Two thirds of cases are missed, app expert says

The British government’s data on coronavirus cases is nonsense and two thirds of cases in Britain are undiagnosed, a leading epidemiologist has claimed.

Tim Spector, professor of genetic epidemiology at King’s College London, has criticised the British government’s refusal to class common symptoms as official indicators.

The government has listed a high temperature and a new, continuous cough as the primary symptoms of COVID-19. There is evidence, however, that a loss of taste or smell is a common sign of infection. Other countries, including the US, have recognised this as a symptom on more detailed lists.

The Australian Department of Health lists fever, coughing, sore throat and shortness of breath as possible symptoms.

Professor Spector has collected data from three million Britons on his team’s symptom-tracking app.

“The reason that we got a bit stuck in this country is we took the data from China and just instantly said, ‘OK, the disease only has two symptoms: it’s fever or it’s persistent cough.’ That meant we were missing about 60 per cent of cases,” he said.

“Only people with those two symptoms got tested and ended up on the statistics. All this governmental data on confirmed cases and how many people have recovered, it’s all nonsense.”

In partnership with the British Department of Health and Social Care, 10,000 app users are being sent COVID-19 tests each week, within the first day or so of developing symptoms.

Clear patterns have emerged from the data in the six weeks since the app went live and the team are close to being able to plot how the disease will progress, depending on the symptoms someone has on day one.

According to the data the virus may have arrived in Britain at the new year as many users reported symptoms in January. At the peak one in 10 people had the virus. The team estimated that at the end of April there were more than 300,000 symptomatic cases, a fall from a peak of more than two million at the start of the month.

Professor Spector said: “We’re able to allocate people into five or six groups at the moment that follow different patterns of symptoms at different time points. It’s not random.”

In one group are those whose symptoms are a sore throat and muscle pains, which then develop to include diarrhoea, stomach pains and fatigue.

People in another group start with a headache, which progresses to a cough and fatigue, then the cough gets worse, they develop shortness of breath and may need to go to hospital. This classification is important in determining which patients are high risk.

Alan McNally, professor of microbial genomics at the University of Birmingham, agreed that there were many other possible signs of coronavirus infection. “There are myriad less common symptoms attached to COVID: things such as COVID toe [a rash on the feet] and loss of appetite,” he said.

He defended the decision by the government to concentrate on a few, however, saying: “I don’t see where on earth you draw a line on symptoms and whether or not they are COVID.”

Users of the COVID Symptom Study app in Britain log how they feel daily, even if they are healthy. The most useful loggers are people who were in good health when they first logged on to the app and have since developed symptoms.

SOURCE 

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Flawed Models Show Why COVID-19 Policies Must Consider Total Mortality

Policymakers need to scrutinize their epidemiological models.

In response to the coronavirus pandemic, the federal government has been heavily influenced by the Institute of Health Metrics and Evaluation’s computer model, which has projected from 60,000 to 240,000 COVID-19 deaths in the U.S.

This epidemiological model is now being criticized as flawed and misleading as a source of public information and for government decision-making. Besides the institute’s model, all other COVID-19 models are grounded in important assumptions about which there is currently little knowledge.

Approaches other than models are needed to properly understand this pandemic.

One approach that has not been explored in any detail is the examination of deaths from all causes in addition to deaths from COVID-19, the disease caused by the new coronavirus.

Two major databases that track COVID-19 cases and deaths in the U.S., but not total mortality, are WorldOMeters and the Johns Hopkins University Hub. These trackers show major variation in COVID-19 mortality risk. 

For example, as of April 22, WorldOMeters showed 47,681 COVID-19 deaths in the U.S. (50 states and the District of Columbia) with a rate of 144 deaths per 1 million people.

However, note that 71% of the deaths have occurred in six high-risk states (New York, New Jersey, Connecticut, Massachusetts, Louisiana, and Michigan) with 17% of U.S. residents and a death rate of 624 per million.

Ten percent have occurred in five medium-risk states (Rhode Island, Pennsylvania, Illinois, Maryland, and Indiana) and the District of Columbia with 12% of U.S. residents and a death rate of 124 per million, and 19% have occurred in the remaining 39 low-risk states with 71% of U.S. residents and a death rate of 40 per million.

It remains to be determined, however, whether these COVID-19 deaths have actually increased the total U.S. deaths this year. The best data on both COVID-19 deaths and total deaths in the U.S. come from the Centers for Disease Control and Prevention‘s National Center for Health Statistics.

During the five weeks ending Feb. 1 through Feb. 29, the Centers for Disease Control and Prevention reported 282,084 total deaths, which were 96% of the expected deaths based on concurrent 2017-2019 deaths. During the five weeks ending March 7 to April 4, the CDC reported 273,798 total deaths, which were 96% of the expected deaths. 

Of the 9,474 COVID-19 deaths reported during these 10 weeks, 78.5% were among people over age 65, 21.4% were between the ages of 25 and 64, and only 0.1% were ages newborn to 24 years.

Those death counts through the end of March are preliminary, but they do not indicate that the total number of deaths in 2020 is greater than the comparable number of deaths during each of the three prior years.

Once the number of COVID-19 deaths and total deaths during the entire month of April are known, it will be clear whether there has been an increase in the total number of U.S. deaths this year.

One reason there may not be an increase in total deaths is because some deaths are being classified as COVID-19 deaths even when COVID-19 is not the underlying cause.

Normally, mortality statistics are compiled in accordance with World Health Organization regulations specifying that each death be assigned an underlying cause based on the current 10th revision of the International Statistical Classification of Diseases (ICD-10).

However, the Centers for Disease Control and Prevention reports that COVID-19 deaths are being coded to ICD-10 code U07.1 when COVID-19 is reported as a cause that “contributed to” death on the death certificate, but is not necessarily the “underlying cause.” Also, some of those deaths do not have laboratory confirmation of COVID-19 infection.

