Under This Doctor’s Care, Most COVID-19 Patients Are Recovering. Here’s His Unusual Approach

One of the biggest hurdles in dealing with a pandemic caused by a completely new virus is grappling with the sheer amount of unknown information.

In the case of the novel coronavirus, SARS-CoV2, this was particularly difficult because the presentation of each patient seemed so vastly different from the previous case.

Furthermore, many patients seemed to improve clinically before deteriorating, requiring an admission to the intensive care unit for weeks at a time. The pernicious behavior of the virus made pandemic response that much more difficult, and the unpredictable nature of the disease consumed and strained health care resources.

Physicians who were treating COVID-19 patients took note and communicated to others by phone call, conference, or social media, but there was no central repository for their experiences, which ensured that the virus spread much faster than information.

Now, approximately four months since the first reported case in America, we are beginning to understand why.

Dr. Thomas Yadegar, a critical care physician for 20 years and now director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California, has been on the front lines of the pandemic response.

The first time one of his patients deteriorated, he was completely stumped for the first time in his two decades in the ICU.

Many of his patients were in acute respiratory distress. But many other patients were experiencing abnormal coagulation, inflammatory heart disease, and some were even experiencing neurological deficits and weakened muscles.

“I have 20 years of critical care experience, and I can’t explain what just happened to my patient,” Yadegar said.

One evening after an exhausting shift, he sat down and pored over patient charts for all those cases, searching for a common thread. Finally, after one of the worst headaches of his life, he found it.

It was inflammation.

Early in the pandemic, Yadegar’s unit used treatment guidelines that came from doctors around the world, which recommended avoiding anti-inflammatory treatment and recommended early and aggressive use of ventilators to prevent patients from declining further.

But those guidelines were aimed at treating a severe viral respiratory disease by using a ventilator to assist with oxygenating the blood while the body uses its inflammatory pathways to mount a response to the virus.

Those guidelines did not address the treatment for when other organ systems began to fail.

In fact, using a ventilator is a highly invasive procedure, and the repeated and forced inspiration of air irritates the lungs, which feeds back into the inflammatory cycle. Many patients, once on a ventilator, never recover.

The only way to explain the highly complex disease course that seems to change from one patient to the next is that the virus is causing an autoimmune response, in which the body’s natural defense mechanisms go haywire and begin destroying the body they’re trying to protect.

The disease course is so unpredictable because every person’s immune system is unique to that person.

This phenomenon is not unheard of, and a common virus, Epstein-Barr virus, is known for potentially initiating the body’s inflammatory pathways to attack the nervous system and causing Guillain-Barre syndrome.

The main difference with SARS-CoV2 is that it’s much more efficient at doing this—and often in a catastrophic manner.

Yadegar and the ICU he manages have adjusted their protocols. Now, patients who test positive in his hospital for SARS-CoV2 are not sent home immediately, but tested for inflammatory markers.

Those with elevated inflammatory markers are kept in the hospital with a close eye on their oxygen saturation levels. If the patient begins to desaturate, the medical team evaluates the patient before starting a course of steroids and an IL-6 inhibitor.

IL-6 (interleukin-6) is a powerful mediator for the inflammatory pathway, so an IL-6 inhibitor would prevent a significant amount of inflammation from happening. Steroids have strong anti-inflammatory effects and also suppress the immune system more broadly.

The two of those do not treat the virus, but the potentially deadly autoimmune response it can cause.

But Yadegar cautioned that “you have to treat each patient within their own protocol.” Doctors must always treat the patients in front of them and cannot simply rely on these types of drugs for all critically ill COVID-19 patients.

That’s because using an IL-6 inhibitor with steroids would effectively strip the body of its immune response. If there’s a concomitant infection, which is extremely common in the hospital setting and even more so if a patient is on a ventilator, then using this combination of drugs will, almost certainly, kill the patient.

Still, Yadegar and his team have had remarkable success. They have not put a patient on a ventilator in at least two weeks, and the mortality rate in their ICU has been in the single digits, whereas nationally the mortality rate of critically ill patients has been between 40% and 70%.

There’s one thing we have known from the start about the COVID-19 virus, which is that it’s a tricky and pernicious one.

One of the important things that Yadegar has learned is that patients admitted to the ICU are often not coming in due to the direct effect of the virus, but rather from the out-of-control autoimmune process.

Information like that can only be had from front-line clinicians, and we should do our best to ensure they are heard.

The Centers for Disease Control and Prevention periodically hosts a Clinical Outreach and Communication Activity, in which clinicians are able to discuss their findings and experiences.

The CDC should be using those frequently to update information about COVID-19 and its multiple disease manifestations and to make the information easily and publicly accessible.

Furthermore, the CDC should be actively seeking this information from the front lines of COVID-19 hot spots, where the most relevant data will be found.

With steps like these, clinicians can be assured of clear lines of communication that may help drive down mortality rates in the future and ease the process of reopening the country.

SOURCE 

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Critically-ill coronavirus patient with 'very grim' outlook is saved after NHS doctors gave him promising arthritis drug that is being trialed worldwide

A critically-ill coronavirus patient was saved after getting a promising arthritis drug that is being trialled by doctors worldwide.

Leonard Whitehurst was admitted to the Royal Cornwall Hospital on March 16 with a confirmed case of COVID-19.

Over the course of his stay, his condition deteriorated until his prognosis was 'very grim', according to medics who treated him.

One of the 72-year-old's doctors decided to give him tocilizumab on compassionate grounds, after it showed promise in treating COVID-19 patients in Italy.

Tocilizumab, marketed as RoActemra or Actemra, is used to suppress the immune system of rheumatoid arthritis patients.

For COVID-19, it has the potential to stop the 'cytokine storm' that happens when the immune system goes into overdrive and starts attacking the body.

As soon as Mr Whitehurst was given the drug as a last-ditch attempt, his condition began improving. He is now recovering at home.

Dr Giorgio Gentile believes he is the first to have tried the arthritis drug in the UK back in March following the advice of worldwide doctors.

Now, tocilizumab is part of three major trials involving British patients - with the first results expected by June or July.

Dr Gentile, a consultant nephrologist from Italy, has worked at the Royal Cornwall Hospitals Trust since 2015, having moved here with his family.

He revealed that Mr Whitehurst needed 19 litres of oxygen but had not been put on a ventilator.

Dr Gentile said: 'Leonard was deteriorating quickly and escalation to intensive care for ventilation was not an option.

'As the patient wasn't prepared to be artificially ventilated, the outlook was very grim.

'I was desperate to try to save the patient. To me, tocilizumab seemed like the only viable option left to try and save his life.'

Dr Gentile had been regularly reviewing the medical literature of COVID-19 that was coming out from countries which battled the peak of their outbreaks before the UK.

He also maintained regular contacts with his network of colleagues involved on the frontline against COVID-19 in Italy - the only European country to record more deaths than the UK.

Doubts have been raised about the safety of tocilizumab, which has a long list of side effects including a cough or sore throat, blocked or runny nose, headaches or dizziness, mouth ulcers, high blood pressure, weight gain and stomach problems.

Tocilizumab has been shown to increase the risk of infections in patients with rheumatoid arthritis, including pneumonia and upper respiratory tract infections, according to Versus Arthritis.

Trials on patients with RA before approval were not designed to assess long-term efficacy and safety.

The Food and Drug Administration has received reports on 1,128 people who died after taking Actemra, according to a report by Stat News in 2017. It said the FDA declined to comment about Actemra.

Dr Gentile had become aware of multiple anecdotal reports of people in very severe conditions who had dramatically improved after treatment with tocilizumab.

'The AIFA, which is the Italian equivalent of the Medicines and Healthcare products Regulatory Agency, had just approved a large trial with tocilizumab and was actively recruiting people,' added Dr Gentile.

'The Italian experience seemed to mirror a preliminary yet promising experience from Chinese scientists, who used tocilizumab in 21 patients with very encouraging results.'

Another promising study of 20 patients in China, published in mid-March, claimed tocilizumab cured 95 per cent of critically ill patients.

Dr Gentile said: 'Our patient had all the laboratory signs of the so-called "cytokine storm", which I was aware of thanks to a paper published in the peer-reviewed journal, The Lancet.

'The same paper speculated that tocilizumab could be used to treat patients with severe COVID-19 pneumonia and hyper-inflammation, who are at high risk of progression towards acute respiratory distress syndrome and death.

'Luckily, we have brave, compassionate and open-minded leadership here at the RCHT. They gave me the green light to use tocilizumab on compassionate grounds. 'The patient agreed to receive the treatment, which was then quickly administered.'

The other drugs being looked at as a treatment for COVID-19 include a combination of Lopinavir and Ritonavir (known by the brand name Kaletra), which is used to treat HIV; low-dose Dexamethasone,a steroid used to reduce inflammation; azithromycin, a commonly used antibiotic which may have antiviral properties; and the steroid Tocilizumab.

Mr Whitehurst received two infusions of tocilizumab 12 hours apart from nurses.

Before the infusion, his oxygen saturation was 75 per cent. A normal reading should be between 80 and 100.

After the infusion, Mr Whitehurst's clinical conditions and his oxygen saturation improved very quickly, and then kept improving gradually and steadily over the subsequent days.

His oxygen requirement decreased gradually over time.

'At the time, we were at the very beginning of the COVID-19 crisis in the UK and the national lockdown had just been declared. So, it is quite possible that the RCHT has been the first NHS trust in the UK to successfully treat a patient with tocilizumab,' added Dr Gentile.

