(photo courtesy of pixabay.com and trumpsignsbystocksnap)
(image courtesy of pixabay.com and TheDigitalArtist)
The South China Morning Post reported today that Chinese authorities have begun to disclose that their official case totals excluded asymptomatic patients. These patients were nonetheless quarantined under China’s rigid isolation protocols. As of today, there were about 1,500 of these asymptomatic patients under observation and about 2,500 with symptoms. Starting tomorrow, the Chinese government will start including reports of all cases, whether they have symptoms or not.
One factor causing confusion is that some of the Chinese coronavirus tests were unreliable; some inaccurate tests were even exported and had to be replaced after complaints from European governments.
The Chinese government’s response to the novel coronavirus has been criticized. It appears that, although there was a mechanism for reporting new and unusual cases of disease in place, doctors were pressured not to make such reports by political cadres. This is a weakness in the Chinese system: political non-expert people are in competition with, and sometimes superior to, local expert non-political workers. This is true in all fields in China: political supervision and meddling in the work of professionals and experienced workers.
The situation is similar in the United States, although not as pervasive. There are thousands of political appointees in federal government who are subject to the whims of the president and his minions. Many obtain their jobs through donations to political campaigns and service in the ranks of candidates’ staff. Many others get work by effusively praising the candidate before, and especially after, he or she is elected. Some of these individuals have proven to be incompetent or worse in the present administration.
During the impeachment hearings, it was revealed that one person who testified got his job as an ambassador by making a million dollar donation to the president’s inauguration fund. This fund turned out to be full of slush: not only was it twice the size of previous inaugural funds, but half of it was not spent on actual inaugural events. Some of this money clearly wound up in the pockets of the president and his family.
China has a highly politicized system of administration. Candidates for government work pass rigorous examinations; the tradition of exams goes back hundreds or thousands of years. There are parallel chains of command that ensure all expert workers are supervised by loyal political appointees who report to the Party. Many of these political supervisors have prioritized “good” reports and covered up bad news in an attempt to look better to their bosses in Beijing. Expert workers who report bad news risk being called in by the police and pressured to be quiet about problems that they encounter.
One Chinese doctor who was punished for reporting on a cluster of patients with an atypical form of pneumonia has become famous. He was posthumously “pardoned” after he died from the disease he was reporting on: COVID-19. The only bright spot in this chain of political cover-ups is that officials have been forced to retract their lies about this disease; now, the Chinese government is admitting that their cases of novel coronavirus are far more numerous than they had said in the past.
(image courtesy of pixabay.com and TheDigitalArtist)
Novel coronavirus treatment is locked in a cycle of political versus scientific arguments. The federal government, via the FDA, is distributing millions of doses of chloroquine and hydroxychloroquine to hospitals. The scientific reports available from France suggest that treatment reduces the time to clearance of the virus dramatically but the studies are small (eighty patients were reported yesterday; one abstract that I accessed today reported statistical significance with only twenty patients).
We will not know for some time what the results will be. Under the circumstances, randomized, double-blind, placebo-controlled studies are next to impossible because very few people will sign up for a fifty-fifty chance of getting a placebo when they feel like they are dying.
Epidemiologists say that, under these circumstances, the only way to proceed is with large case-control studies. Patients will be given the drug where it is available and their outcomes will be compared with those in patients who couldn’t or didn’t get the drug. The absence of placebo controls militates against small studies, and that is all that is available right now.
Although chloroquine has large toxicities at relatively small doses (not much more than is needed to be effective), patients have little to lose when it is offered. The only problem is that, if everyone gets the drug, how will we know whether it made a difference?
Where is remdesivir? I think that there is very little of it available, but I could be wrong.
Another unknown is whether our current supply of chloroquine will be restocked. India has stopped exports of this drug, which is generic and made mostly there and in other Asian countries. What if we run out? Then we will have those controls that we needed in the first place.
A final word: what will happen to the news? Free newspapers will soon die for lack of advertising. Print newspapers have been dying for years and this will be the final nail in the coffin for most of them. McClatchy is already in bankruptcy. Soon we will remember the novel coronavirus as “The Great Winnowing” as only NYT, Washington Post, and a few others remain. Even the TV networks will not be spared.