Thus, it’s possible that the focus on COVID-19 deaths has resulted in a lower number of deaths from seasonal flu, pneumonia, and other causes, compared with the number that would normally occur this year.

The CDC has stated that the number of flu hospitalizations estimated for this season is lower than total hospitalization estimates for any season since the CDC began making these estimates.

Furthermore, it’s possible that the lethality of COVID-19 is no greater than that of the seasonal flu. 

A new Stanford University survey indicates that the population prevalence of COVID-19 in Santa Clara County, California, ranges from 2.5% to 4.2% and that the number of infected persons is 50 to 85 times the number of confirmed COVID-19 cases.

This preliminary finding suggests that at most 0.1% of infected persons will die from COVID-19, comparable to the seasonal flu death rate. Several other new studies indicate similarly lower fatality rates for COVID-19.

Americans need clarity. The federal government response to the coronavirus pandemic should not be based on flawed models, but rather on a localized public health approach that focuses on the high-risk areas of the United States and also on the high-risk elderly and those with comorbid conditions.

The emphasis should be on changes in personal behavior, such as staying at home for work or school if ill, covering coughs or sneezes, hand-washing, and avoiding those with respiratory symptoms.

Above all, the pandemic and COVID-19 deaths must be put in proper perspective, given the unprecedented societal and economic disruption of the current national lockdown.

SOURCE 

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Coronavirus treatment: Antibody that blocks infection discovered

Researchers from Utrecht University in the Netherlands, as well as the Erasmus Medical Centre and the company Harbour BioMed (HBM), identified it as a potential method of neutralising COVID-19.

And while the team’s discovery was made on human cells grown in the laboratory, they are hopeful it will produce the same results in patients.

The breakthrough offers hope of a treatment or a vaccine for the deadly virus, which has infected more than 3.6 million worldwide and killed over 250,000 people.

Study co-lead author Professor Berend-Jan Bosch said the antibody targets the deadly bug’s infamous ‘spike protein’.

The virus hooks onto a locking point on human cells to insert its genetic material, make multiples copies of itself and spread throughout the body.

“Such a neutralising antibody has potential to alter the course of infection in the infected host, support virus clearance or protect an uninfected individual that is exposed to the virus,” Prof Bosch said

It could lead to a therapy that would be given to somebody immediately after they become infected or exposed.

The antibody binds to an enzyme called ACE2 which has been identified as the receptor COVID-19 latches onto when it attacks the body.

In tests, the monoclonal antibody neutralised SARS-CoV-2 – however, further studies are planned to see if the findings translate to the clinic.

Prof Bosch and his colleagues identified it from 51 cell lines from mice that had been engineered to carry human genes.

When they were exposed to different coronaviruses they produced antibodies to the spike protein.

Only one, named 47D11, destroyed both SARS-CoV and SARS-CoV-2. It was then turned into a human version.

Prof Bosch said: “This cross-neutralising feature of the antibody is very interesting and suggests it may have potential in mitigation of diseases caused by future emerging related coronaviruses.”

The study, published in Nature Communications, offers potential for “prevention and treatment of COVID-19,” said Prof Bosch.

It builds on almost two decades of work by the same team since the first SARS epidemic of 2002 which killed almost 800 people and infected over 8000.

Prof Bosch said: “Using this collection of SARS-CoV antibodies we identified an antibody that also neutralises infection of SARS-CoV-2 in cultured cells.”

“The antibody used in this work is ‘fully human’ – allowing development to proceed more rapidly and reducing the potential for immune-related side effects.”

Conventional therapeutic antibodies are first developed in other species and then must undergo additional work to ‘humanise’ them.

The therapy is being developed by Massachusetts-based global tech giant Harbour BioMed.

SOURCE 

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IN BRIEF

Federal judge orders officials to restore New York primary, drawing cheers from Sanders camp (The Washington Post)

Gov. Gavin Newsom's office refuses records request on "murky" $1 billion mask deal with Chinese company (Fox News)

In 1991, Joe Biden voted to block creation of Senate office that handles sexual-harassment complaints (The Washington Free Beacon)

Nothing to see here — move along! Obama's office condemns Senate investigation into Ukraine, Biden (The Washington Post)

San Francisco police chief bans "thin blue line" face masks (PoliceOne)

Policy: Tom Cotton is right about restricting Chinese student visas (The Federalist)

Policy: Washington must preclude a flood of tort claims that threaten to kneecap the economy even further (City Journal)

Justice John Roberts and leftist colleagues wary of exemptions to birth-control mandate — an issue that shouldn't even exist in a country that cherishes religious liberty (The Washington Free Beacon)

Supreme Court reverses fraud convictions of Chris Christie aides in New Jersey "Bridgegate" scandal (CNBC)

The EU is facing its worst-ever recession; economy projected to shrink by 7.4% (The New York Times)

Health workers that volunteered to come to New York during pandemic have to pay state income tax, says socialist Governor Cuomo (PIX11)

Policy: Blame the federal government for militarized police crackdowns on citizen protests (Washington Examiner)

Policy: America needs to rediscover civics in education (E21)

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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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Simple arithmetic demonstrates that the epidemic, outside nursing homes, is essentially over

Daniel Horowitz

We are weeks past the peak of coronavirus hospitalizations, yet the reported national death numbers keep rising 2,000 or more every single day. It made no sense to anyone who has followed the curves in any other country, but now we have our answer. The Hartford Courant reported that 90% of all deaths in Connecticut last week were in senior care facilities. This explains why these increased deaths don’t make sense with the reality of empty hospitals in most places.

This revelation should change everything we know about the current state of affairs with coronavirus. Governors are justifying the continued lockdown by pointing to rising deaths, sometimes significantly, in many states and counties. But it now appears, using simple arithmetic, that in most states, the overwhelming majority of deaths are in nursing homes, and in some states and counties, nearly every new death is in a senior facility. And in fact, even in nursing homes, it appears that while numbers are being recorded now, the actual deaths occurred earlier during the peak. Nothing else matters until this fact comes to life.

