image courtesy of pixabay.com
photo courtesy of kzd via pixabay.com
(photo courtesy of pixabay.com)
The New York Times, in a piece entitled “They Turned Out to Vote in Wisconsin During a Health Crisis. Here’s Why.” quoted an in-person voter in Wisconsin, Clarence Carter, 70, as saying that he filed for an absentee ballot weeks ago but never received it. He said “his wife has health issues and couldn’t stand in the line… The polling place next to my house closed down, so I’m here… I’m just disappointed. This is really crazy.”
The piece finishes: “So why vote?” Mr. Carter said, “It’s the ballot or the bullet.”
Republicans should be put on notice. They have been said to prefer their own rule to allowing democracy to function normally. If they continue to do so, they will be risking Civil War II.
photo courtesy of pixabay.com and ErikaWittlieb
The US Supreme Court put the final nail in the coffin for attempts to allow full access by mail-in votes in Wisconsin. The Court, by 5-4, refused to allow a delay for one week in the cut-off for mail-in ballots to be counted. This leaves voters who have not yet received the mail-in ballots high and dry. In order to vote, they will be forced to attend polling places in person. Because of refusal by volunteers to help out at polling places for fear of infection, only 5 of 180 polling places will be open today.
This catastrophe prefigures what will happen in November if the pandemic continues to rage. Mail-in balloting is only allowed in mostly Democratic states because Republicans rightly figure they cannot be re-elected if they allow everyone to vote without exposing themselves.
The situation is dire because about a third– up to 40%– of voters are supporters of He-who-must-not-be-named (you know, [redacted], or Don the Con). These people are brainwashed to blindly stay in line by Fox (Faux) “News”. These people cannot be redeemed (except possibly by infection with the novel coronavirus, not that I would wish that fate on a dog, much less a Republican).
Yet rejection of the Republican/fascist model of government depends on all of the other 60% coming to the polls en masse to cast their votes and throw the bums out. How difficult this is can be seen when we look at the results in Wisconsin and other gerrymandered states. 54% of voters cast votes for Democratic state candidates in Wisconsin, yet nearly two-thirds of the state representatives elected were Republican. Democratic voters have been carefully packed into districts that over-represent the majority by expert gerrymanders aided by computer programs.
The prospect for democratic government in November is appalling. If He is re-elected, we will descend into a proto-fascist, narcissistic form of government that will be dysfunctional for all but the elite and unable to support those who most need it: the lower half of the population. I fear more for our country than I have ever feared before, even after Nixon was re-elected in 1972. I remember those days well: we hate-watched Nixon as he proceeded to govern from the right and approach the most totalitarian government in the world with an olive branch (I’m talking about Nixon and China, in case you forgot).
I had hope for our country after Nixon resigned, but now I am in abject fear. If I could die to get Biden elected in November, I would gladly offer my life. But my death would serve no purpose. If He is re-elected, the country will descend into a situation in which the separation of red and blue states and incipient civil war is possible. I will probably live to see this day, but I won’t enjoy it.
photo courtesy of Gerd Altmann (geralt) via pixabay.com
A comparative study of RT-PCR (reverse transcriptase-polymerase chain reaction) testing for COVID-19 found widely varying sensitivity for different test sites. A total of 1070 tests were done in 205 patients. Broncho-alveolar lavage specimens (obtained at bronchoscopy, a risky procedure in these cases) were positive in 93% (14/15) tests. Here is a quote from the article:
Most of the patients presented with fever, dry cough, and fatigue; 19% of patients had severe illness. Bronchoalveolar lavage fluid specimens showed the highest positive rates (14 of 15; 93%), followed by sputum (72 of 104; 72%), nasal swabs (5 of 8; 63%), fibrobronchoscope brush biopsy (6 of 13; 46%), pharyngeal swabs (126 of 398; 32%), feces (44 of 153; 29%), and blood (3 of 307; 1%). None of the 72 urine specimens tested positive.
