EM of sars-cov-2 budding from apoptotic (dying) cells–NIAID
This story from WaPo tells it all. If anyone was actually listening to the daily update/re-election campaign show by our con-man president, when Dr. Fauci tried to answer a question about treatment of COVID-19 with hydroxychloroquine, the Man cut him off. He gets defensive whenever reporters ask hard questions, and he can’t get used to the fact that they have a lot of hard questions to ask.
This is what Dr. Fauci said on “Face the Nation”:
“There have been cases that show there may be an effect and there are others to show there’s no effect, so I think in terms of science, I don’t think we can definitely say it works.”
This is what the president of the American Medical Association (AMA) said, when indicating that she would not prescribe hydroxychloroquine to a patient with the virus:
“You could lose your life,” Harris said. “It’s unproven. And so certainly there are some limited studies, as Dr. Fauci said. But at this point, we just don’t have the data to suggest that we should be using this medication for covid-19.”
This Chinese study (full text .pdf) reports positive results with use of hydroxychloroquine. There were 31 patients treated with the drug and 31 patients not treated; 80 patients were excluded from the study for a number of reasons, including clinically severe infection, kidney or liver failure, possibility of being transferred to another hospital within 72 hours, oxygen saturation less than 93% (indicating severe disease), and retinal conditions or potential heart arrhythmia (irregularity). The number of patients excluded/included for each of the individual criteria was not specified.
The results were a 2-day lesser duration of fever and cough. Pneumonia improved in about 81% of patients and about 55% of controls. Other antiviral drugs were given, but their names were not specified in the report. The significance levels of each individual result were not specified in the report; a confidence level of 95% (p=0.05), was given overall (this means that, of twenty studies like this, one would falsely give a negative result and one would falsely give a positive result). These results are encouraging but not conclusive. There may be problems with the study not obvious to the untrained eye.
Given the results of this study, it would be reasonable to try hydroxychloroquine (alone, without azithromycin) in hospitalized patients with mild pneumonia who have relatively normal blood oxygen saturation. This presupposes that the drug is available, the patient is hospitalized, and there are no contraindications. Severely ill patients may or may not benefit and it is these with whom we are most concerned. Note that more than half of the controls improved without the drug within five days.
The problem with the president promoting the use of hydroxychloroquine and azithromycin is that he is not in any sense an expert in any field. He is “followed” by tens of millions of people on Twitter, many of whom hang on every word. The doctors who follow him have the power to prescribe these drugs, and they have done so for preventive use in most cases. This has resulted in a run on hydroxychloroquine and chloroquine which makes the drugs unavailable for their previously intended uses as well as for hospitalized patients (the FDA will address this issue by distributing millions of doses to hospitals, or so they say).
We are rightly scornful of laymen with huge Twitter followings who endorse unproven therapies and cause other laymen to demand treatments that they don’t (yet) need from their doctors. The problem is that, if he left it alone, doctors would receive the information they need from their regular sources (of which there are good and plenty right now) and laymen would remain blissfully (and rightly) ignorant.
The guy who drank aquarium cleaner and died wouldn’t have done so without His tweets. His purpose in publicizing these studies is not to relieve the suffering of others but to pump himself up and get people to vote for him. He doesn’t care who (ignorantly or accidentally?) dies as a result of his behavior, as long as it’s not blamed on Him.
We are, however, interested in further evaluation of hydroxychloroquine in particular. Formal studies and collection of anonymous data from hospitals that can record this information under the stress of an overwhelming pandemic are needed.
photo courtesy of pixabay.com and ErikaWittlieb
I previously reported on the fact that the *president fired the intelligence community inspector general (IG) on Friday night, hoping that nobody would be watching a that time. No such luck: lots of people noticed that Michael Atkinson, the IG who passed on the anonymous whistleblower complaint about our Commander-in-Cheat and his “perfect” phone call with the President of Ukraine, was on his way out. Since He couldn’t fire the IG outright, He put him on 30 days’ leave, effectively shepherding him out the door with cardboard box (containing the personal contents of his desk) in hand. Here’s the WaPo story with Mr. Atkinson’s quote.