(image courtesy of pixabay.com and TheDigitalArtist)
Royal Philips NV had a $13.8 M contract with the US government to produce simple, basic ventilators that was signed five years ago (in 2014?). In September 2019, with FDA approval in hand, the federal government ordered 10,000 ventilators for $3,280 each (totalling over 30 million dollars, which wasn’t actually paid out, I don’t believe). None of these ventilators have been delivered and none are going to be produced for the US under the contract for another year, according to Pro Publica. Now a retailer is selling this same ventilator for over $17,000 online. It is known as the Trilogy Evo Universal.
For those who don’t know, Royal Philips NV is a Dutch company that produces many electronic consumer items (such as CD and DVD players, on which “Philips” appears prominently). The company which signed the contract is a subsidiary of Philips based in Pennsylvania. In 2016, Philips paid a $34 M plus fine to the US after the Justice Department sued under the False Claims Act and the Anti-Kickback Statute (Justice claimed that the company was essentially paying kickbacks to retailers on its CPAP facemasks). The company also signed a Corporate Integrity Agreement that is still in effect nearly five years later.
The ventilator problem is highly complex and once you read all the details, you may think, “Well, with the best of intentions, a lot of people dropped the ball”. But, as with another company that signed a similar contract of a similar size some eight years ago and then was bought out by another company that was bought out by Medtronics, capitalism plays a large part in “dropping the ball”.
Pro Publica is a news organization that investigates and publicizes problems in government… headlines are dramatic, but the story never mentions the word “capitalism” to explain the failures involved here. Why not? They’re afraid of being shut down and/or disappearing if they get too radical. Just my personal, radical opinion. Bye for now… if I disappear, it’s because I got sick. No-one but renxkyoko reads this stuff.
(image courtesy of pixabay.com and TheDigitalArtist)
A newish company that produces digital thermometers hooked up to the web, Kinsa Health, first showed a national map of fever levels on March 22 on the Rachel Maddow show on MSNBC at 9PM EDT (at least that’s where I first saw it) that indicated the obvious hot spots in NYC and Washington state, as well as a much hotter area in southern Florida that still has not been publicized widely.
Now, the NYT states that data from New York State and Washington State confirm that there have been reductions in rates of new infections. The story in the New York Times also states that the map was first shown on March 22.
According to the NYT story, there are more than a million of the Kinsa thermometers in circulation (I heard elsewhere that there were eight million, but don’t quote me) and there have been up to 162,000 daily temperature readings uploaded to the web. This “web” of thermometers has accurately predicted, two to three weeks ahead of time, influenza outbreaks since 2018. That was when they only had half a million thermometers distributed.
This news, along with the documented drop in new infections in Italy, makes me cautiously optimistic that isolation measures are going to be effective at “flattening the curve”.
(image courtesy of pixabay.com and TheDigitalArtist)
The New York Times reports that daily deaths in Italy blamed on SARS-COV-2 were continuing between 800 and 1000 (including those who died at home without asking for medical care, who are not in the official statistics) but the new infection rate has dropped by half to roughly 1,648 people.
Since deaths lag new infections by anywhere from five days to three weeks, the continued death rate was not a surprise. The good news is that there has been a dramatic drop in new diagnoses. Either the isolation protocols have begun to show an effect, or the population is becoming saturated. Exponential growth always comes to an end, and we know that the death rate can’t be any higher (it’s already roughly ten percent of total diagnoses, which is shocking enough) unless the medical system completely collapses and patients are left to themselves to starve and wither away. So the Italian/Spanish phase of this pandemic may be finally topping out. I could be wrong about this, there may be many reasons for the halving of new infections, but I’m optimistic, slightly.
(thanks to pixabay.com for this gruesome image)
This is a subject that is painful for me because I dropped out of Twitter for a long time after being dissed for announcing a clinical diagnosis for Himself. There are two reasons for first, making, and second, publicizing a clinical diagnosis for that certain person:
- Ordinarily, diagnosis of disease requires a personal examination. This is not possible in this case and is not necessary in such a flagrant case of the disease from which he suffers. If I were to clinically interview such a person, he would only lie to me and I would have to make my diagnosis based on talking to his relatives, friends, and victims. It is easy, in fact it doesn’t take a weatherman, to diagnosis sociopathic narcissism in such an advanced case.
- Once having made such a diagnosis, it is necessary to consider dangerousness to others (especially since the prognosis for treatment is so negative). In this case, especially today, this person is extremely dangerous. He may have doomed thousands of people to a painful, lonely, lingering death already.