The article goes on to say that nasal swab specimens that were positive had the largest amounts of virus present. While virus was found in feces and another article suggests that fecal-oral transmission might be an issue, attempts to isolate “live virus” in cell culture from feces were unsuccessful in yet another study (which I couldn’t find after seeing it a few days ago– there are already over a thousand studies on BioRxiv).
This result gives us cause for concern about official figures for the new virus and our policy of isolating people until they get negative test results. Bayesian analysis (statistical decisions based on “prior probability”, or likelihood based on what you already know before testing) suggests that patients with cough, fever, and other consistent symptoms who have negative tests for influenza should be presumed to have the novel coronavirus even if an initial nasopharyngeal swab test is negative. For example, noncontrast CT (computer-assisted tomography) could be done to detect the typical ground-glass opacities (areas of darkening) found in the lungs of COVID patients– this is what the Chinese did during their epidemic.
Detection of SARS-COV-2 in asymptomatic patients still depends on nasopharyngeal swabs. Once the recently approved blood antibody test becomes widely available, we may discover that many more people have had asymptomatic or mild infections than we suspected.
Finally, “potent neutralizing antibodies” specific to SARS-COV-2 (not to SARS-COV) were found in this March 21 study, suggesting that infection with COVID-19 will result in immunity after recovery. This is a good indication that people who survive the infection will be able to avoid re-infection and need not be further isolated.
photo courtesy of qimono (Arek Socha) via pixabay.com
India produces 70% of the world’s supply of hydroxychloroquine (HCQ) and they claim to have enough production capacity, according to an article on livemint.com (an Indian publication). This drug is available over the counter for malaria treatment and prophylaxis (prevention). The government of India, however, initially embargoed export of their stocks of HCQ and two dozen others. After a personal phone call from our Dear Leader to the head of the Indian government, Narendra Modi, this embargo was reversed. According to the article, He threatened to “retaliate” if India embargoed exports of HCQ and paracetamol (acetaminophen). To make things even more complicated, Indian manufacture of HCQ depends on imports of the active pharmaceutical ingredient (API) from China. The article lists the major producers and suppliers of the API’s as well as export figures. Apparently, India exported about 1-1/2 billion dollars worth of HCQ last year.
According to the article, India used about 24 million tablets of HCQ last year but can produce 200 million tablets. That may change, as the Indian Council of Medical Research (ICMR) recommended HCQ be used as a preventive medication for COVID-19 high-risk groups (despite the lack of conclusive research on treatment, much less prophylaxis). This advice may cause demand for HCQ to spike dramatically since no prescription is required and the price is relatively low (by US standards).
(photo courtesy of pixabay.com)
This morning I received an email from MPR (sorry, I couldn’t find what this is an abbreviation for) Daily Dose; as usual, these emails promote multiple articles about COVID-19. Today, they reported on a letter written by the ASHP (American Society of Hospital Pharmacists; this is an educated guess). The letter, which was dated April 1, is addressed to Vice President Pence (in his capacity as head of the White House COVID team?) and can be seen in a .pdf file here.
The Medscape web article reporting ASHP’s letter states:
Rather than basing supply on historical allocation, the organization is calling for an immediate increase in production to keep up with the rising demand prompted by the pandemic. With regard to controlled substances used for supportive care, the ASHP has requested that the Drug Enforcement Administration (DEA) increase annual production quota allocations of the most critical medications.
In addition, ASHP is asking the government to release drugs from the Strategic National Stockpile to states that have the greatest number of cases.