80%-90% of new deaths, 50%+ total deaths are in senior care facilities

As I reported yesterday, not only do deaths in nursing homes now compose more than 50% (and in some states as high as 80%) of total deaths from the beginning of the entire epidemic, that percentage is sharply increasing in every state day by day. This means that nearly all the new deaths, depending on the state, are occurring in nursing homes.

Every state has a recorded death count that you can track by date, but the recording of the subcategory of nursing home deaths is pretty new in most states, and there is no cumulative tally by date. Nonetheless, using news reports and data from previous dates, we can easily see how many of the new total deaths since then were from nursing homes.

Phil Kerpen has recorded these numbers in his Twitter account, and I have independently verified them by going to each state’s database.

Those are some state numbers of the total nursing home deaths in a respective state’s overall deaths since the beginning of the epidemic. But then you have Virginia, where there have been new recorded nursing home deaths that are higher than the entire total from the past week.

What this demonstrates is that not only are most new deaths occurring in nursing homes, some of them are also being backfilled into the count now that states are beginning to focus on nursing homes as an important demographic data point. This means that depending on the state, either some of the deaths weren’t originally recorded at all during the peak weeks, or they were recorded in the state’s total but because the patient died in a hospital, they weren’t initially listed as a nursing home death, even though the patient came from such a facility.

I’m seeing the same thing in my home state of Maryland. There have been 317 new recorded deaths in Maryland from April 28 through May 6, and 333 from nursing homes! Again, clearly, not only are there few coronavirus deaths outside nursing homes any more, but even some of the nursing home deaths are either being added retroactively to the state’s overall total or having the effect of revising the previously reported non-nursing home subtotal down because they are now researching past hospital deaths of nursing home patients.

For example, in Baltimore County, 124 of 149 total deaths occurred in these facilities. That is 83% of all deaths. But if you tally the numbers since April 29, there are 59 new nursing home deaths, even though the total county deaths only went up by 55.

Different states and counties have varying numbers. In Minnesota, for example, 89 percent of the new deaths recorded on Tuesday were in nursing homes. Some might not be quite as dramatic, but they tell the same story. The curve has long been flattened, the deaths have nearly stopped in most areas of the country outside nursing homes, and even in nursing homes, some of the numbers are being backfilled, and there are serious questions about the data and criteria for coding these deaths.

This is why some counties in Pennsylvania are asking the state to be transparent and separate out nursing home deaths from other deaths per day. They are being told they cannot open up because there are still people dying, but the question of whether the tragedy is largely confined to nursing homes or whether it’s widespread makes a huge difference. Most counties in Pennsylvania are seeing upwards of 80% of deaths occurring in nursing homes in recent days and weeks. The government of Livingston, New Jersey, is making the same request because 80% of all recorded deaths are occurring in long-term care facilities, and the growth of that share of the pie is accelerating every day.

I have checked over 30 states that produce data on nursing home deaths and have found that in each one, the share of deaths that nursing homes compose of the statewide total has dramatically increased to varying degrees over the past 1-3 weeks.

The implication is that there is no excuse whatsoever not to open up the country and throw all our resources at protecting nursing homes. But it also raises questions as to what is going on with the count in nursing homes.

A scary national death tally built on questionable nursing home data

Fox News reported on Tuesday regarding the New York numbers: “Exactly how many nursing home residents have died remains uncertain despite the state’s latest disclosure, as the list doesn’t include nursing home residents who were transferred to hospitals before dying.”

At least during the peak time, that could have been a large number, if not the majority of nursing home deaths. This could shed light on what is going on now. Could it be that the numbers aren’t surging quite as much as the toplines suggest, but that some states are now recording more prior deaths as nursing home deaths? The implication of this would mean that even the states that have less than 50% of deaths recorded from nursing homes, such as New York (it’s about 36%) might wind up all being over 50%. The Washington Post already predicts that more than half of the nation’s total deaths are in nursing homes. That would mean that no more than 36,000 deaths so far were ever from non-nursing home patients and that nearly none of them are now.

Then there is also the issue of reliability of the data. There are concerns overall that too many people who tested positive for COVID-19 but died of “a clear alternate cause,” to quote Illinois Public Health Director Dr. Ngozi Ezike, are being added to the count. However, this concern is magnified now that most of the numbers are coming from nursing homes. We know that once the virus gets into nursing homes, the overwhelming majority, if not all, of residents will test positive for the virus, as we’re seeing in other confined spaces, such as ships and prisons. While it is very deadly and dangerous for them, clearly not all who die in nursing homes are dying of COVID-19. People die fairly suddenly in nursing homes every day, probably more so than anywhere else.

Take New York’s nursing home death data, for example. States and counties began adding “presumptive” deaths to the overall fatality count in recent weeks. But usually the presumptive deaths are only a fraction of the confirmed deaths, and with New York’s overall total deaths, that fact is no different. Now, take a look at these numbers in New York just for nursing home deaths:

Confirmed: 2418

Presumed: 2585

There are actually more presumed deaths than confirmed deaths among the nursing home demographic. That is astounding. It doesn’t take Sherlock Holmes to smell something fishy.

Remember, roughly 20%-24% of all deaths in America every year occur in nursing homes, and studies have shown that most die from dementia (36%), cardiovascular issues (30%), or pulmonary issues (23%). It’s very easy to see how, now that they are testing everyone in these homes, and most are likely testing positive, any typical death would be coded as a COVID-19 death.

Then there is the question of how many nursing home patients are dying now as a result of decisions by governors to force nursing homes to take back patients from hospitals after they tested positive for the virus. We know this had devastating results in the tristate area around New York City, and now Governor Gavin Newsom is doubling down on the same policy in California.