Mr Whitehurst was discharged from hospital last week 'smiling and overjoyed', having spent more than a month in the hospital.

Dr Gentile stressed that although tocilizumab worked for his patient, further evidence from rigorous randomised controlled trials is necessary to fully establish the role of the drug in COVID-19 pneumonia.

SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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Funeral Directors Blow the Whistle on Deaths Falsely Attributed to Coronavirus

“Basically, every death certificate that comes across our desk now has COVID on it,” said a funeral director in Williston Park, N.Y., on a recorded phone call with Project Veritas in a newly-released video. James O’Keefe has been asking for people inside the medical system to blow the whistle if they see corruption or inconsistencies in reports about the Chinese WuFlu known as COVID-19. In conversations with several funeral directors across New York City, O’Keefe uncovered a shocking narrative where, without fail, every director he spoke to expressed his or her concern that coronavirus deaths are being inflated and every death in NYC is being recorded as a COVID death with or without testing to confirm.

“They are putting COVID on a lot of death certificates because people who are going to their hospital with any kind of respiratory distress, respiratory problems, pneumonia, the flu — the flu-like symptoms lead into the COVID-19,” said Joseph Antioco of Schafer Funeral Home. “To me, all you’re doing is padding the statistics. You’re putting people on that have COVID-19 even if they didn’t have it. You’re making the death rate for New York City a lot higher than it should be.”

One funeral director talked about a family who is related to an unnamed Supreme Court Justice who insisted on a private autopsy that discovered their relative did not have COVID-19. “I had one that was autopsied because the sister was famous, and apparently, and I don’t know who the Supreme Court Justice is, but the Supreme Court Justice was related to this family, and she says I know my sister didn’t die of COVID-19,” said Josephine Dimiceli of Dimiceli & Sons Funeral Home. “She said she had Alzheimer’s and they didn’t suction her. You have to suction because they forget how to swallow. And right away they put down COVID-19 on her death certificate, and the Supreme Court justice, whoever it is, contacted the hospital. They did an independent autopsy; bingo. No COVID-19.”

Dimiceli had other shocking tales to share. One nursing home assumed all its patients were positive without testing. “The guy that I just buried a little while ago from Long Island National Cemetery, they called me from the nursing home. They said, ‘Did Raymond have COVID-19?’ She said, ‘Well, no. It was a failure to thrive. But we’re assuming they all have it.’ And I’m all, ‘Why would you assume? Why aren’t they all in the hospital?’ She had no answer. ‘I can’t answer you,’ she said. They put it down on Raymond’s death certificate,” said Dimiceli. “He didn’t have COVID-19.”

There are several more funeral directors with similar stories.

SOURCE 

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Coronavirus: ‘Flattening the curve’ to eliminate COVID-19 could be dangerous, researchers say

No one can say for sure how the pandemic will unfold, but our lives will certainly be changed for the foreseeable future.
New research suggests “flattening the curve” may not be the most effective way to fight the COVID-19 pandemic.

A team of international researchers, led by Peking University Professor Liu Yu, have projected that the “flatten the curve” approach could destroy economies while having not enough of an effect on cutting infections.

“The turning point will never come, the peak value of case numbers will remain the same as if there are no such measures,” the team said in a non-peer-reviewed paper released last week. “We strongly suggest they reconsider.”

WHAT DOES THE RESEARCH SAY?

“Flattening the curve” refers to shutting down non-essential businesses and issuing social distancing measures to ensure that a country’s health system can cope with the number of infections and deaths.

The research, first reported on by the South China Morning Post, looked at daily infections, the geographical spread of the disease, economic output and public transport to assess the effectiveness of social restriction policies on flattening the curve.

They found that only a few countries, including South Korea, Qatar, Norway and New Zealand, have been able to stop the spread with minimum disruption to the economy.

Others, like the United States, Britain, France, Italy and Spain, have suffered major blows to their economies while also struggling with soaring infections and death rates.

They found that China’s “elimination” strategy was most effective at suppressing the virus, but was unsustainable due to its heavy impact on the economy. In other words, “flattening the curve” produces too little but costs too much.

The researchers suggested that the disruption to the economy and social life did not align with the reduction in cases.

“This choice still incurs 20-60 per cent loss of economic output, but only achieves a 30-40 per cent reduction in the number of cases, an extent which is insufficient to overturn the epidemic curve,” the researchers said. “Our results show that this is usually the worst scenario in terms of cost-effectiveness.”

But the basis of the research has been questioned. Jaymie Meliker, professor of public health with the Stony Brook University in New York, said the research failed to put a value on each life lost to COVID-19. “I could not find how much they estimate a life is worth in their cost benefit model,” he told the SCMP.

“If the hospitals are overrun and more people are dying because of that, then we need to quantify that cost for a cost-benefit model. “That is needed for us to be able to evaluate the pros and cons of the different containment strategies.”

SO DOES THAT MEAN WE SHOULD LIFT THE VIRUS RESTRICTIONS?

In short, no it doesn’t.

Australia’s response to COVID-19 is proof that social distancing measures do work. The latter half of March saw virus cases increase more than ten-fold, from 376 cases on March 16 to over 4500 by the end of that month. Social distancing rules came into effect on March 21, and the case rate has been declining since the beginning of April.

On April 22, Australia recorded just four cases nationally, with several states recording zero new cases.

The researchers acknowledged that simply removing social restrictions, as US President Donald Trump has suggested, would be a dangerous way to go.

They warned relaxing lockdown measures without ramping up infection control capacity could prove disastrous and see countries’ death tolls skyrocket.

The solution, they said, is to only relax lockdowns while rapidly increasing testing and patient isolation.

The good news is that this is similar to Australia’s next move.

Prime Minister Scott Morrison has repeatedly stressed there are three criteria points that need to be met before our social restrictions will be lifted: increased testing, contact tracing and greater ability to respond to local outbreaks.

“If you're going to move to an environment where there are fewer restrictions, then you need these three things in place,” he said at an earlier press conference.

Even so, easing the lockdown will not be considered for a few more weeks.

“National Cabinet agreed that we will use the next four weeks to ensure that we can get these in place.”

Australia’s deputy chief medical officer Dr Nick Coatsworth explained that eliminating the virus was not a realistic option.

He told the ABC on Wednesday that Australia was “in a pivotal moment” of the fight against the pandemic, but that we cannot become complacent.

He said social restrictions will need to remain in place “for at least another three weeks to May 11” but “easing restrictions would, by definition, mean some of those numbers (of cases) could change”.

“Businesses and individuals need to prepare, though, that physical distance from one another will need to keep going,” Dr Coatsworth said.

“Great hand hygiene and cough etiquette will need to keep going, because we won’t have a vaccine. So, while some restrictions may be lifted, the way we behave has to stay the same.”

He rejected the notion that Australia could “eliminate” the virus.

“I’m using the word ‘suppression’,” Dr Coatsworth said. “I’ll tell you why I’m doing that. The problem with using words like ‘elimination’ and ‘eradication’ is that we are a non-immune population.

“So, you have to be so sure that you’ve got to that point that you would need to extend your restrictions for so long to get to that point, that I think that that would lead to Australians having to be under social restrictions for too long to get there. That’s an honest view.

“If, in the process of suppressing, we get to the point of eradication, then that would be a magnificent outcome. But we must continue to build capacity and we must continue to contain the virus, and remember that we’re not immune from it. So, the word that — the strategy that we’re using — is to ‘suppress’ COVID-19 until there’s a vaccine.”

SOURCE 

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Study: Nearly all NY coronavirus patients suffered underlying health issues

A new study by a medical journal revealed that most of the people in New York City who were hospitalized due to coronavirus had one or more underlying health issues.

Health records from 5,700 patients hospitalized within the Northwell Health system -- which housed the most patients in the country throughout the pandemic -- showed that 94 percent of patients had more than one disease other than COVID-19, according to the Journal of the American Medical Association (JAMA).

Data taken from March to early April showed that the median age of patients was 63 years old and 53 percent of all coronavirus patients suffered from hypertension, the most prevalent of the ailments among patients.

In addition, 42 percent of coronavirus patients who had body mass index (BMI) data on file suffered from obesity while 32 percent of all patients suffered from diabetes.

The study also revealed that the overwhelming majority of patients who were on ventilators eventually died, and those who did more often had diabetes.

Data gathered from 2,634 patients who either died or were discharged from the hospital showed that 12 percent of them were placed on ventilators and of those who were, 88 percent of them died.

“Having serious comorbidities increases your risk,” said Karina Davidson, one of the study’s authors and senior vice president for the Feinstein Institutes for Medical Research, which is part of the Northwell Health system, according to reports by Time.

“This is a very serious disease with a very poor outcome for those who have severe infections from it. We want patients with serious chronic disease to take a special precaution and to seek medical attention early, should they start showing signs and symptoms of being infected. That includes knowing that they’ve been exposed to someone who has this virus.”

SOURCE 

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Governors Provide a Liberty vs. Tyranny Contrast 

Governors were in the driver’s seat in terms of setting policies for stay-at-home orders, and they will be the ones deciding when those orders end and Americans can begin getting back to normal. The federalist system America’s Founders designed is as brilliant now as it was then, in part because everyone’s able to see the comparisons and contrasts across the nation.

All but five states issued some level of stay-at-home order, and many of those orders will remain in effect well into May, if not longer. Some orders are more restrictive than others. New York is encouraging citizens to snitch on other citizens for not abiding by restrictions. Some states are monitoring citizens with Chinese-made drones. Others are cracking down on Christians meeting in parking lots.