This firing is outrageous and is an obvious and nearly successful attempt to completely undermine independent oversight of the intelligence community. With the departure of the IG, our con-man president is free to pressure supposedly impartial intelligence community professionals. We saw the results of personal, biased internal initiatives in the Second Gulf War: poorly sourced, misleading reports that the Iraqis were still pursuing weapons of mass destruction. A truck designed to produce hydrogen gas for makeshift weather balloons was misinterpreted as a machine for spreading biological weapons. Niger supposedly was selling “yellowcake” (uranium ore) to Saddam Hussein. There’s more, but that was so long ago that my memory fails me and I don’t have time under the pressure of the novel coronavirus pandemic to look it up.
That is part of the point of His “Friday night massacre”: nobody will notice that you are trying to seize autocratic power when everyone is afraid of dying from an invisible enemy that is seeping under our doors as we speak. Luckily, the primary purpose of this legal but inappropriate discharge is only personal revenge from a *president who has the attention span of a fruit fly and the self-control of a third-grader. We can only hope that His attention will be diverted long enough for the virus to strike down all the candidates for intelligence community inspector general, putting them out of service until November 3 (in case you forgot, there’s an election coming up).
cartoon courtesy of pixabay.com and cdd20
An article published April 3 on the Nature Medicine preprint server and publicized on today’s “Das Coronavirus Update” reports on experiments conducted to determine whether respiratory viruses can be filtered out of the wearer’s breath by surgical masks. The answer is yes, a mask will filter out viruses from your breath and protect others from being infected when you are sick or carrying a virus like coronavirus (the cause of 1/3 of colds) and influenza virus.
Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
This doesn’t mean that homemade cloth face masks are equally effective. It is not hard to generalize from this study, though. A homemade, tightly-woven cotton mask made up of multiple layers of fabric is much better than nothing. What’s more, it proves that you care and you are listening to the advice of the CDC (Centers for Disease Control). Even better would be a printed message on the front of the mask: you choose the text.
photo courtesy of pixabay.com and ErikaWittlieb
Recently, news accounts have surfaced that the CDC (Centers for Disease Control) has produced a “fact sheet” on the unproven drug combination hydroxychloroquine and azithromycin. This fact sheet speaks of anecdotal evidence and a preliminary study from France, but references no sources. This is highly unusual for CDC, which normally cites scientific authority and careful research in making recommendations for any form of treatment. In addition, the FDA has given emergency use authority for these drugs, and large quantities of them have been “donated” to hospitals for patient use.
Reports have come to light that these unusual steps by normally careful branches of our government have come about as a result of pressure from our Commander-in-Cheat. Direct evidence that this pressure has been brought to bear by personal phone calls has been cited. This information comes on the heels of His tweets endorsing this drug combination and calling it a possible “game-changer”. What is more, personal lawyer Giuliani has been pushing the same remedies.
This type of behavior is unbecoming the office of president of the United States. The chief executive should not be putting his nose into affairs about which he knows nothing. He is not a “very stable genius” nor is he the least bit versed in the complexities of drug treatment for any disease, much less a pandemic of a new virus. The evidence for effectiveness of this drug combination is preliminary at best and little better than anecdotal– hardly a panacea.
The evidence that has come out so far is that severe COVID disease is the result of an out-of-control immune reaction to infection in the lungs, not caused by the virus directly. Treatment of overwhelming COVID pneumonia appears to hinge upon suppression of the so-called “cytokine storm” in the lungs and not direct inhibition of virus replication. Evidence for the effectiveness of the drug combination is weak and contradictory, and clarification as to whether it really works will take time.
In the meantime, the president has caused a run on supplies of hydroxychloroquine, leaving not enough to treat patients with lupus, rheumatoid arthritis, and malaria– the diseases for which this drug is proven to be effective. Someone should tell this con man president to stick to what he knows: real estate.
photo courtesy of pixabay.com
This New England Journal of Medicine article explains the confusion surrounding the use of certain medications for treatment of high blood pressure and heart failure: ACE (Angiotensin Converting Enzyme) inhibitors and ARBs (Angiotensin Receptor Blockers). Despite theoretical concerns about these drugs, the article states that they might actually be beneficial in patients infected with SARS-COV-2. There is no certainty on this issue; for the present, patients are advised to continue taking their medications as they are beneficial for treating chronic conditions which are not going to go away. There is preliminary evidence that the drugs actually reduce inflammation during a COVID episode.
(image courtesy of pixabay.com and Gerd Altmann)
The economy has suddenly shut down due to the “social distancing” rules enforced on over 90% of the US population. Ten million people succeeded in applying for unemployment over the last two weeks, even though the lines were jammed by an enormous influx of applications. The stock market is in bear territory. The South China Morning Post (SCMP) reports that a People’s Bank of China official is warning of the possibility of a new “Great Depression” worse than that which occurred starting in 1929.