We need transparency

With our entire way of life destroyed because of false arithmetic and false science, what is the CDC doing with the tens of billions of dollars we gave it? At a minimum, they should publish a breakdown every day of the following:

How many nursing home residents died, as distinct from those who died among the general population, along with a state-by-state breakdown.

How many deaths occurred on the day they were recorded vs. how many were backfilled.

How many of the nursing home deaths are confirmed as having died as a result of the virus, as opposed to just having tested positive (like tens of millions of Americans who likely had the virus but didn’t get a severe case).

How many coronavirus patients were admitted straight from hospitals to nursing homes, broken down by state.

The results of any antibody serology tests the CDC has conducted (there’s no way they haven’t, and if they didn’t, that would be criminal) and a full breakdown of the real fatality rate, stratified for each cohort of age, gender, race, and health status. If they don’t have this data, then what is the purpose of throwing tens of billions at them?

A definitive national and state-by-state number of how many of the 72,000+ deaths were in long-term senior care facilities.

The reason we need independent conservative writers like me to investigate what should be the most publicized data ever is because our overlords do not want us to discover what these results would reveal.

SOURCE 

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Herd immunity

Because of its virulence, wide spread and the many asymptomatic cases it causes, Covid-19 cannot be contained in the long run, and so all countries will eventually reach herd immunity. To think otherwise is naive and dangerous. General lockdown strategies can reduce transmission and death counts in the short term. But this strategy cannot be considered successful until lockdowns are removed without the disease resurging.

The choice we face is stark. One option is to maintain a general lockdown for an unknown amount of time until herd immunity is reached through a future vaccine or until there is a safe and effective treatment. This must be weighed against the detrimental effects that lockdowns have on other health outcomes. The second option is to minimise the number of deaths until herd immunity is achieved through natural infection. Most places are neither preparing for the former nor considering the latter.

The question is not whether to aim for herd immunity as a strategy, because we will all eventually get there. The question is how to minimise casualties until we get there. Since Covid-19 mortality varies greatly by age, this can only be accomplished through age-specific countermeasures. We need to shield older people and other high-risk groups until they are protected by herd immunity.

Among the individuals exposed to Covid-19, people aged in their 70s have roughly twice the mortality of those in their 60s, 10 times the mortality of those in their 50s, 40 times that of those in their 40s, 100 times that of those in their 30s, and 300 times that of those in their 20s. The over-70s have a mortality that is more than 3,000 times higher than children have. For young people, the risk of death is so low that any reduced levels of mortality during the lockdown might not be due to fewer Covid-19 deaths, but due to fewer traffic accidents.

Considering these numbers, people above 60 must be better protected, while restrictions should be loosened on those below 50. Older people who are vulnerable should stay at home. Food should be delivered and they should receive no visitors. Nursing homes should be isolated together with some of the staff until other staff who have acquired immunity can take over. Younger people should go back to work and school without older coworkers and teachers at their sides.

While the appropriate magnitude of countermeasures depends on time and place as it is necessary to avoid hospital overload, the measures should still be age-dependent. This is how we can minimise the number of deaths by the time this terrible pandemic is over.

Among anti-herders, it is popular to compare the current number of Covid-19 deaths by country and as a proportion of the population. Such comparisons are misleading, as they ignore the existence of herd immunity. A country much closer to herd immunity will ultimately do better even if their current death count is somewhat higher. The key statistic is instead the number of deaths per infected. Those data are still elusive, but comparisons and strategies should not be based on misleading data just because the relevant data are unavailable.

While it is not perfect, Sweden has come closest to an age-based strategy by keeping elementary schools, stores and restaurants open, while older people are encouraged to stay at home. Stockholm may become the first place to reach herd immunity, which will protect high-risk groups better than anything else until there is a cure or vaccine.

Herd immunity arrives after a certain still unknown percentage of the population has acquired immunity. Through long-term sustainable social distancing and better hygiene, like not shaking hands, this percentage can be lowered, saving lives. Such practices should be adopted by everyone.

Social distancing that cannot be permanently sustained is a different story. Some people will eventually be infected, and for every young low-risk person avoiding infection, there will ultimately be roughly one additional high-risk older person that is infected, increasing the death count.

Anti-vaxxers do not suffer the consequences of their beliefs, as they are protected by the herd immunity generated by the rest of us. Neither will the anti-herders, many of whom can afford to isolate themselves from Covid-19 until natural herd immunity is achieved by others. It is older and working-class people that disproportionately suffer from the current approach, becoming infected and thereby indirectly protecting much lower-risk college students and young professionals who are working from home.

The current one-size-fits-all lockdown approach is leading to unnecessary deaths. Protecting older people and other high-risk groups will be logistically and politically more difficult than isolating the young by closing schools and universities. But we must change course if we want to reduce suffering and save lives.

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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What If We Already Have a Vaccine?

AS the world waits for a coronavirus vaccine, tens of thousands of people could die. But some scientists believe a vaccine might already exist.

Surprising new research in a niche area of immunology suggests that certain live vaccines that have been around for decades could, possibly, protect against the coronavirus. The theory is that these vaccines could make people less likely to experience serious symptoms — or even any symptoms — if they catch it.

At more than 25 universities and clinical centers around the world, researchers have begun clinical trials, primarily in health care workers, to test whether a live tuberculosis vaccine that has been in use for 99 years called the bacillus Calmette-Guérin, or B.C.G., vaccine, could reduce the risks associated with the coronavirus.

Another small but esteemed group of scientists is raising money to test the potential protective effects of a 60-year-old live polio vaccine called O.P.V. It’s counterintuitive to think that old vaccines created to fight very different pathogens could defend against the coronavirus. The idea is controversial in part because it challenges the dogma about how vaccines work.