As we noted last week, Michigan Democrat Gov. Gretchen Whitmer’s orders are so tyrannical that residents are protesting in the streets. She insists that makes her more likely to extend the orders. Protests have also flared up in Ohio, Minnesota, Virginia, Wisconsin, and elsewhere.

Likely thinking at least partly of Whitmer, who has been floated as a possible running mate for Joe Biden, President Donald Trump observed, “Some governors have gone too far. Some of the things that have happened are maybe not so appropriate.” Effectively ordering stores to rope off certain sections to prevent sales of items Whitmer deems nonessential is definitely an example of something being “maybe not so appropriate.”

It’s not just governors. House Majority Whip James Clyburn infamously said of last month’s massive relief bill that it was “a tremendous opportunity to restructure things to fit our vision.”

In short, one thing the pandemic has revealed is the authoritarian impulses of many politicians. Well before corona-anything was heard of, some governors, legislators, and bureaucrats — all egged on by a complicit news media — were already geared toward exercising control over the citizenry. The pandemic merely gave them “justification” for things they maybe couldn’t do previously.

Arguably the most revealing quote came from New Jersey Democrat Gov. Phil Murphy, who said of his shutdown order, “I wasn’t thinking of the Bill of Rights when we did this.”

It’s still too soon to give a true evaluation of the actions we’ve taken as a nation, but it will serve us well to contrast the heavy-handed crackdowns in Democrat-run states with the easier approach of many Republican-run ones

SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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The Unseen Death Toll of COVID-19 Measures

The accumulating death toll from COVID-19 can be seen minute-by-minute on cable news channels. But there’s another death toll few seem to care much about: the number of poverty-related deaths being set in motion by deliberately plunging millions of Americans into poverty and despair.

In the first three weeks since governors began shutting down commerce in their states, 17 million Americans filed for unemployment, and according to one survey, one quarter of Americans have lost their jobs or watched their paychecks cut. Goldman Sachs predicts that the economy will shrink 34 percent in the second quarter, with unemployment leaping to 15 percent.

Until the COVID-19 economic shut-down, the poverty rate in the United States had dropped to its lowest in 17 years. What does that mean for public health? A 2011 Columbia University study funded by the National Institutes of Health estimated that 4.5 percent of all deaths in the United States are related to poverty. Over the last four years, 2.47 million Americans had been lifted out of that condition, meaning 7,700 fewer poverty-related deaths each year.

It’s a good bet these gains have been completely wiped out, and it’s anyone’s guess how many tens of millions of Americans will have been pushed below the poverty line as governments destroy their livelihoods. It’s also a good bet the resulting deaths won’t get the same attention.

And that doesn’t count an unknown number of Americans whose medical appointments have been postponed indefinitely while hospitals keep beds open for COVID-19 patients. How many of the 1.8 million new cancers each year in the United States will go undetected for months because routine screenings and appointments have been postponed? How many heart, kidney, liver, and pulmonary illnesses will fester while people’s lives are on hold? How many suicides or domestic homicides will occur as families watch their livelihoods evaporate before their eyes? How many drug and alcohol deaths can we expect as Americans stew in their homes under police-enforced indefinite home detention orders? How many new cases of obesity-related diabetes and heart disease will emerge as Americans are banished from outdoor recreation and instead spend their idle days within a few steps of the refrigerator?

I have participated in many discussions among top policymakers in Congress and the Administration over the last few weeks. Such considerations are rarely raised and always ignored. Instead, policymakers fixate on epidemiological models that have already been dramatically disproven by actual data.

On March 30, Drs. Deborah Birx and Anthony Fauci gave their best-case projection that between 100,000 and 200,000 Americans will perish of COVID-19 “if we do things almost perfectly.” As appalling as their prediction seems, it is a far cry from the 200,000 to 1.7 million deaths the CDC projected in the United States just a few weeks before. And even their down-sized predictions look increasingly exaggerated as we see actual data.

Sometimes the experts are just wrong. In 2014, the CDC projected up to 1.4 million infections from African Ebola. There were 28,000.

Life is precious and every death is a tragedy. Yet last year, 38,800 Americans died in automobile accidents and no one has suggested saving all those lives by forbidding people from driving – though surely we could.

In 1957, the Asian flu pandemic killed 116,000 Americans, the equivalent of 220,000 in today’s population. The Eisenhower generation didn’t strip grocery shelves of toilet paper, confine the entire population to their homes or lay waste to the economy. They coped and got through. Today we remember Sputnik – but not the Asian flu.

It’s fair to ask how many of those lives might have been saved then by the extreme measures taken today. The fact that the COVID-19 mortality curves show little difference between the governments that have ravaged their economies and those that haven’t, suggests not many.

The medical experts who are advising us are doing their jobs – to warn us of possible dangers and what actions we can take to mitigate and manage them. The job of policymakers is to weigh those recommendations against the costs and benefits they impose. Medicine’s highest maxim offers good advice to policymakers: Primum non nocere -- first, do no harm.

SOURCE 

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Boss of tiny Oxford firm is 'extremely optimistic' over one-a-day pill it has developed to combat coronavirus

A tiny British company could beat the world’s pharmaceutical giants in the race to defeat Covid-19 after developing a one-a-day pill that is as convenient as aspirin.

Thousands of scientists at the world’s drug giants are battling to find ways of combating coronavirus, but experts at BerGenBio, a British-Norwegian company with just 38 staff, believe they have found the key.

Their bemcentinib drug, originally developed for cancer, defends against coronavirus by stopping it from entering cells and preventing it ‘switching off’ one of the body’s most important antiviral defence mechanisms.

Bemcentinib has been fast-tracked to be tried on NHS hospital patients in Government-backed trials, one of only a dozen or so drugs to be picked.

Last night, BerGenBio chief executive Richard Godfrey told The Mail on Sunday that he was ‘extremely optimistic’ the pill would save lives. ‘I think there’s an 80 per cent probability of it working and being of benefit to patients,’ he said.

When US drugs firm Gilead last week announced that tests of its antiviral treatment remdesivir helped patients recover four days earlier from the virus, stock markets in the US and Asia soared.

But the impact on death rates is less clear, with eight per cent of those given it dying, against 11 per cent of those who did not get the drug. The difference was not big enough for scientists to be sure it was having an effect.

But Mr Godfrey said of bemcentinib: ‘I’m expecting something bigger because it’s so different to anything else that’s been tried. We are stopping the virus surviving.’

 When the drug was used in the laboratory on live SARS-Cov-2 – the coronavirus that causes Covid-19 – it showed ‘some very big effects that dwarf what I’ve seen’ from other drugs, said Mr Godfrey.

‘So I’m extremely optimistic and think there’s going to be something quite profound [in human trials].’

Two-thirds of BerGenBio’s staff are based in Oxford, with the rest in Bergen, Norway.

Mr Godfrey said the drug had been tested on 300 cancer patients, had a good safety record and was relatively easy to manufacture.

It works by stopping the virus from utilising a naturally occurring protein called AXL, which it uses to trick cells to allow it entry. The virus also uses the protein to cut production of interferon, the body’s own antiviral substance.

The drug should stop coronavirus ‘hijacking’ AXL, making it harder for it to replicate and leaving it more vulnerable to the immune system.

The first of the 120 trial patients is due to be given the drug at Southampton General Hospital in the next few days. Results are expected at the end of June.

SOURCE 

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Incredible scenes at Michigan Capitol as anti-lockdown protesters armed with rifles storm Senate gallery while lawmakers wearing BULLETPROOF VESTS vote against extending Gov. Gretchen Whitmer's state of emergency

Lawmakers were seen wearing bulletproof vests as armed protesters stormed Michigan's Capitol in Lansing just moments before the state's House of Representatives denied Gov Gretchen Whitmer's request to extend her state of emergency. 

Photos from inside the Michigan House Chamber showed elected officials wearing bulletproof vests while men holding guns stood above them.

'Directly above me, men with rifles yelling at us. Some of my colleagues who own bullet proof vests are wearing them. I have never appreciated our Sergeants-at-Arms more than today,' Sen Dayna Polehanki tweeted Thursday afternoon.

In Michigan, guns are permitted inside the state's Capitol as long as they are visible and carried with lawful intent.

Protesters, who weren't wearing masks, were seen yelling within inches of officers from the Michigan State Police.

Others were heard chanting: 'Let us in! Let us in!'

The 'American Patriot Rally' which was organized by Michigan United for Liberty, drew in hundreds of residents who carried pro-Trump banners and held anti-Whitmer signs while protesting outside of the Capitol.

Demonstrators began descending on the Capitol at 9am Thursday morning while lawmakers were trying to decide whether to extend Whitmer's state of emergency request for 28 more days. 

Ultimately, the lawmakers denied the governor's request and passed a resolution authorizing the Speaker of the House to commence legal action, which will challenge the governor's actions during the pandemic. Whitmer is unable to veto the resolution. 

Whitmer has acknowledged that her order was the strictest in the country.

Protesters, many from more rural, Trump-leaning parts of Michigan, have argued it has crippled the economy statewide even as the majority of deaths from the virus are centered on the southeastern Detroit metro area.

Organizers of a mid-April protest in Michigan took credit when Whitmer recently rolled back some of the most controversial elements of her order, such as bans on people traveling to their other properties.

Whitmer's stay-at-home order is set to continue through May 15, though she has said she could loosen restrictions as health experts determine new cases of COVID-19 are being successfully controlled.