The only thing that will prevent a depression now is the application of economic stimuli by our Treasury and the levers of government, which are capable of borrowing vast amounts of money. Over $2 trillion has already been legislated, and more is under contemplation by the House. Those who suffer the most from the economic consequences of sudden cancellation of all public events will be the homeless and the unemployed. Here’s hoping that the economic stimulus won’t flow to stock buybacks and CEO compensation, as it did when the last downturn happened twelve years ago.
If not for government action to support the economy (the next step is the infrastructure programs which have been talked about for over three years) then, by the time a vaccine becomes widely available (in twelve to eighteen months) the world will already be in depression.
(photo courtesy of pixabay.com)
The New Yorker has a story entitled “The coronavirus is the world’s only superpower (The [redacted]’s America? Not so much)” from which the title of this post is taken. The story emphasizes the absence of confirmed heads for numerous parts of this administration. On March 6, [redacted] fired his chief of staff and named a Republican congressman, Mark Meadows, to be his replacement. Mr. Meadows had just started a two-week quarantine after he was exposed to another legislator with SARS-COV-2 positivity, Rand Paul (although Mr. Paul claims he is asymptomatic and was exercising in the Congress gym the day his test results were announced).
Like Mr. Meadows, other heads of departments are missing or “acting”. The Secretary of the Department of Homeland Security (DHS) was forced out over her disagreements with [redacted] and refusal to take actions she considered illegal, actions demanded by [redacted] despite his being warned of their questionable legal status. DHS is still in the hands of a temporary secretary.
Extensive quotes from the article follow:
When you are done being angry about all the crazy, nasty, inconsistent, and untrue things that Donald Trump says each day about the coronavirus and other matters, remember that the flood of words is cover for an Administration that in some ways barely exists relative to its predecessors, especially when it comes to crucial areas of domestic, economic, and international security—or even straightforward crisis management. Turnover at the upper levels of Trump’s White House stands at eighty-three per cent, according to a Brookings Institution tracker.
…the former Swedish Prime Minister Carl Bildt summed up the week’s events, and those of the many painful weeks to come: “This is the first great crisis of the post-American world,” he wrote on Twitter. “The UN Security Council is nowhere to be seen, G20 is in the hands of the Crown Prince of Saudi Arabia and the White House has trumpeted America First and Everyone Alone for years. Only the virus is globalized.”
(lovely flowers I photographed in the desert last year)
This story was in my inbox today but dated March 30. The test depends on a proprietary “black box” the size of a small toaster; although they didn’t say, I have heard that there are as many as 7,000 of these boxes already in use at outpatient and ER facilities. According to Abbott’s March 27 publicity release:
When not being used for COVID-19 testing, ID NOW is the leading molecular point-of-care platform for Influenza A&B, Strep A and respiratory syncytial virus (RSV) testing.
If this test is reliable and as available as the other tests (for influenza, strep throat, and infantile RSV infection) then it will dramatically improve our ability to detect the new virus. As many have already said, testing, testing, testing is one key to bringing this pandemic under control. The second key is smartphone-based contact tracing, as implemented in South Korea. The third key is population buy-in for the instructions from the government (which have finally caught up with reality, at least in what-to-do-now recommendations) which is another thing entirely from the administration’s attempts to blame the previous administration (which tried to warn the incoming admin) and its shoot-the-messenger behavior (firing the captain of the aircraft carrier now docked in Guam).
photo courtesy of pixabay.com
photo by William Iven via pixabay.com
I wrote yesterday that an article in Science magazine revealed the South Korean secret to reducing their transmission rate to a manageable level: a smartphone app. I refer you to yesterday’s post for more details. This morning, I consulted Wikipedia for some abstruse details, and sure enough, they agree:
Given the unknown horizontal transmission parameters of the virus, advocates for digital contact tracing, such as smartphone apps, assert that if a presumptive diagnosis of COVID-19 based on symptoms were accepted in high-prevalence areas, and only quarantines for their contacts were implemented, populations could resume ordinary lives without the economically crippling results of ‘lockdowns’.
Contact me if you think this is a good idea. Or don’t. I don’t have time to natter on right now. Too busy trying to stay alive by living a normal life. Seriously, you should try to do everything you normally do, only “contactless”.
Conrad Theodore Seitz 