But scientists’ understanding of an arm of immunology known as innate immunity has shifted in recent years. A growing body of research suggests that live vaccines, which are made from living but attenuated pathogens (as opposed to inactivated vaccines, which use dead pathogens) provide broad protection against infections in ways that no one anticipated.

“We can’t be certain as to what the outcome will be, but I suspect it’ll have an effect” on the coronavirus, said Jeffrey Cirillo, a microbiologist and immunologist at Texas A&M University who is leading one of the B.C.G. trials.

“Question is, how big will it be?” Scientists stress that these vaccines will not be a panacea. They might make symptoms milder, but they probably won’t eliminate them.

And the protection, if it occurs, would most likely last only a few years.

Still, “these could be a first step,” said Dr. Mihai Netea, an immunologist at Radboud University in the Netherlands who is leading another one of the trials. “They can be the bridge until you have the time to develop a specific vaccine.” The first evidence to suggest that live vaccines could be broadly protective trickled in nearly a century ago, but no one knew what to make of it. In 1927, soon after B.C.G. was rolled out, Carl Naslund of the Swedish Tuberculosis Society observed that children vaccinated with the live tuberculosis vaccine were three times less likely to die of any cause compared with kids who weren’t.

“One is tempted to explain this very low mortality among vaccinated children by the idea that B.C.G. vaccine provokes a nonspecific immunity,” he wrote in 1932.

Then, in clinical trials conducted in the 1940s and ’50s in the United States and Britain, researchers found that B.C.G. reduced nonaccidental deaths from causes other than tuberculosis by an average of 25 percent.

Also in the 1950s, Russian researchers, including Marina Voroshilova of the Academy of Medical Science in Moscow, noticed that people who had been given the live polio vaccine, compared with people who hadn’t, were far less likely to fall ill with the seasonal flu and other respiratory infections. She and other scientists undertook a clinical trial involving 320,000 Russians to more carefully test these mysterious effects.

They found that among individuals who had received the live polio vaccine, “the incidence of seasonal influenza was reduced by 75 percent,” said Konstantin Chumakov, Voroshilova’s son, who is now an associate director for research in the U.S. Food and Drug Administration’s Office of Vaccines Research and Review.

Recent studies have produced similar findings.

In a 2016 review of 68 papers commissioned by the World Health Organization, a team of researchers concluded that B.C.G., along with other live vaccines, “reduce overall mortality by more than would be expected through their effects on the diseases they prevent.” The W.H.O. has long been skeptical about these “nonspecific effects,” in part because much of the research on them has involved observational studies that don’t establish cause and effect. But in a recent report incorporating newer results from some clinical trials, the organization described nonspecific vaccine effects as “plausible and common.” Dr. Stanley Plotkin, a vaccinologist and emeritus professor at the University of Pennsylvania who developed the rubella vaccine but has no involvement in the current research, agreed.

“Vaccines can affect the immune system beyond the response to the specific pathogen,” he said.

Peter Aaby, a Danish anthropologist who has spent 40 years studying the nonspecific effects of vaccines in Guinea-Bissau, in West Africa, and whose findings have been criticized as implausible, is hopeful that these trials will be a tipping point for research in the field. “It’s kind of a golden moment in terms of actually having this taken seriously,” he said.

The possibility that vaccines could have nonspecific effects is brow-furrowing in part because scientists have long believed that vaccines work by stimulating the body’s highly specific adaptive immune system.

After receiving a vaccine against, say, polio, a person’s body creates an army of polio-specific antibodies that recognize and attack the virus before it has a chance to take hold. Antibodies against polio can’t fight off infections caused by other pathogens, though — so, based on this framework, polio vaccines should not be able to reduce the risk associated with other viruses, such as the coronavirus.

But over the past decade, immunologists have discovered that live vaccines also stimulate the innate immune system, which is less specific but much faster. They have found that the innate immune system can be trained by live vaccines to better fight off various kinds of pathogens.

For instance, in a 2018 study, Dr. Netea and his colleagues vaccinated volunteers with either B.C.G. or a placebo and then infected them all with a harmless version of the yellow fever virus. Those who had been given B.C.G. were better able to fight off yellow fever.


MAXWELL HOLYOKE-HIRSCH
Research by Dr. Netea and others shows that live vaccines train the body’s immune system by initiating changes in some stem cells. Among other things, the vaccines initiate the creation of tiny marks that help cells turn on genes involved in immune protection against multiple pathogens.

This area of innate immunity “is one of the hottest areas in fundamental immunology today,” said Dr. Robert Gallo, the director of the Institute of Human Virology at the University of Maryland School of Medicine and co-founder of the Global Virus Network, a coalition of virologists from more than 30 countries. In the 1980s, Dr. Gallo helped to identify H.I.V. as the cause of AIDS.

Dr. Gallo is leading the charge to test the O.P.V. live polio vaccine as a treatment for coronavirus.

He and his colleagues hope to start a clinical trial on health care workers in New York City and Maryland within six weeks.

O.P.V. is routinely used in 143 countries, but no longer in the United States. An inactivated polio vaccine was reintroduced here in 1997, in part because one out of every 2.7 million people who receive the live vaccine can actually develop polio from it.

But O.P.V. does not pose this risk to Americans who have received a polio vaccine in the past. “We believe this is very, very, very safe,” Dr. Gallo said. It’s also inexpensive at 12 cents a dose, and is administered orally, so it doesn’t require needles.

Some scientists have raised concerns over whether these vaccines could increase the risk for “cytokine storms” — deadly inflammatory reactions that have been observed in some people weeks after they have been infected with the coronavirus. Dr. Netea and others said that they were taking these concerns seriously but did not anticipate problems. For one thing, the vaccines will be given only to healthy people — not to people who are already infected.

Also, B.C.G. may actually be able to ramp up the body’s initial immune response in ways that reduce the amount of virus in the body, such that an inflammatory response never occurs. It may “lead to less infection to start with,” said Dr. Moshe Arditi, the director of the Infectious and Immunological Diseases Research Center at Cedars-Sinai Medical Center in Los Angeles, who is leading one of the trial arms.