On Wednesday, she said the construction industry could get back to work starting May 7

The slow reopening of state economies around the country has taken on political overtones, as Republican politicians and individuals affiliated with Trump's re-election promoted protests in electoral battleground states, such as Michigan.

SOURCE 

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Almost 18,000 more people could die of cancer due to coronavirus, study shows

Research has shown that amid the crisis, one in 10 people would not contact their GP even if they discovered a lump or a new mole that remained for a week

There could also be a 20 per cent spike in fatalities of newly-diagnosed cancer patients, according to research by University College London (UCL) and DATA-CAN, the Health Data Research Hub for Cancer.

The figures stem from real-time hospital data for urgent cancer referrals and chemotherapy attendances, which have experienced a 76 per cent and 60 per cent fall respectively.

While England’s top cancer doctor has urged people to not hesitate in seeking help or being checked.

The advice from Professor Peter Johnson, the NHS clinical director for cancer, comes after worrying research showed nearly half of the public have concerns about seeking help.

Moreover, the poll by Portland revealed one in 10 people would not contact their GP even if they discovered a lump or a new mole that remained for a week or more.

After analysing data from 3.5 million patients, experts predicted before the Covid-19 crisis that approximately 31,354 newly-diagnosed cancer patients would die within a year in England.

But the pathogen could lead to at least 6,270 extra deaths in newly-diagnosed cancer patients — a rise of more than 20 per cent.

While the figure jumps further to 17,915 excess deaths if all people currently living with cancer are included.

There have been 21,678 fatalities from the virus at the time of writing, including more than 100 NHS staff and care home workers.

The main reasons for the increased likelihood that the public would ignore symptoms stems from a fear of contracting the virus itself by leaving quarantine.

There is also the selfless feeling from some that notifying their GP would further burden the NHS during this unprecedented time, though this has been rebuffed by Professor Johnson, who insists the opposite may be true if the public fail to seek help.

“NHS staff have made huge efforts to deal with coronavirus but they are also working hard to ensure that patients can safely access essential services such as cancer checks and urgent surgery,” said Professor Johnson.

“From online consultations to the roll-out of cancer treatment hubs, we are doing all we can to make sure patients receive the life-saving care that they need.

“We know that finding cancer early gives us the best chance to cure it, and ignoring potential problems can have serious consequences now or in the future.”
SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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Five facts that suggest lockdown is a mistake

The tragedy of the Covid-19 pandemic appears to be entering the containment phase. Tens of thousands of Americans have died, and Americans are now desperate for sensible policymakers who have the courage to ignore the panic and rely on facts. Leaders must examine accumulated data to see what has actually happened, rather than keep emphasizing hypothetical projections; combine that empirical evidence with fundamental principles of biology established for decades; and then thoughtfully restore the country to function. Five key facts are being ignored by those calling for continuing the near-total lockdown.

Fact 1: The overwhelming majority of people do not have any significant risk of dying from Covid-19. The recent Stanford University antibody study now estimates that the fatality rate if infected is likely 0.1 to 0.2 percent, a risk far lower than previous World Health Organization estimates that were 20 to 30 times higher and that motivated isolation policies.

In New York City, an epicenter of the pandemic with more than one-third of all U.S. deaths, the rate of death for people 18 to 45 years old is 0.01 percent, or 10 per 100,000 in the population. On the other hand, people aged 75 and over have a death rate 80 times that.

For people under 18 years old, the rate of death is zero per 100,000. Of all fatal cases in New York state, two-thirds were in patients over 70 years of age; more than 95 percent were over 50 years of age; and about 90 percent of all fatal cases had an underlying illness. Of 6,570 confirmed Covid-19 deaths fully investigated for underlying conditions to date, 6,520, or 99.2 percent, had an underlying illness. If you do not already have an underlying chronic condition, your chances of dying are small, regardless of age. And young adults and children in normal health have almost no risk of any serious illness from COVID-19.

Fact 2: Protecting older, at-risk people eliminates hospital overcrowding. We can learn about hospital utilization from data from New York City, the hotbed of Covid-19 with more than 34,600 hospitalizations to date. For those under 18 years of age, hospitalization from the virus is 0.01 percent, or 11 per 100,000 people; for those 18 to 44 years old, hospitalization is 0.1 percent. Even for people ages 65 to 74, only 1.7 percent were hospitalized. Of 4,103 confirmed Covid-19 patients with symptoms bad enough to seek medical care, Dr. Leora Horwitz of NYU Medical Center concluded “age is far and away the strongest risk factor for hospitalization.” Even early WHO reports noted that 80 percent of all cases were mild, and more recent studies show a far more widespread rate of infection and lower rate of serious illness.

Half of all people testing positive for infection have no symptoms at all. The vast majority of younger, otherwise healthy people do not need significant medical care if they catch this infection.

Fact 3: Vital population immunity is prevented by total isolation policies, prolonging the problem. We know from decades of medical science that infection itself allows people to generate an immune response – antibodies – so that the infection is controlled throughout the population by “herd immunity.”

Indeed, that is the main purpose of widespread immunization in other viral diseases – to assist with population immunity. In this virus, we know that medical care is not even necessary for the vast majority of people who are infected. It is so mild that half of infected people are asymptomatic, shown in early data from the Diamond Princess ship, and then in Iceland and Italy.

That has been falsely portrayed as a problem requiring mass isolation. In fact, infected people without severe illness are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in the low-risk group who then generate antibodies, they block the network of pathways toward the most vulnerable people, ultimately ending the threat. Extending whole-population isolation would directly prevent that widespread immunity from developing.

Fact 4: People are dying because other medical care is not getting done due to hypothetical projections. Critical health care for millions of Americans is being ignored and people are dying to accommodate “potential” Covid-19 patients and for fear of spreading the disease. Most states and many hospitals abruptly stopped “nonessential” procedures and surgery. That prevented diagnoses of life-threatening diseases, like cancer screening, biopsies of tumors now undiscovered and potentially deadly brain aneurysms. Treatments, including emergency care, for the most serious illnesses were also missed. Cancer patients deferred chemotherapy. An estimated 80 per cent of brain surgery cases were skipped. Acute stroke and heart attack patients missed their only chances for treatment, some dying and many now facing permanent disability.

Fact 5: We have a clearly defined population at risk who can be protected with targeted measures. The overwhelming evidence all over the world consistently shows that a clearly defined group – older people and others with underlying conditions – is more likely to have a serious illness requiring hospitalization and more likely to die from Covid-19. Knowing that, it is a commonsense, achievable goal to target isolation policy to that group, including strictly monitoring those who interact with them. Nursing home residents, the highest risk, should be the most straightforward to systematically protect from infected people, given that they already live in confined places with highly restricted entry.

The appropriate policy, based on fundamental biology and the evidence already in hand, is to institute a more focused strategy like some outlined in the first place: Strictly protect the known vulnerable, self-isolate the mildly sick and open most workplaces and small businesses with some prudent large-group precautions. This would allow the essential socializing to generate immunity among those with minimal risk of serious consequence, while saving lives, preventing overcrowding of hospitals and limiting the enormous harms compounded by continued total isolation. Let’s stop underemphasising empirical evidence while instead doubling down on hypothetical models. Facts matter.

SOURCE 

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Coronavirus patients can’t relapse, South Korean scientists believe

South Korean scientists have concluded that coronavirus patients cannot relapse after recovering from the disease, despite hundreds of recovered people testing positive again.

The new findings suggest that rather than indicating reinfection, the positive results were caused by shortcomings in the standard virus test. They will greatly reassure governments threatened by the nightmarish prospect of a never-ending cycle of infection and reinfection.

Positive test results on people who had tested negative were the result of “fragments” of the virus lingering in their bodies, but with no power to make them or ill or to infect others, according to South Korea’s central clinical committee for emerging disease control.

A total of 277 patients appeared to have relapsed

SOURCE 

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The forgotten Trump

Liz Crokin

Donald Trump is a racist, bigot, sexist, xenophobe, anti-Semitic and Islamophobe -- did I miss anything?....Yup: he is also deplorable. The left and the media launch these hideous kinds of attacks at Trump every day; yet, nothing could be further from the truth about the real estate mogul.

As an entertainment journalist, I've had the opportunity to cover Trump for over a decade, and in all my years covering him I've never heard anything negative about the man until he announced he was running for president. Keep in mind, I got paid a lot of money to dig up dirt on celebrities like Trump for a living, so a scandalous story on the famous billionaire could've potentially sold a lot of magazines and would've been a Yuge feather in my cap.

Instead, I found that he doesn't drink alcohol or do drugs. He's a hardworking businessman.

On top of that, he's one of the most generous celebrities in the world, with a heart filled with more gold than his $100 million New York penthouse.

Since the media has failed so miserably at reporting the truth about Trump, I decided to put together some of the acts of kindness he's committed over three decades which have gone virtually unnoticed or fallen on deaf ears.

 *  In 1986, Trump prevented the foreclosure of Annabell Hill's family farm after her husband committed suicide. Trump personally phoned down to the auction to stop the sale of her home and offered the widow money. Trump decided to take action after he saw Hill's pleas for help in news reports.

 *  In 1988, a commercial airline refused to fly Andrew Ten, a sick Orthodox Jewish child with a rare illness, across the country to get medical care because he had to travel with an elaborate life-support system. His grief-stricken parents contacted Trump for help and he didn't hesitate to send his own plane to take the child from Los Angeles to New York so he could get his treatment.

