(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)
(photo courtesy of pixabay.com)
(photo courtesy of pixabay)
Experts have been saying that the novel coronavirus is spread through close contact and physical touching. They also have downplayed transmission from asymptomatic individuals. Now evidence on the ground from Skagit County WA shows that airborne spread can occur from asymptomatic carriers to other individuals. A report in the Los Angeles Times from last night tells how, with no reported cases in the county, choir practice was assembled with half the normal cohort of singers on March 10. A few days later, an outbreak of COVID19 has felled two and laid 45 members low. The rest can be assumed to remain asymptomatic but be carriers of the virus.
These results confirm the indications from multiple scientific studies of the experience in China. A large proportion of cases have been attributed to asymptomatic or presymptomatic carriage and transmittal of virus from one person to another.
Now, due to a lack of testing, we have no idea who is a carrier and who has already recovered from asymptomatic or trivial symptoms of infection. If those who have recovered are recruited to the front lines, many of the shortages of protective equipment and personnel could be alleviated. Already, police in New York who have recovered from the illness are returning to work due to a lack of essential (even more so than medical) personnel.
As usual, data reported above are sourced from multiple news agencies– LA Times, Washington Post, NBC to name a few. Fox News has been left out of this conversation due to the lack of primary sources and a high level of cant which makes it difficult for realistic people to listen or watch.
(cartoon courtesy of pixabay)
(cartoon courtesy of pixabay)
(photo courtesy of pixabay)
Yesterday’s Washington Post carried an article telling the story of Birdie Shelton, a woman who returned rental cars for servicing to their central locations. In her job, she was exposed to secretions and excretions from people who had driven and ridden in cars that they had rented. In part, their motives were to prevent exposure through riding on public transportation. Her job, which she was forced to do by economic necessity, probably killed her.
The story was particularly affecting and effective because it was told by her partner, who dictated his recollections of her sudden illness and demise within days of its onset. These people, Indiana residents and members of the lower middle class, are helpless in the face of economic and epidemiological pressures that prevent them from taking time off when they are sick and massively expose them in the course of their work.
Never mind that she had multiple risk factors for severe disease. Never mind that she voluntarily chose this job. The rental car companies are responsible for their employee’s well-being.
First, the story shows how massive exposure can result in sudden, fatal symptoms. Second, this story shows why the capitalist system, without sufficient regulation and supervision, will be the death of us all (except the lucky 0.1%).
PS at the time the story was published, Birdie’s partner was also ill and confined to his home. He was unable to access her cell phone because she was too sick to give him the password. His electricity had been turned off (he got it back on, luckily). He was in danger because she had handled the finances for the two of them, and he was unable to find work. He will probably die too, because his exposure to her was of the same magnitude as her exposure to others.
(photo courtesy of pixabay)
An article in today’s New York Times demonstrates that the profit motive, manifested as industry consolidation, has handicapped preparations for today’s pandemic of novel coronavirus:
Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.
Back in April 2012, a small specialty manufacturer of ventilators (devices that inflate the lungs with oxygenated air to relieve shortness of breath due to weakened lung function) demonstrated a working model of a $3,000 ventilator that had been commissioned by the Centers for Disease Control (CDC) to fill the national stockpile. Projections that the US would need 70,000 ventilators in case of a flu pandemic (H1N1 had just passed through the world) alarmed experts at CDC, and they developed with Newport a contract to produce 40,000 of them, redesigned to be simpler and more portable.
Just as the demonstrator working models were rolled out, Newport was bought out by a larger generalist producer of medical equipment, Covidien, for $100 million. In May 2012, apparently fearing that the cheap ventilator would cut into its profits on selling larger, more complex ones, Covidien demanded more front money and a higher price for the new machine. The project fell apart, and no new ventilators that could be stockpiled for use in emergencies were produced.
Once again, the profit motive has over-ruled the altruistic motive in the boardroom. We can see that capitalism without regulation and oversight is deadly to the human race. Communism, with its totalitarian tendencies and its use of unrealistically high expectations to prod superhuman efforts from motivated “commies”, would be even worse. Don’t tell that to our Commander in Cheat: he’s too busy preening in front of his bathroom mirror. Time and time again, projects that use our motives for the common good to spur low-profit production have been derailed by Tea Partiers crying “communism!” to tar socialist policies with the unwarranted slur of totalitarianism. When will these red-baiters learn that we are all in this together?
Conrad Theodore Seitz 