THE science on this is still early days.

Several pre-prints — scientific papers that have not yet been peer-reviewed — published over the past few months support the idea that B.C.G. could protect against the coronavirus. They have reported, for instance, that death rates are lower in countries that routinely vaccinate children with B.C.G. But these studies can be fraught with bias and difficult to interpret; it’s impossible to know whether the vaccinations, or something else, provided the protection.

Such studies are “at the very bottom of the evidence hierarchy,” said Dr. Christine Stabell Benn, who is raising funds for a Danish B.C.G trial. She added that the protective effects of a dose of B.C.G given to adults decades ago, when they were infants, may well differ from the protective effects the vaccine could provide when given to adults during an outbreak.

“In the end,” said Dr. Netea, “only the clinical trials will give the answer.” Thankfully, that answer will come very soon.

Initial results from the trials that are underway may be available within a few months. If these researchers are right, these old vaccines could buy us time — and save thousands of lives — while we work to develop a new one.

SOURCE 

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An Alternative to the Lockdown Strategy in the Fight Against Coronavirus

The current coronavirus strategy of most governments is a recipe for a worldwide economic disaster. In many countries, the strategy of confinement and forcing shops to close is a sure-fire path to large-scale business failures. The cascade of economic and financial repercussions to come is likely to lead to another Great Depression.

The Costs of Prolongation

Italy, for example, already had a 135 percent debt-to-GDP ratio before the crisis. It is hard to imagine how it will be able to borrow more without a commitment from other European countries to jointly be responsible for more Italian debt—something the northern European countries are still strongly opposed to. The ECB is already printing money like crazy, and another Greece-like situation will make it ramp up the printing presses even more. We have been down this path many times before, where the cure is clearly much worse than the disease. The German hyperinflation of 1921-1923 created a resentful, impoverished middle class which ultimately led to Hitler’s rise to power.

The coronavirus (SARS-CoV-2) that originated in China is highly contagious. More than 80 percent of the patients show only mild flu-like symptoms but for the remaining 20 percent, mostly the elderly or people with preexisting conditions, the virus can be life-threatening. To save lives short term, the entire population in Europe is currently being held under house arrest and many businesses have been put into a pre-liquidation state by no longer being able to realize a profit due to inactivity.

The current strategy is not to stop the virus in its tracks but to spread out the contagion so that the peak is a level that will be more manageable for the health care system. Governments took the biased advice of health care professionals without a real weighing of all the pros and cons. This prolongation in time, however, will come at a steep economic and human cost.

Unemployment Correlates with Death

In the longer term, more lives will be lost if we continue this strategy. How many victims of financial ruin will end their own lives? In the modern era, for every one percent increase in the unemployment rate, there has typically been an increase of about one percent in the number of suicides. A study conducted by Brenner in 19791, found that for every 10 percent increase in the unemployment rate, mortality increased by 1.2 percent, cardiovascular disease by 1.7 percent, cirrhosis of the liver by 1.3 percent, suicides by 1.7%, arrests by 4 percent, and reported assaults by 0.8 percent (see here). How many lost lives out of 300 million in the USA does a 10 percent, 15 percent, 20 percent unemployment rate represent?

The use of the free market gives another strategy to control the spread of the coronavirus. For example, we now have strong evidence from trials in France and China that in 75 percent of the cases a combination of two extremely well-known antimalarial drugs (hydroxychloroquine in combination with the antibiotic azithromycin) can bring the viral load down to nearly zero after just six days (complications usually arrive after the 6th day). These drugs could make the latent effects of the Wuhan virus as mild for 20 percent as the other 80 percent, and they were recently cleared for use.

There are many other possible drug combinations that might offer similar results, but FDA and EMA regulations requiring long term testing make it much more difficult for these drugs to be available in time to treat the virus. Yet the world economy is at stake and we cannot sit and argue on the quality of the water while our house is burning down.

An obviously better solution than sinking the world economy into a great depression is a greater use of “laissez-faire.” The current lockdown strategy is a bleak choice of (allegedly) fewer short term deaths against a much larger long-term death toll. We must return to a business-as-normal situation as soon as possible. We need to free drugs from overbearing drug regulations and make them widely available (with appropriate dosages and warnings) everywhere at a market price without the need for a prescription. We need markets to be free so they can provide a wide choice of medications.

Market-Oriented Strategy

The argument is not for a non-strategy; it is for allowing the markets to define the strategy. For example, the elderly might consider taking chloroquine preventively; it has a long history of being taken to prevent malaria in Africa. It is naïve to think that people can’t inform themselves and take appropriate actions for their own health benefits.

It is also naïve to think that businesses and people won’t adapt to the perceived threat. Restaurants can seat patrons several meters apart. Waiters and cooks can wear masks and gloves. There is an infinite number of innovative ways people will adjust. Just because we cannot imagine a voluntary market solution does not mean one does not exist. South Korea is an example to emulate. Instead of an authoritarian locking down of its people, it took a much more libertarian approach to the problem and is already showing promising results.

This market-oriented strategy is obviously not without risks, but we must move away from the current defensive 16th-century bunker mentality and consider less disastrous economic alternatives.

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 Worldwide Lockdown May Be the Greatest Mistake in History

The idea that the worldwide lockdown of virtually every country other than Sweden may have been an enormous mistake strikes many — including world leaders; most scientists, especially health officials, doctors and epidemiologists; those who work in major news media; opinion writers in those media; and the hundreds of millions, if not billions, of people who put their faith in these people — as so preposterous as to be immoral. Timothy Egan of The New York Times described Republicans who wish to enable their states to open up as “the party of death.”

That’s the way it is today on planet Earth, where deceit, cowardice and immaturity now dominate almost all societies because the elites are deceitful, cowardly and immature.