There are two aspects of this problem that particularly concern me. The first is that some of these medications that are looming-shortage-prone exist under Schedule II from the Drug Enforcement Administration (DEA) and are subject to annual production quotas. These quotas are narrowly tailored to prevent drug companies from making more than the government believes should be on the market to supply “legitimate needs” (that is, not available for use and abuse by those who “don’t really need them”). These annual quotas are strict, to put it mildly, and utterly inadequate for such sudden crises as we are currently experiencing. If past history is any guide, it will be supremely difficult to get these quotas increased, and without that, the supply of fentanyl (and certain other opioids) will run out very shortly. If you try to intubate someone without fentanyl (or its equivalent) they will experience excruciating pain, even if they are paralyzed with a curare-like (eg, pancuronium, succinylcholine) drug (and the curare-like drugs are also on the soon-to-be shortage list). Apparently, fentanyl and morphine have already been on the drug-shortage list for months before the current emergency.
The other aspect I am concerned about is the “immediate increase in production”. As noted elsewhere, most of these drugs are manufactured overseas, in China, India, and other countries. The primary active ingredients for synthesis of the drugs are produced in one place, shipped to another, and further processed elsewhere. The drug industry is globalized, and just-in-time manufacturing practices have been fully utilized because of stiff price competition. This means that, with just-in-time principles in place, there exist no large stocks of precursors available to soften sudden demand shocks when raising production quantities. Globalization means that materials have to cross multiple borders, and shipping has already seen an impact from the pandemic which will only get worse.
See my next post for a discussion of the situation with hydroxychloroquine, which has been pushed by our Dear Leader as a “game changer” for the new virus.
photo courtesy of geri cleveland via pixabay.com
The New Yorker is providing free articles about the deep story behind the novel coronavirus pandemic. Today’s story is about the search for drugs that will kill viruses like the coronavirus; one of them is remdesivir. The author covers researchers who have been working in the field for many years and have come up with treatments for HIV (the virus that causes AIDS), hepatitis C (chronic hepatitis), and the epidemics of SARS (severe acute respiratory syndrome, the ancestor of SARS-COV-2) and MERS (Middle Eastern Respiratory Syndrome, a lethal disease that came from camels and disappeared with good public health).
They are working on diseases that don’t pay well; their research is supported by grants from billionaires and the National Institutes of Health. Pharmaceutical companies have generally lost interest in looking for drugs to cure epidemic viruses since they seem to come and go at will; they’d rather treat common, chronic viruses like hepatitis C or else treat cancer. As always, this story is extremely well written, engrossing, and well worth a half hour of your time.
sars-cov-2 virions (complete virus) in EM by NIAID (via Medscape.com)
This letter to Nature Cell Research on February 4, from China, reported on in vitro (literally, in glass, that is, in the test tube) studies of multiple drugs and their effects on different cell cultures. The authors tested to see whether the drugs would prevent the virus from effectively infecting and transforming (changing) cells in culture. Here is their concluding sentence:
Our findings reveal that remdesivir and chloroquine are highly effective in the control of 2019-nCoV infection in vitro. Since these compounds have been used in human patients with a safety track record and shown to be effective against various ailments, we suggest that they should be assessed in human patients suffering from the novel coronavirus disease.
The authors reported several other drugs, some of which were highly effective at low concentrations, and others which didn’t seem to work so well. For your perusal of abstruse research, this is a paper which will lead you in several directions at once. Just remember that this is not clinical research, it’s laboratory tests– so your mileage may vary.
image courtesy pixabay.com and Pete Linforth (TheDigitalArtist)
News media reports that, yesterday, Boris Johnson was admitted to hospital with COVID-19 “as a precaution”. Today, he is reported in the ICU after his condition deteriorated overnight. He was said to have been shaking hands with stricken patients “until a few weeks ago”. Great Britain’s response to the new virus was, initially, to allow “herd immunity” to take over… until the scale of the crisis became apparent to all. I’m not sourcing this report; everyone is carrying it. I just thought you’d like to know that he appears to have been deliberately exposing himself to it; he’s too smart to think he was immune… oh, and his pregnant partner is toughing it out at home with “mild to moderate” symptoms. The word for his behavior is either arrogance or “tip of the spear”, you decide.
Conrad Theodore Seitz 