 *  In 1991, 200 Marines who served in Operation Desert Storm spent time at Camp Jejune in North Carolina before they were scheduled to return home to their families. However, the Marines were told that a mistake had been made and an aircraft would not be able to take them home on their scheduled departure date. When Trump got wind of this, he sent his plane to make two trips from North Carolina to Miami to safely return the Gulf War Marines to their loved ones.

 *  In 1995, a motorist stopped to help Trump after the limo he was traveling in got a flat tire. Trump asked the Good Samaritan how he could repay him for his help. All the man asked for was a bouquet of flowers for his wife. A few weeks later Trump sent the flowers with a note that read: We've paid off your mortgage.

 *  In 1996, Trump filed a lawsuit against the city of Palm Beach, Florida, accusing the town of discriminating against his Mar-a-Lago resort club because it didn't allow Jews and blacks. Abraham Foxman, who was the Anti-Defamation League Director at the time, said Trump put the light on Palm Beach not on the beauty and the glitter, but on its seamier side of discrimination. Foxman also noted that Trump's charge had a trickle-down effect because other clubs followed his lead and began admitting Jews and blacks.

 *  In 2000, Maury Povich featured a little girl named Megan who struggled with Brittle Bone Disease on his show and Trump happened to be watching. Trump said the little girl's story and positive attitude touched his heart. So he contacted Maury and gifted the little girl and her family with a very generous check.

 *  In 2008, after Jennifer Hudson's family members were tragically murdered in Chicago, Trump put the Oscar-winning actress and her family up at his Windy City hotel for free. In addition to that, Trump's security took extra measures to ensure Hudson and her family members were safe during such a difficult time.

 *  In 2013, New York bus driver Darnell Barton spotted a woman close to the edge of a bridge staring at traffic below as he drove by. He stopped the bus, got out and put his arm around the woman and saved her life by convincing her to not jump. When Trump heard about this story, he sent the hero bus driver a check simply because he believed his good deed deserved to be rewarded.

 *  In 2014, Trump gave $25,000 to Sgt. Andrew Tamoressi after he spent seven months in a Mexican jail for accidentally crossing the US-Mexico border. President Barack Obama couldn't even be bothered to make one phone call to assist with the United States Marine's release; however, Trump opened his pocketbook to help this serviceman get back on his feet.

 *  In 2016, Melissa Consin Young attended a Trump rally and tearfully thanked Trump for changing her life. She said she proudly stood on stage with Trump as Miss Wisconsin USA in 2005. However, years later she found herself struggling with an incurable illness and during her darkest days, she explained that she received a handwritten letter from Trump telling her she's the bravest woman, I know. She said the opportunities that she got from Trump and his organizations ultimately provided her Mexican-American son with a full-ride to college.

 *  Lynne Patton, a black female executive for the Trump Organization, released a statement in 2016 defending her boss against accusations that he's a racist and a bigot. She tearfully revealed how she's struggled with substance abuse and addiction for years. Instead of kicking her to the curb, she said the Trump Organization and his entire family loyally stood by her through immensely difficult times.

Donald Trump's kindness knows no bounds and his generosity has touched and continues to touch the lives of people from every sex, race, and religion. When Trump sees someone in need, he wants to help. Two decades ago, Oprah Winfrey asked Trump in a TV interview if he would run for president. He said: If it got so bad, I would never want to rule it out totally because I really am tired of seeing what's happening with this country.

That day has come.

Trump sees that America is in need and he wants to help. How unthinkable!

On the other hand, have you ever heard of Hillary Clinton or Barack Obama ever doing such things with their own resources?

Now that's really unthinkable!

SOURCE 

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IN BRIEF

Sanders and Biden reach convention compromise — the deal helps avoid a potentially messy intra-party fight over delegates (Politico)

Nearly 900 workers at Tyson Foods plant in Indiana test positive for coronavirus (Fox News)

Tiny airports rake in big cash after botched stimulus formula (Politico)

Narrative buster: My Native American father drew the Land O'Lakes maiden. She was never a stereotype. (Robert DesJarlait, The Washington Post)

Taiwan thankfully emerging from pandemic with a stronger hand against the ChiComs (Bloomberg)

Policy: Ten steps America should take now to respond to the China challenge (The Heritage Foundation)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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Gilead trial reveals more than half of life-threateningly ill coronavirus patients treated with Ebola drug remdesivir go from relying on oxygen to leaving hospital in two weeks

A trial of the antiviral drug remdesivir has produced 'positive data' for treating coronavirus patients, its maker, Gilead Sciences, said Wednesday.

Gilead announced the results of a clinical trial testing the drug, which was originally developed to treat Ebola patients, in people severely ill with coronavirus.

Half of the 397 patients, who were sick enough to need additional oxygen, but not to be placed on ventilators, improved within 10 days of a five-day treatment course and those who were on a 10-day regimen were better by the eleventh day.

More than half of the patients were discharged from the hospital within two weeks, Gilead announced in a press release.

Meanwhile, Dr Anthony Fauci addressed reports of 'positive data' from the National Institutes of Health's (NIH) own trial of remdesivir in a pool meeting with President Donald Trump and Louisiana Governor John Bel Edwards, calling the findings 'very optimistic'.

The NIH trial is separate from Gilead's own, and details have not yet been officially released, though Dr Fauci said that eight percent in the remdesivir group died, compared to 11 percent in the placebo group. 

Fauci added that the trial was proof 'that a drug can block this virus', and compared the finding to the arrival of the first antiretrovirals that worked against HIV in the 1980s, albeit with modest success at first.

The announcement of promising preliminary remdesivir results sent the Dow soaring by more than 500 points, though Gilead's own stocks were halted pre-trading ahead of the announcement of the trial's findings.

Remdesivir was developed by Gilead Sciences to treat Ebola, the deadly hemorrhagic fever that emerged in West Africa in 2014.

Remdesivir produced encouraging results earlier this year when it showed promise for both preventing and treating MERS - another coronavirus - in macaque monkeys.

The drug appears to help stop the replication of viruses like coronavirus and Ebola alike.

It's not entirely clear how the drug accomplishes this feat, but it seems to stop the genetic material of the virus, RNA, from being able to copy itself.

That, in turn, stops the virus from being able to proliferate further inside the patient's body. 

NIH researchers in charge of the macaque study recommended that it move ahead to human trials with the new coronavirus.

Scientists have listened, and human trials for remdesivir first began in Nebraska.

Most recently, researchers trialing the drug at the University of Chicago reported that most of the 125 COVID-19 patients they'd treated with the drug had been discharged from the hospital, according to Stat News. Two patients died over the course of the trial.

Remdesivir has been among the top contenders of existing drugs being trialed for treating coronavirus, although World Health Organization documents leaked last week suggested it had failed to help patients in a more than 200-person trial recover.

Gilead defended the trial, saying it believed the leaked data was a 'mischaracterization' of the study's results. It's unclear whether the newly-announced results are from the same trial.

The NIH is also studying remdesivir in a randomized controlled trial of 400 patients, meaning about half of the group would take the Ebola antiviral, and the others would get a placebo drug.

In addition to the results of its own trial (which did not have a placebo arm, making its data less informative), Gilead hinted at promising results from the NIH trial.

Addressing these reports in a pool meeting at the White House, Dr Fauci said: 'So that's something that will go with 31 percent improvement, doesn't seem like a knock out, 100 percent, it is a very important proof of concept.

'This is very optimistic, the mortality rate trended towards being better in the sense of less deaths in the REM designate group. Eight percent versus eleven percent in the placebo group.

'So bottom line. You're going to hear more details about this this will be submitted to a peer reviewed journal, and will be peer reviewed appropriately.'

Timing mattered as well. People who were treated early - within 10 days of their first symptoms - fared better, with 62 percent being discharged from the hospital within 14 days.

But the trial's results suggest the drug may still be beneficial, even if given relatively late. Nearly half of those who received remdesivir 10 or more days after they developed symptoms were also released from the hospital by day 14.

Generally speaking, the drug appeared safe in the trial, regardless of the duration of the treatment course.

More than 10 percent of patients treated with the antiviral became nauseous, and six percent of the five-day treatment group and 10.7 percent of the 10-day treatment group were in acute respiratory failure (also a complication of the infection itself).

The greatest risk posed to the coronavirus patients treated with remdesivir was liver damage. Lab work showed enzyme build up in 7.3 percent of the patients. the risk of liver damage became great enough that three percent were removed from the trial. 

SOURCE 

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How Close Is US to Herd Immunity for COVID-19? What the Numbers Show

There has been considerable interest lately in Sweden’s response to the COVID-19 pandemic. According to Sweden’s top epidemiologist, Dr. Anders Tegnell, Sweden is expected to achieve herd immunity in several weeks’ time.

Sweden pursued a much more relaxed mitigation strategy, practicing social distancing while avoiding a national lockdown, and approximately 20% of Swedes may have been infected and may now be immune to the virus.

Herd immunity is the point at which a large enough percentage of the population is immune to a disease that new cases are not likely to spread to others.

In other words, it’s when there are enough people who are immune to the disease that the disease has nowhere to go and eventually dies off. Therefore, every person who has been infected and recovered, or infected and remained asymptomatic, will help contribute to herd immunity.

But how close are we to achieving this? Although several studies are suggesting that there are far more people with antibodies to the virus than we know of, it’s not clear that we are very close.

An earlier study of pregnant women found that 29 out of 33 women who tested positive for SARS-CoV-2 were asymptomatic at the time of the test, and 26 of them never developed any symptoms at all. That finding suggests that for every pregnant woman with symptomatic COVID-19, there were seven who were infected with the virus, but never developed the disease.