But for those open to reading thoughts they may differ with, here is the case for why the worldwide lockdown is not only a mistake but also, possibly, the worst mistake the world has ever made. And for those intellectually challenged by the English language and/or logic, “mistake” and “evil” are not synonyms. The lockdown is a mistake; the Holocaust, slavery, communism, fascism, etc., were evils. Massive mistakes are made by arrogant fools; massive evils are committed by evil people.

The forcible prevention of Americans from doing anything except what politicians deem “essential” has led to the worst economy in American history since the Great Depression of the 1930s. It is panic and hysteria, not the coronavirus, that created this catastrophe. And the consequences in much of the world will be more horrible than in America.

The United Nations World Food Programme, or the WFP, states that by the end of the year, more than 260 million people will face starvation — double last year’s figures. According to WFP director David Beasley on April 21: “We could be looking at famine in about three dozen countries. … There is also a real danger that more people could potentially die from the economic impact of COVID-19 than from the virus itself” (italics added).

That would be enough to characterize the worldwide lockdown as a deathly error. But there is much more. If global GDP declines by 5%, another 147 million people could be plunged into extreme poverty, according to the International Food Policy Research Institute.

Foreign Policy magazine reports that, according to the International Monetary Fund, the global economy will shrink by 3% in 2020, marking the biggest downturn since the Great Depression, and the U.S., the eurozone and Japan will contract by 5.9%, 7.5% and 5.2%, respectively. Meanwhile, across South Asia, as of a month ago, tens of millions were already “struggling to put food on the table.” Again, all because of the lockdowns, not the virus.

In one particularly incomprehensible act, the government of India, a poor country of 1.3 billion people, locked down its people. As Quartz India reported on April 22, “Coronavirus has killed only around 700 Indians … a small number still compared to the 450,000 TB and 10,000-odd malaria deaths recorded every year.”

One of the thousands of unpaid garment workers protesting the lockdown in Bangladesh understands the situation better than almost any health official in the world: “We are starving. If we don’t have food in our stomach, what’s the use of observing this lockdown?” But concern for that Bangladeshi worker among the world’s elites seems nonexistent.

The lockdown is “possibly even more catastrophic (than the virus) in its outcome: the collapse of global food-supply systems and widespread human starvation” (italics added). That was published in the left-wing The Nation, which, nevertheless, enthusiastically supports lockdowns. But the American left cares as much about the millions of non-Americans reduced to hunger and starvation because of the lockdown as it does about the people of upstate New York who have no incomes, despite the minuscule number of coronavirus deaths there. Or about the citizens of Oregon, whose governor has just announced the state will remain locked down until July 6. As of this writing, a total of 109 people have died of the coronavirus in Oregon.

An example of how disinterested the left is in worldwide suffering is made abundantly clear in a front-page “prayer” by a left-wing Christian in the current issue of The Nation: “May we who are merely inconvenienced remember those whose lives are at stake.”

“Merely inconvenienced” is how the Rev. Dr. William J. Barber II, a Protestant minister and president of the North Carolina NAACP, describes the tens of millions of Americans rendered destitute, not to mention the hundreds of millions around the world rendered not only penniless but hungry. The truth is, like most of the elites, it is Barber who is “merely inconvenienced.” Indeed, the American battle today is between the merely inconvenienced and the rest of America.

Michael Levitt, professor of structural biology at Stanford Medical School and winner of the 2013 Nobel Prize in chemistry, recently stated, “There is no doubt in my mind that when we come to look back on this, the damage done by lockdown will exceed any saving of lives by a huge factor.”

To the left, anyone who questions the lockdown is driven by preference for money over lives. Typical of the left’s moral shallowness is this headline on Salon this week:

“It’s Time To Reject the Gods of Commerce: America Is a Society, Not an ‘Economy,'” with the subhead reading, “America Is About People, Not Profit Margins.”

And, of course, to smug editors and writers of The Atlantic, in article after repetitive article, the fault lies not with the lockdown but with President Donald Trump. The most popular article in The Atlantic this week is titled “The Rest of the World Is Laughing at Trump.” The elites can afford to laugh at whatever they want. Meanwhile, the less fortunate — that is, most people — are crying.

SOURCE 

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The Unintended Consequences of COVID-19 Lockdowns

There will be much still to learn when COVID-19 has passed. Books will certainly be written questioning the knee-jerk authoritarian response from most governments. Opinions championing a more modest approach to future pandemics are already emerging, even as this one continues to smolder. Dr. Michael Ryan, the WHO’s executive director for health emergencies, recently praised the Swedish government’s response, which largely resisted wide-scale shutdowns. Calm, rational heads will increasingly wonder if this situation should have been handled differently.

The financial devastation from forced lockdown will likely outlast the pandemic itself. While unfortunate (to put it mildly), most have argued that it has been necessary. The prevailing wisdom is that governments must choose either physical or economic health for citizens during this difficult time. Apparently, we cannot manage both ourselves. But believing that government actions have been justified also requires one to suspend reality and imagine that COVID-19 occurs in a vacuum. It requires one to pretend that nothing else factors into health and well-being. While the heavy hand of government has been intended to quell cases of COVID-19, it’s certainly worthwhile to examine the collateral damage directly resulting from its actions.

The pandemic has negatively impacted oncology services worldwide. Elective screening procedures (colonoscopies, mammograms, etc.) have been cancelled by government order. Naturally, this has led to a decrease in new cancer diagnoses. Obviously, new cancers haven’t stopped arising, but thousands of them have been neglected over the past few months. Those delays in diagnosis will equal delays in treatment. Even some patients with known cancers have experienced delays in therapy. A study from the University College London and the Health Data Research Hub for Cancer reports that in England and Northern Ireland, admissions for chemotherapy have fallen 45–66 percent and urgent referrals for early cancer diagnosis are down 70–89 percent, compared to pre-COVID-19 levels. Ominously, they predict that “Under conservative assumptions of the emergency affecting only people with newly diagnosed cancer … the model estimated 6,270 excess deaths at 1 year in England and 33,890 excess deaths in the US.”

