in America, as the food banks are under unprecedented stress from rising demand and smaller donations.
Surely, the US government could find a billion here or a billion there in its over $3 trillion relief program to help the hungry in Africa. But Mitch McConnell (Senate Majority Leader), the most powerful man in the US government after the *president, has said to the states, “drop dead”, literally telling them to file for bankruptcy (which they cannot do under law) in part to get out from under their onerous, underfunded pension obligations. There is no compassion in the people who run our government– none for our own states, who have been forced to compete for scarce supplies with the federal government, and none for the hungry of the world.
[the information about world famine was sourced from the BBC article referenced above; the part about our government comes from multiple recent news sources.]
photo by Susanne Jutzeler courtesy of pixabay.com
The New Yorker on April 20 published an article by Jim Yong Kim titled “It’s not too late to go on offense against the coronavirus”.
The five main categories of offensive action against the novel coronavirus (SARS-COV-2) are as follows: 1) social (physical) distancing; 2) contact tracing; 3) testing; 4) isolation; and 5) treatment.
These strategies have been employed by the countries with the best records against the virus: South Korea, Singapore, Taiwan, and Hong Kong. The article describes how these strategies can bring the spread of the virus under control, even at this late date. The author describes how Massachusetts (to which he is a special advisor) is beginning to implement the elements of this aggressive plan. The Broad Institute is also going to help.
We need considerable help to implement these elements. Contact tracing requires people who can do the “shoe leather” detective work. Isolation requires direct assistance to those who are quarantined, to help them with food, shelter, and medicine– and to explain to their bosses why they can’t come to work. Medically supervised isolation facilities are also needed. Treatment requires research and production of new medicines.
All of these things require a lot of work. It is better to engage in this work than it is to just shelter in place and hope for the best. Rather than just throw money at impacted businesses, we should invest in hiring and supporting the people who can do the work needed to trace and isolate all contacts.
From the article:
When we presented our plan to Governor Baker, he didn’t say that it was too expensive or too hard or too late. He said, “We have to do this. We have no choice. It feels like we’re just sitting and waiting. We have to go on offense against the virus.”
photo courtesy of pixabay.com
Reported by the Washington Post on April 22. The death only came to light now because tissue samples from the autopsy were sent to the Centers for Disease Control (CDC) for analysis by the county medical examiner and analyzed for the new virus. A second patient who died February 17 was similarly analyzed and announced at the same time.
[redacted] and Dr. Deborah Birx also claimed that the US has one of the lowest death rates from the virus in the world– a patently false claim. According to the Post, the US has a higher rate than 101 other countries.
puzzle by Gerd Altmann courtesy of pixabay.com
The Washington Post published a story on April 19 about patients missing from the normal retinue of emergency cases: those with the usual non-infectious illnesses such as appendicitis, heart attacks, strokes, cholecystitis, and gallbladder stones. Mount Sinai cardiovascular surgeon John Puskas was quoted as saying, “Everybody is frightened to come to the ER [emergency room]”. People who don’t come in with early signs of these acute emergency conditions are going to come later, when their symptoms have reached unbearable levels, and are going to be harder to help, with more complications or even death from untreated illness.
One anecdote, a patient with appendicitis in his twenties: he tried to “tough it out” with over-the-counter painkillers, until his appendix had ruptured and formed a large abscess in his belly. He had to have open surgery (where a laparoscopy could successfully have removed an unruptured appendix) and a colostomy, meaning he was forced to spend days in the hospital. He would have to return later to take down the colostomy to restore normal bowel functioning. He had to take antibiotics for an extended period and could have died. He was afraid to come to the hospital early, when his condition could have been quickly treated, because he was afraid of contracting the virus– even though, at his age, he might have had an asymptomatic infection or quickly recovered without any problems.
Evert Eriksson, trauma medical director at the Medical University of South Carolina, described this patient and said, “… 70 percent of the appendicitis on my service right now are late presentations. What happens when you present late with appendicitis is, we can’t operate on you safely.” Yet his 700-bed hospital is only 60 percent full because most of their patients have been discharged to make room for an expected surge of coronavirus patients.
A report accepted April 7 as a pre-print in the Journal of the American College of Cardiology (cited in the Washington Post article) documented a 38% reduction in patients admitted for percutaneous coronary artery revascularizations at nine major cardiac catheterization labs in the Northeast and Midwest in March 2020 as compared to the previous fourteen months. These patients, all with acute myocardial infarctions (heart attacks) with ST segment elevation (a sign of complete blockage of a major coronary artery to the heart), simply were not seen. Some of them would have died without this treatment; the rest suffered severe heart damage and were left with weakened or reduced heart function. This happened at a time of stress when heart attacks would have been expected to increase rather than decrease.
From the Washington Post article:
A Gallup online poll taken March 28 to April 2 asked people with different conditions how concerned they would be about exposure to the coronavirus if they needed “medical treatment right now” at a hospital or doctor’s office. Eighty-six percent of people with heart disease said they would be either “very concerned” or “moderately concerned.” Among people with high blood pressure, the figure was 83 percent.
One major stroke center found a more than 60 percent reduction in referral calls from hospital ERs about possible stroke patients and a more than 50 percent reduction in patient phone calls. It seems that patients with mild or moderate stroke symptoms are simply not calling in for help.
Some conditions are less common because of the almost universal “stay at home” orders blanketing the country. There has been a steep drop in car crashes, for example. There has not been a drop in domestic violence incidents.
Some heart attacks may be prevented by people not going to work and not exerting themselves at home. Others may be prevented by not eating high-fat restaurant meals and the drop in air pollution (and air pollution, especially particulates, does bring on heart attacks). Some patients with heart attacks may never make it to the hospital because emergency medical protocols have changed. Those who suffer cardiac arrest and do not have return of spontaneous heart action (and circulation) after resuscitation efforts are not being taken to the ER, but are declared dead in the field.
Finally, some patients with COVID-19 may have double diagnoses: both new virus disease and heart attacks at the same time. Only time and thorough review of all findings will tell us where all the emergency patients have gone.
Deep uncertainty about the new virus and its effects on patients with pre-existing conditions has made the job of treating all patients during this pandemic much harder. We already know that conditions like diabetes, high blood pressure, and heart disease make infections with the new virus worse. What we don’t know is why other factors, many of which are more prevalent in elderly patients, make recovering from an infection so much harder. We don’t know what other genetic or social conditions are doing to make the infection and death rates so much higher in African-American and Caribbean-American patients; we just know that things are much harder for black people.