That also suggests that for every woman with symptomatic COVID-19, there may be up to four other women who were infected, but don’t show symptoms.

The study is difficult to generalize because the sample was small and because the study took place in New York City, where incidences are expected to be very high. Furthermore, women seem to be less susceptible to the COVID-19 disease, which would cause the numbers to overestimate the asymptomatic prevalence of SARS-CoV-2.

To get a better idea, the state of New York has been conducting antibody tests and announced preliminary results on April 23, which found that 13.9% of New York residents had the virus and recovered.

In New York City, that rate was up to 21.2%. In upstate New York, away from the metropolitan centers, the rate was much lower at 3.6%.

If those numbers bear out, approximately 2.6 million people have been infected in the state, including 1.7 million people in New York City.

As of this writing, the state’s health department is reporting that it has had 288,045 positive test results. Initial testing has focused on symptomatic patients, so the majority of the positive cases reported by the health department likely indicate a symptomatic case of COVID-19.

If that’s the case, there would be approximately nine asymptomatic infections for every symptomatic case of COVID-19. Granted, those are suppositions based on preliminary data that hasn’t been released in its entirety.

In one of the first complete antibody studies on prevalence, researchers from the Stanford University School of Medicine tested a representative sample of 3,330 people in Santa Clara County, California.

When adjusted by demographics to represent the county, it found that the estimated prevalence of the virus ranged from 2.49% to 4.16%, which would represent between 48,000 and 81,000 people.

If those estimates prove true, the actual prevalence in Santa Clara County would be 50 to 85 times greater than the number of confirmed cases.

However, some have raised issues with this study. The raw, unadjusted prevalence found in the study was 1.5%, representing 50 people testing positive for the antibody out of 3,330 study participants.

According to the manufacturer of the test, the false-positive rate for the test is 0.5%, which would correspond to 17 false-positives in this study. Based on that, a third of the positive results may in fact be false-positives, which would greatly inflate the estimated prevalence.

Still, the study of Santa Clara County echoes the studies from New York that suggest that actual prevalence of SARS-CoV-2 is likely much higher than the number of confirmed cases would lead us to believe (albeit likely not 50 to 85 times higher).

While Sweden’s 20% immunity corresponds to New York City’s estimated 21.2% immunity, the same is not true for the rest of the country.

There are nearly 1 million cases in the United States at this time, so even with the greatest estimated prevalence from the Santa Clara County study, there would be 85 million actual cases, each of which would result in a person being immune to the virus.

The obvious problem is that there are approximately 245 million Americans left to be infected.

Given that the Santa Clara County numbers are likely overstated even for the COVID-19 hot spot of Santa Clara, the actual number of Americans left to be infected is many tens of millions more than that.

Herd immunity is an unrealistic goal for the United States until there is a vaccine. Even if the virus proves to spread much faster than previously thought, that would only require a much larger proportion of Americans to get infected and develop immunity.

That’s not to say that we should hunker down until a vaccine comes, but rather that we should proceed with the assumption that we will not have herd immunity. That will require careful planning and deliberate steps, but it’s certainly possible.

SOURCE 

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IN BRIEF

Andrew Cuomo's malfeasance: New York refused to send nursing home's COVID-19 patients to nearly empty and underutilized USNS Comfort, which is returning to Virginia (New York Post)

Senate Democrats — the same ones who feverishly castigated Brett Kavanaugh — refuse to acknowledge sexual-assault accusations against Joe Biden (The Daily Caller)

Former Hillary Clinton adviser calls on Biden to drop out: "We lose all moral authority" if we don't take Tara Reade seriously (The Daily Caller)

This week, Colorado, Mississippi, Minnesota, Montana, and Tennessee will get their economies rolling again, Reuters reports. Last week, it was Georgia, Oklahoma, Alaska, and South Carolina.

Better late than never (but still maybe too late for her political career): Michigan Gov. Gretchen Whitmer extends stay-at-home order while liberating state of draconian bans (The Federalist)

States face $500 billion shortfalls as Congress debates aid (Washington Examiner)

Trump calls reports he may fire HHS Secretary Alex Azar "fake news" (The Washington Post)

Navy recommends reinstating Brett Crozier, who was ousted as commander of the USS Theodore Roosevelt (Fox News)

How noble of them: Saudi Arabia bans flogging as criminal punishment (New York Daily News)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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“We’re all looking for answers”

Dr. Robert Cerfolio says his “aha” moment came at the bedside of a COVID-19 patient, who seemed literally to be suffocating to death on his own mucus. After hearing the code for a cardiopulmonary arrest, Cerfolio had rushed into the unconscious patient’s room and pulled out the thin ventilator tube delivering air into his lungs, to find it stopped up with discharge that had hardened to the consistency of concrete.

“Why aren’t we doing a bronchoscopy?” Cerfolio called out, referring to a procedure where physicians snake a thin scope through the tube in a patient’s airwaves and suck out obstructions. “This guy’s not dying of COVID. He’s dying of an obstructed tube!”

It was the early days of the crisis in New York City back when NYU Langone Health still had only a handful of COVID-19 patients. (The hospital declined to give a current number more precise than “hundreds and hundreds.” ) The answer that came back from the doctors in attendance was not what Cerfolio expected to hear. We aren’t allowed to, they told him. The procedure, which involved threading a smaller tube into the respirator conduit and down into the airways—and then pulling it out—could “aerosolize” the virus, dispersing it through the room and possibly infecting all the front-line health care workers around it. Which is why statements instructing against the procedure had been issued by a wide range of surgical and medical professional organizations.

Cerfolio, a thoracic surgeon whose many titles at the sprawling New York City medical center included senior vice president, vice dean and chief of hospital operations, was one of the few NYU Langone medical personnel in a position to override the directive. He was also the past president of the Thoracic Surgeons association, one of the organizations that had come out in opposition to the technique.

Cerfolio overrode the guidance. The patient lived. And Cerfolio and his colleagues at NYU Langone developed a new protocol for protective equipment and other precautions for doctors willing to do the procedure. They have since performed bronchoscopies on hundreds of COVID-19 patients.

Luis Angel, one of Cerfolio’s colleagues, invented a new self-contained method for tracheostomies that can sometimes keep doctors from putting critically-ill patients on ventilators, which requires them to be put in a medically induced coma. The procedure, which requires incisions into the lower neck, is known to place health care providers at risk, but if safely performed allows doctors to use a bigger tube than is used for ventilation, one that is easier to clean.

NYU posted a video demonstrating the procedure and Cerfolio’s phone lines lit up.

“I’ve been called by the head of thoracic surgery at the main academic institution in Spain, I’ve talked to a guy in Italy and we’re doing the exact opposite of what they have done there—even a friend at another hospital called me and said, ‘I heard you guys are doing traches, what the hell you doing?’” Cerfolio says. “We’ve done 63 of these and not a single doctor or nurse has gotten sick—not one. Sixty-two of the patients are still alive. We know we can do it safely and we know we are helping patents.”

As COVID-19 washes over the United States, doctors in hotspots across the nation are still deciding how best to battle a mysterious and deadly disease scientists don’t yet fully understand. And while many are looking to the experience of health care providers in China and Europe, they are also racing to develop new procedures of their own and debating best approaches—often on the fly. In a fast-moving pandemic, there’s not always time to wait for medical journals to publish. And the flood of reading material is growing so vast it’s hard for many to track. So every day, clinicians around the world are helping each other as they find their way, trading and debating tips through social media, over conference calls and even over old medical school email chains. Doctors at Columbia University Medical Center are cautious about the Langone procedures. “The experience we have from China, Italy, Spain, and Iran shows an increased risk to healthcare workers performing airway procedures and caring for patients with tracheostomy,” says Dr. Susannah Hills, a surgeon. “It’s crucial to learn from other countries that have been dealing with this for longer than we have.”

On the other side of the nation, Dr. Tom Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in California, had his first “aha” moment when he got his first patients last month.

In those early days, he treated both a 60-year-old patient and an 80-something man, both of whom arrived stable, with good vitals, and normal X-rays, then spiraled into a rapid decline for seemingly no reason. Both ended up on ventilators, which drove Yadegar to the literature.

Through his research Yadegar realized that what he was seeing was a “cytokine storm,” a violent inflammatory reaction that often kills the sickest COVID-19 patients. Soon he identified several blood markers, like the levels of ferritin, a protein that contains iron, that seemed to predict which patients were most likely to develop the overactive immune response. He wrote up protocol guidelines for his staffto follow that have them sometimes administering immunosuppressant drugs normally used to avoid organ rejection to patients who seem likely to get in trouble.

“Up until a month ago, I didn’t know about cytokine storms,” he says. “I wasn’t looking for it. And then to treat it, you’re doing something that you probably have never done in your life, which is to give a patient in the ICU strong medications to suppress the immune system. It’s totally counterintuitive.”

Though similar protocols had previously been reported in China, Yadegar’s experience was the first time many of his local peers had heard of the approach. He estimates he’s kept three critically ill patients offof ventilators and removed three more as a result of the protocol. Now he is overseeing COVID-19 response in two affiliated area hospitals. Yadegar shared his experiences with 50 or so fellow graduates of USC Medical School on a weekly call coordinated by his old program director. He then was interviewed about his approach on Fox and Friends, which prompted a flood of inquiries from other caregivers across the nation. “This is such a new disease that all of us are struggling just trying to figure out what’s going on,” he says.

Through these kinds of discussions and experimentation, unexpected observations are emerging that could transform care in the months ahead. One of the more significant is the debate about when best to place patients on ventilators.