It’s important to note that most of these deaths both here and abroad will be from delays in diagnosis and/or therapy, not COVID-19 infection. When considering total cancer patients living in England, they project the number of excess deaths could be up to 18,000 in that country alone. Dr. Alvina Lai, the lead author, claims the study demonstrates “the serious potential for unintended consequences of the response to the Covid-19 pandemic, which may negatively impact on patients with cancer and other underlying health conditions.”

Perhaps the greatest harm from this pandemic comes from the toll on mental health.

Oncology patients are not the only ones being negatively affected by shelter-in-place edicts. Visits to pediatricians are also down, according to the American Academy of Pediatrics. In an effort to decrease exposure to SARS-CoV-2, children are missing routine vaccinations. Data from the Physicians Computer Company (an electronic medical record company focusing on pediatric settings) shows that, across the U.S., “The number of vaccines administered for diseases including measles, mumps, whooping cough and HPV each dropped by at least 40% during the week of April 5, compared to a week in February of this year.” Dr. Eileen Costello, a pediatrician and the chief of ambulatory pediatrics at Boston Medical Center, claims that her center’s clinic volume was down approximately 80 percent last month. She fears that “We’ll be having pertussis and measles outbreaks in a couple months, which are going to be way more devastating.” Generally speaking, COVID-19 infections in children are asymptomatic. The desire to keep them from becoming asymptomatic carriers is valid, but if the end result is an increase in fatal (yet preventable) childhood illnesses, should this be considered a win?

Perhaps the greatest (and most difficult-to-measure) harm from this pandemic comes from the toll on mental health. During this time of financial ruin and forced isolation, it’s logical to expect that rates of depression and suicide will increase. The Disaster Distress Helpline, a service of the Substance Abuse and Mental Health Services Administration (SAMHSA), has reportedly seen an 891 percent increase in call volume when comparing March 2020 to March 2019. The psychological harm that accompanies bankruptcy and related crises cannot be understated. Dr. Glenn Sullivan, a clinical psychologist and professor of psychology at the Virginia Military Institute, warns, “If the U.S. [suicide] rate jumps in the same manner it did after the 1929 stock market crash, then … 2021 could see more than 54,000 deaths by suicide (versus about 48,000 in 2018). The 6,000 excess deaths … would be additional victims of the coronavirus emergency and its economic impact.”

Out of supposed necessity, heads of state in the U.S. and abroad have admittedly been picking winners and losers on the economic front. Will they ever admit that, indirectly, they have been choosing winners and losers on the health-care front, as well? Whether it’s a missed mammogram, a missed vaccine, or a suicide attempt spawned from forced bankruptcy, these are not trivial matters. In fact, some peoples’ economic and physical health are being greatly harmed by the government’s heavy hand during this time. The exact amount and scope of the collateral damage will only be known in hindsight. Unfortunately, the unintended consequences will be significant. With government serving as referee, this game may end up with more losers than winners.

SOURCE 

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‘Fear Is The Problem’: Stanford’s Dr. Scott Atlas Defends Reopening Stance

Dr. Scott Atlas, senior fellow at Stanford’s Hoover Institution and the former chief of neuroradiology at Stanford University Medical Center, defended his position, in the wake of rising model numbers, that Americans should reopen the country.

Atlas originally made national news after his column, “The Data Is In — Stop The Panic And End The Total Isolation,” was published at The Hill and went viral last month. In it, the Stanford doctor cites several facts currently “being ignored by those calling for continuing the near-total lockdown,” along with evidence behind each.

Before his introduction on Monday night’s “The Story with Martha MacCallum,” Fox News host Martha MacCallum pointed out “unsettling data” that points to “a very big jump” in predicted U.S. deaths by August.

“Do these rising models change anything about your headline, that we need to stop panicking about this?” she asked.

“No, in fact they underscore some of the very things I was saying and they reveal a lot of, again, the same sort of misconception about models,” Atlas responded before pointing out that such models “change all the time.”

However, he said the most “important point” is that “nothing has changed here.”

“We should look at the evidence,” he said. “We don’t need to rely on hypothetical projections. We have a ton of evidence, and the evidence is consistent all over the world that we know the fatality rate is much lower than what the models were based on originally.

“We know that we have flattened, the curves have been flattened and the curves, to note, are not the numbers of cases. The only curves that count are the deaths per day and the hospitalizations per day and when you take all that into account, including the very important things that are catastrophically destructive about total isolation, you come to the same conclusion that I and many, many people all over the world support,” he continued.

Atlas called the notion that current reopenings are driving any spike today “completely false.”

“If you open the doors today and you have deaths in three days, there is no correlation there,” said the Stanford researcher. “It takes 23 to 30 days on roughly average to have somebody [go] from getting the infection to dying. When the number of deaths goes up in three days in the state opening their doors, there is no correlation whatsoever. That’s just a false conclusion to be made.”

After making an argument for protecting nursing homes and regulating sanitation and hygiene in certain areas, Atlas called fear the “real contagion.” (RELATED: Staying In Place Is ‘Actually Harmful’: Stanford’s Scott Atlas Makes The Case For Herd Immunity)

“There is a new standard evolving from this, but you can’t really make policy based on fear and catastrophic projections and this is another thing that’s actually harming, even things like the food supply chain,” Atlas said. “It’s the fear that’s the real contagion here. The fear is the problem.”

Atlas finished the interview by criticizing the logic behind keeping schools closed by saying there is “little, if any risk” to those under 18 who emerging research may show are even “less likely to transmit the disease.”

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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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.

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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.”

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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.”

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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

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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.

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