So, ethically speaking, I believe that I am on safe ground saying it, and saying it loud: HE is a sociopathic, narcissistic solipsist.
(image courtesy of pixabay.com and tdd20)
France’s director-general of health has been quoted as saying this new authorization will allow treatment of novel coronavirus patients while retaining supplies of chloroquine needed for those already on the drug for lupus or malaria. A study of eighty patients showed that treatment shortened the time to recovery from an average of fourteen days to five. Those dramatic results suggest that this, as yet unproven, drug may be sufficiently effective to justify its potential toxicity. Chloroquine’s therapeutic index (the difference between the effective dose and the toxic dose) is low; just three times the dose needed to treat illness is enough to cause life-threatening toxicity. This report comes from France 24 English through the International Business Times.
If this report is what prompted France to make chloroquine widely available to treat novel coronavirus and led the FDA to approve it, then I take back what I said about pressure from our Commander-in-Cheat. I could be wrong, but I suspect that they may have acted before they heard from France because Himself, some days ago, touted chloroquine on his Twitter account as a miracle cure. What do I know? All I know is what I read in the newspaper.
(image courtesy of pixabay.com)
A new study in the Lancet, reported in the International Business Times, examined 23 patients in Hong Kong with viral load counts. Viral loads indicate how much virus a person is excreting into his or her environment, therefore how infectious they can be. Saliva examination measured the amount of SARS-COV-2 a person puts out, and found that the load is highest when symptoms first appear. 22 of the 23 patients had fever, suggesting that they had more than mild disease, although only ten had “severe disease” (two died). Four of the ten with severe disease had high blood pressure (hypertension).
The presence of early high viral load is different from other coronaviruses like MERS and SARS, in which viral load is highest much later in the course of illness (about ten days). This early presence of high levels of virus is also seen in influenza, in which patients are contagious at symptom onset. Viral load declines as the illness progresses, but virus RNA is still detectable for 20 days in one-third of patients, when they are recovering. Old age appears to be linked to higher viral load, meaning older patients are probably more infectious.
Dr. Yuen, whose team conducted the study, said that the results show that SARS-COV-2 is easily transmitted even when symptoms are mild. The presence of RNA traces during recovery may not indicate that recovering patients are still infectious; cell culture is required to determine whether those traces are actually effective at transmitting infection. One result that is confusing but not discussed was that three patients did not have detectable virus RNA but developed antibodies.
The study report states that its results argue for “early use of potent antiviral agents” (eg, remdesivir)– because high viral loads are present early in the course of disease. This is unlikely to happen if individual cases are forced to be processed through the red tape involved in non-FDA-approved uses of investigational drugs. I argue that remdesivir should receive an immediate emergency approval for use from the FDA to eliminate the red tape involved in using investigational drugs. Instead, the FDA has approved chloroquine (a questionably effective and highly toxic drug), probably under pressure from Himself. Lopinavir, ritonavir, ribavirin, or interferon 1b was given to most of these patients, but these drugs did not have any appreciable effect.
Another study published in the American Journal of Respiratory and Critical Care Medicine and reported in the International Business Times says that 50% of patients continued to shed virus after their symptoms had disappeared. Shedding times are longer in patients with more severe illness. Dr. Sharma, the study’s lead author, is at the Yale School of Medicine, but the sixteen patients studied were hospitalized at the People’s Liberation Army General Hospital Treatment Center in Beijing, China. The time from infection to manifestation of symptoms (the incubation period) averaged five days, and the average duration of symptoms was eight days. Patients were said to remain “contagious” for one to eight days after symptoms disappeared, but again cell culture to determine infectiousness as opposed to mere shedding of fragmentary, nonviable virus was not performed.
These studies show that the virus can appear in saliva on the first day of illness or even hours before, and high viral loads suggest extreme contagiousness early in the disease. This means that the virus will be impossible to contain, even with isolation of most of the population, and people worried about getting sick should isolate themselves from everyone. Even those who appear to be well may be carrying high loads of virus and infecting others without realizing it.
After the acute illness has subsided, about half of patients continue to shed some virus. There have been reports that apparently recovered patients have transmitted the infection to others, but how many can do so is unknown and is not being systematically studied. Such a post-recovery study would be difficult to perform because it would require susceptible people to expose themselves, perhaps knowingly, to convalescent patients.
(image courtesy of pixabay.com)
Conrad Theodore Seitz 