Dr. Scott Weingart, a critical care physician at Stony Brook University Hospital, one of the busiest COVID-19 hospitals on Long Island, recently made an observation that he was literally able to broadcast out to the world. The key metric used to move patients to respirators is “oxygen saturation,” which measures how much oxygen is being held in a patient’s blood. Usually, when a patient receiving oxygen through a normal mask can’t get above 80 percent, doctors assume the lungs are compromised and the patient needs to be intubated. But Weingart was noticing that patients at levels that guidelines told him needed immediate ventilation weren’t behaving like patients who were suffocating. Many, though short of breath, were able to speak in complete sentences, give full medical histories and were even cheerful—a state he and his colleagues call “happy hypoxia.”

Although Weingart couldn’t explain the discrepancy, he began to suspect some unknown characteristic of the virus was distorting the results. He began second-guessing the protocols.

“These levels are at numbers that would scare the hell out of us before this,” he says. “But when we started holding off on putting those breathing tubes in and used simple measures like making the patient roll over in bed like you do every night while sleeping, all of a sudden there is a cohort, a group of these patients that didn’t wind up needing the breathing tube.”

Weingart, who hosts a popular podcast and blog followed by tens of thousands of ER doctors and critical care doctors, shared his experience on air and online—and heard from scores of others around the world who were noticing the same thing.

The finding is significant. Not just because it saves ventilators for sicker patients but because in order to go on a ventilator, the patient must be put in a medically induced coma, and there is anecdotal evidence that the pressure exerted by mechanical breathing machines can be injurious to the lungs of COVID-19 patients, Weingart says.

“Supportive care and watchful waiting have worked out in a lot of these COVID-19 patients, as opposed to what I call a knee-jerk response to sticking a tube down their throats,” he says.

For physicians just now seeing their first patients— or still waiting for the full brunt of the pandemic to hit their areas—the experiences of frontline providers like Weingart, Yadegar and Cerfolio are proving invaluable. Sometimes the tips are as simple as telling conscious patients in the hallways to lie on their stomachs, instead of their backs, which results in more effective oxygen delivery to the lungs involved in air-blood transfer. Some are learned through hard experience, such as that the use of the blood thinner heparin seems to help prevent potentially deadly blood clots in patients with a body mass index greater than 40, who seem to be at greater risk of dying. (Both additional modifications were recently adopted at NYU Langone). But the tips can also prove logistical.

In the weeks before she saw her first cases, Michelle Diaz, an ER physician who works at hospitals across New Hampshire through her company EMstaff, tuned in regularly to Weingart’s podcast and others like it where she learned about the changing views on the timing of intubation. She also picked up numerous tips about what to expect and how best to prepare for it through an email chain that had previously been used to announce baby births by colleagues she had met while doing her residency back in the late aughts at Brooklyn’s Kings County Hospital.

“One day somebody wrote that their hospital was still quiet and asked how everybody else was doing, and people just started posting stuff,” Diaz recalls. “People are just sharing their experience, they are saying, ‘I’ve seen this kind of clinical course, I tried this way of helping their oxygenation.’ But also people are sharing ideas about what they’re doing at their hospital to help with the volume and manage flow—‘we have a tent set out over here and we have this personnel over there.’”

For physicians seeing their first patients, the experiences of frontline doctors is proving invaluable. Diaz even learned how to convert a wall oxygen outlet into a makeshift ventilator if she were to run out of equipment. “It’s been really helpful to see these ideas being exchanged,” she says. “It’s not just informative, it’s inspiring.”

SOURCE 

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Do Lockdowns Save Many Lives? In Most Places, the Data Say No.

Do quick shutdowns work to fight the spread of Covid-19? Joe Malchow, Yinon Weiss and I wanted to find out. We set out to quantify how many deaths were caused by delayed shutdown orders on a state-by-state basis.

To normalize for an unambiguous comparison of deaths between states at the midpoint of an epidemic, we counted deaths per million population for a fixed 21-day period, measured from when the death rate first hit 1 per million—e.g.,‒three deaths in Iowa or 19 in New York state. A state’s “days to shutdown” was the time after a state crossed the 1 per million threshold until it ordered businesses shut down.

We ran a simple one-variable correlation of deaths per million and days to shutdown, which ranged from minus-10 days (some states shut down before any sign of Covid-19) to 35 days for South Dakota, one of seven states with limited or no shutdown. The correlation coefficient was 5.5%—so low that the engineers I used to employ would have summarized it as “no correlation” and moved on to find the real cause of the problem. (The trendline sloped downward—states that delayed more tended to have lower death rates—but that’s also a meaningless result due to the low correlation coefficient.)

No conclusions can be drawn about the states that sheltered quickly, because their death rates ran the full gamut, from 20 per million in Oregon to 360 in New York. This wide variation means that other variables—like population density or subway use—were more important. Our correlation coefficient for per-capita death rates vs. the population density was 44%. That suggests New York City might have benefited from its shutdown—but blindly copying New York’s policies in places with low Covid-19 death rates, such as my native Wisconsin, doesn’t make sense.

Sweden is fighting coronavirus with common-sense guidelines that are much less economically destructive than the lockdowns in most U.S. states. Since people over 65 account for about 80% of Covid-19 deaths, Sweden asked only seniors to shelter in place rather than shutting down the rest of the country; and since Sweden had no pediatric deaths, it didn’t shut down elementary and middle schools. Sweden’s containment measures are less onerous than America’s, so it can keep them in place longer to prevent Covid-19 from recurring. Sweden did not shut down stores, restaurants and most businesses, but did shut down the Volvo automotive plant, which has since reopened, while the Tesla plant in Fremont, Calif., was shuttered by police and remains closed.

How did the Swedes do? They suffered 80 deaths per million 21 days after crossing the 1 per million threshold level. With 10 million people, Sweden’s death rate‒without a shutdown and massive unemployment‒is lower than that of the seven hardest-hit U.S. states—Massachusetts, Rhode Island, Louisiana, Connecticut, Michigan, New Jersey and New York—all of which, except Louisiana, shut down in three days or less. Despite stories about high death rates, Sweden’s is in the middle of the pack in Europe, comparable to France; better than Italy, Spain and the U.K.; and worse than Finland, Denmark and Norway. Older people in care homes accounted for half of Sweden’s deaths.

We should cheer for Sweden to succeed, not ghoulishly bash them. They may prove that many aspects of the U.S. shutdown were mistakes—ineffective but economically devastating—and point the way to correcting them.

SOURCE 

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IN BRIEF

Trump lays out new coronavirus testing "blueprint" as states weigh reopening (NBC News)

U.S. District Judge Roger Benitez tosses California's "onerous and convoluted" ammunition purchase law (AP)

24th Judicial Circuit Judge Judge F. Patrick Yeatts says Gov. Ralph Northam's gun-range shutdown violates state law (The Washington Free Beacon)

Two more people come forward to corroborate account of Joe Biden accuser (Bongino.com)

Michael Flynn files court documents with evidence he was "deliberately set up" by the FBI (The Daily Wire)

Senate will return on May 4 to start Phase 5 coronavirus relief bill (The Hill)

New York cancels Democrat presidential primary, angering Bernie Bros (The New York Times)

Policy: Ending the lockdowns isn't about saving money. It's about saving lives. (Mises Institute)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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How sunlight may help us fight coronavirus

People with low levels of Vitamin D are almost twice as likely to get the extreme lung infections that are now killing COVID-19 patients.

Even before the pandemic, acute respiratory tract infections have been a major killer. They were responsible for 2.8 million deaths worldwide in 2015.

In Neale’s review, which encompassed 78,000 participants, it was found that those with low levels of vitamin D — the “sunshine vitamin” — were almost twice as likely as those with high vitamin D levels to get the type of extreme lung infections that now are killing COVID-19 sufferers, and they were even more likely again to be sicker for longer.

And so how does this translate to the pandemic? “Now, more than ever, is not the time to be vitamin D deficient,” Neale says from Brisbane’s QIMR Berghofer Medical Research Institute. “It would make sense that being vitamin D deficient would increase the risk of having symptomatic COVID-19 and potentially having worse symptoms. And that’s because vitamin D seems to have important effects on the immune system.”

Neale was speaking before US President Donald Trump weighed in with his comments last week about disinfectant and ultraviolet light being used to combat the virus. And, as bizarre as it may seem, there is reason to think the President is on to something, at least as far as the sunlight goes.

It’s a message that people seem innately to understand. The carpark at my local beach has been more full in recent weeks than it usually is in the middle of summer school holidays. People are out there soaking it all up, feeling sorry for all those city folk denied access to their shimmering sands, not even allowed to sunbake in parks.

For all vitamin D’s advantages, Neale doesn’t take vitamin D pills. She is cognisant of the emerging evidence that the sun provides more benefits than just the sunshine vitamin.

Those other benefits are varied.  Dermatologist Richard Weller from the University of Edinburgh discovered more than a decade ago that the body got a shot of a molecule called nitric oxide when exposed to sunlight. He has been curious about the notion that nitric oxide and sunlight may have some effect on COVID-19.

Nitric oxide has been shown to cause blood vessels to widen, increasing oxygen flow and lowering blood pressure. The discovery of its role in the human body paved the way for Viagra.

“There are mechanistic reasons to think about benefit,” says Weller. “Ultraviolet light (which produces nitric oxide in the skin) lowers blood pressure and also markers of diabetes. Both of these are risk factors for death from COVID-19.” He points out that most viral infections wax and wane with the seasons, probably because of ultraviolet light, not heat.

The story of nitric oxide goes back to the 1990s when it was a hot molecule that won three scientists the Nobel prize. At that time, Goran Hedenstierna had a PhD student at Sweden’s Uppsala University who was among the first in the world to show that if you gave humans nitric oxide when they were suffering from severe constriction of the lungs, the lungs relaxed and oxygen levels normal­ised. During the severe acute respiratory syndrome outbreak of 2003-04, Hedenstierna had another student, Luni Chen, who wanted to go back to her home country, China, to see if nitric oxide worked to help patients dying of acute respiratory failure from that coronavirus.

“She went there in May 2003 when it was a most severe situation,” recalls Hedenstierna, Skyping from Sweden. “I organised things to be shipped — ventilators and bottles of nitric oxide gas. It took a lot of organising with the local authorities because it was a major intrusion on their crisis.”

Chen managed to get the nitric oxide treatment to six patients and she had eight in a control group receiving placebo. Five of the six who received nitric oxide were on ventilators when the study began. Only one was still on it by the end. Chest X-rays showed their lung congestion improved. One died.

Whereas in the control, six were on ventilators at the beginning and five were still being ventilated at the end. The X-rays showed only two improved, three stayed the same and three worsened. Two died.

The study was only small but Hedenstierna was surprised at the strength of the results. “We most often do see an improvement of oxygenation of 20 per cent or more in people with acute respiratory failure, but these SARS patients, they increased their PAO (the ratio of oxygen in the blood to oxygen that is breathed) almost threefold. I have never seen this big an increase. We never dis­cussed that to any extent at that time.”

To understand why nitric oxide appeared so devastatingly effective against SARS, Hedenstierna was involved in a further study in a high-security lab in Brussels where it was shown that nitric oxide killed the SARS virus in a test tube.

“It had an antiviral effect which was what we had hoped to see in view of the improved chest X-rays. So it’s helping the patient breathe and it’s killing the virus,” he says.

The way forward

Such results are now being picked up. Nitric oxide, this molecule we produce naturally with sunshine, has been used by doctors in Italy with success to help COVID-19 patients, but not in a study format. A trial of 240 COVID-19 patients is up and running in Sweden, the US and Austria.

Weller says the doses of nitric oxide the patients will receive are much greater than what you could get from sunlight. But the other half of the equation is whether people catch the disease in the first place. He is running a study to see what effects UV radiation has on the flu because there’s still not enough data on COVID-19. “I hope that our epidemiological studies will show whether it (sunshine) makes any difference at population level.”

One of Weller’s collaborators, Prue Hart from Perth’s Telethon Kids Institute, has spent a career pursuing matters of immunity and ultraviolet light and vitamin D. She isn’t so sure that UV light will have a direct effect on the novel coronavirus.

“I think the greater benefits of UV radiation during this pandemic are about our brain health,” she says. “We all know how good we feel after time in the sun, and these good feelings cannot be replaced by vitamin D from a bottle. Now that it is autumn, and the sun is not so intense and burning, I think everyone should be encouraged to get exposed to more sun, as long as they never get sunburnt. In addition, whilst outside getting a little bit more sunshine, they will be exercising.”

She says while the link between sunshine, endorphins, serotonin and mood have been known for years, in 2018 Chinese researchers proved another important piece of the mental puzzle involving a molecule called urocanic acid that resides in the outermost layer of the skin. The researchers proved that after giving shaved mice the equivalent of 30 minutes of sunshine, urocanic acid was released from the skin into the blood, then crossed the blood brain barrier and went into almost all parts of the brain. In the brain, it is involved in making glutamate — the brain’s most abundant “excitatory neurotransmitter” — which has long been known to play an important role in learning and memory.

“This is another reason time outside in the sun is important for children who are now doing online learning at home,” Hart says. Food for thought as police shoo sunbathers out of parks and arrest people lying on beaches.

And it certainly will encourage Neale to continue with her five-to-10 minute routine of midday Brisbane sun. “I personally think the best way of getting vitamin D is sun exposure because we get the other benefits that might be there, but I accept there is a role for pills for people who can’t get out,” she says, adding that she always takes care not to burn.

SOURCE 

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'It's a horror movie.' Nurse working on coronavirus frontline in New York claims the city is 'murdering' COVID-19 patients by putting them on ventilators and causing trauma to the lungs

A frontline nurse working in New York on coronavirus patients claims the city is killing sufferers by putting them on ventilators.

'It's a horror movie,' she said through a friend. 'Not because of the disease, but the way it is being handled.'

And she said relatives of the sick need to make it clear as soon as a person is taken to the hospital that they do not want them hooked up to the breathing machines.

The nurse, who has relocated to New York temporarily to help with the city's COVID-19 crisis, persuaded a friend — a nurse practitioner who is not working on coronavirus patients — to make the video for her in order to tell the world what she says is happening inside hospitals.

'I am her voice here. I'm going to tell you what she has told me,' said the nurse practitioner, who was identified only as Sara NP. 'She wants this to get out.'

'She has never seen so much neglect. No one cares. They are cold and they don't care anymore. It's the blind leading the blind.'

'People are sick, but they don't have to stay sick. They are killing them, they are not helping them,' added the friend in the video posted on YouTube.

'She used the word murder, that coming from a nurse who went to New York City expecting to help. 'Patients are left to rot and die — her words. People are being murdered and no one cares.'

Sara would not reveal which hospital the nurse is working in 'for the safety of those involved.'

More than 12,000 people have died from the virus in New York City, with another 4,300 dying in other parts of the Empire State, which is a far larger number than any other state in the country.

Republican Minnesota state Senator Scott Jensen told Fox News' Laura Ingraham that Medicare pays hospitals three times as much if patients are placed on ventilators.

'How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars,' Jensen later posted on his Facebook page.

New York Governor Andrew Cuomo has said that around 80 percent of people who go on the machines die, although he's referencing patients who were already in dire conditions before being put on the machines.

 This is not the first time the use of ventilators have been questioned for its efficacy. 

In a YouTube video posted earlier this month New York emergency room doctor Cameron Kyle-Sidell said: 'I've talked to doctors all around the country and it is becoming increasingly clear that the pressure we're providing may be hurting their lungs.

'It is highly likely that the high pressures we're using are damaging the lungs of the patients we are putting the breathing tubes in.

'It's not our fault. We didn't know,' added Kyle-Sidell, saying that is the way other acute respiratory syndromes have been treated.

'We are running the ventilators the wrong way,' he said, calling for the protocols to be changed.

'COVID positive patients need oxygen, they do not need pressure. They will need ventilators, but they must be programmed differently.'

Kyle-Siddell did not return calls from DailyMail.com. He told Medscape on April 6 he stepped down from working in the intensive care unit at Maimonides Medical Center in Brooklyn because he didn't want to follow the hospital's ventilator protocol.

'I could not morally, in a patient-doctor relationship, continue the current protocols which, again, are the protocols of the top hospitals in the country. 'I could not continue those,' he said. 'You can't have one doctor just doing their own protocol.'

Maimonides also did not answer a request for comment.

Sara said COVID-19 patients are placed on ventilators rather than less invasive CPAP or BiPAP machines due to fears about the virus spreading.

She said: 'The patients don't know any better. They don't have family with them. There is no one there with them to advocate for them. So they are scared, and they give consent.

'The ventilators have high pressure, which then causes barotrauma, it causes trauma to the lungs', adding that the best way to survive is to 'buck the system.'

'Your loved one is not going to have you in there advocating for them once they go in, you're not allowed in. 'Do not give consent for intubation if you don't want to be intubated or for your loved one to be intubated… As soon as you give that consent, you might not come out of it.'

And she said if there is a specific medication — such as the hydroxychloroquine that President Donald Trump has touted, the best thing to do is lie.

'A tip from inside the system — if you want a medication to be given, you've got to report that it's an at-home medication, and that you demand that it be continued.'

Sara claimed patients who stop breathing are not resuscitated — again due to fear of the virus spreading. 'Full code, not doing compressions, family is not there. They have no one to answer to. No one is being held accountable.'

She said there are other problems in the 'crappy' hospital where her friend is working, such as lack of personal protective equipment.

'They stay in the same PPE all shift, except for the top pair of gloves… they're only changing the gloves on the outside.'

They keep the same gowns and masks on because the theory is that all patients on a COVID-19 floor will already have the virus. But she says that is faulty logic as some are there to see if the coronavirus can be ruled out.

'So even if they're rule-out COVID and they're not COVID they're going to get COVID because they're using the same PPE all shift and they're carrying that contamination to all of the patients

And she claimed some nurses who have been brought to New York are sitting in hotels never being called.

'Yet they're still understaffed and there are hundreds of people, hundreds of nurses in the hotels waiting to be called on to a shift. So there is manpower enough if the goal were to actually save people, but resources are not being utilized properly or to full capacity in a way that maximizes the patient benefit or improves the outcomes.'

The nurse practitioner also criticized some of the nurses who are risking their own health to treat COVID-19 patients.

'We have nurses being celebrated as heroes who are killing people,' she said.

'They're not heroes, and they're being brainwashed to think they're doing something great just by going to work because they're brave enough to go to work.

'But what are you doing at work? You're certainly not saving people if you're not even running codes. You're not even going into patients' rooms. You're a coward. You're hurting people, you're killing them, you're contributing to the problem.

The nurse practitioner said she knows she will receive hate messages for her comments. 'Frankly, I don't care because this could save someone's life.'

SOURCE 

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here  (Personal).  My annual picture page is here.  Home page supplement

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