Covid-19 Diary : Thursday 4 June, 2020

It seems time to share some of the interesting things that have happened over the last three days.  I’m thinking I’ll continue with updates at least once a week, maybe twice.

Current Numbers

Daily new cases and deaths in the US are slowly reducing.  But the rate of reduction is terribly slow, as you can see.

Our new case count peaked at the beginning of April.  Two months later, and it has only dropped by about one-third.  That’s dismayingly slow.  There is more encouragement to be gleaned from the death count, which is of course the ultimate measure of everything.  We’ve halved the daily death rate in a shorter period of time.  But we need many more halvings before numbers are down to an acceptably low rate.

We desperately need to get these curves declining more steeply than they are.  Currently, many/most of the states that are re-opening are pushing their luck, and there are clear reasons for concern that they are opening up too much, too soon.

I have a new presentation of data to share that might perhaps be well suited to an occasional type of publication – simple “top ten” lists.  I know that graphs would be better, but I’m not sure how to do that without requiring substantial extra time on my part.  I continue to ponder this.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rates Major Countries

I Am Not a Doctor, But….

The last few days have seen an extraordinary unraveling of the Lancet article (and a not quite so widely discussed similar article in the New England Journal of Medicine) purporting to show hydroxychloroquine has no effect on Covid-19 sufferers.  It now transpires that the company providing the data for both studies – with the company’s CEO not coincidentally being one of the Lancet-reported study’s authors – has a dark and murky past, with little to recommend it as a source of data which it also refuses to allow independent verification of.

This article in particular is a great dissection of the company and its data and its CEO, and we were especially impressed with the way the article seems to have clearly proven that the data is – well, let’s be polite and not say fraudulent – seriously erroneous, at least as can be determined from the Australian portion of the data.

Both The Lancet and the NEJM have now added warning notices to their articles, and earlier today, three of the authors of the Lancet article have withdrawn their authorship.  But we have to roll our eyes at their high-minded justification for now withdrawing their authorship.  The truth is not that they are adhering to the highest standards of scientific enquiry and analysis by doing so.  The real truth they are seeking to obscure is that they utterly and totally failed to adhere to the same scientific standards they now claim to respect, when first authoring this study.

We were surprised that only half the US population is open to getting a Covid-19 vaccine.  This is an interesting article that shows the reasons why people would or would not choose to be vaccinated.  Perhaps we shouldn’t be too surprised.  As we mention in the discussion on vaccines, further below, we have absolutely no intention of rushing to be vaccinated ourselves.

Here’s an interesting concept – a “disinfectant tunnel” you walk through, but we think it is a solution to a non-problem.  The major risk is not getting the virus after touching a person’s clothing, or having an infected person transfer some virus to a surface that you subsequently touch.  The largest risk is breathing in virus particles that an infected person breathed out.  The disinfectant tunnel does nothing to reduce this, the most major, risk.

Sure, anything and everything is better than nothing, but no-one should think this device will actually measurably reduce the risk of catching the virus.

Timings And Numbers

This is an interesting weekly presentation (shown immediately above) on which states have rising or falling numbers of new virus cases.  Its findings are similar to, but not identically the same, as those shown on the rt.live website, which today was listing 12 states with rising case numbers.

There is an amazing number of different government departments and organizations involved with a response to the virus.  This article indicates that the US Army is hard at work at developing a vaccine, as well as all the other places, both public and private, doing the same thing.

It probably makes sense to have multiple vaccine candidates being developed in parallel with each other, particularly in the amazing world where vaccines can be very much more/different than the old fashioned concept of a simple inactivated virus.  But we do hope there is some efficient coordination between every different laboratory working on this problem, so there isn’t duplication of effort, and so there is generous sharing of data and results.

Here’s another of the articles chronicling the extraordinary and broad failure of the CDC to do what it was reasonably expected to do in response to the virus threat.  I can not understand how presumably super-intelligent professional people can be so utterly incompetent at something they’ve dedicated their lives to studying and preparing for.

It does make one worry as to what other government functions there are that might prove to be similarly useless when tested in a different type of future emergency, too.

Shortages

There’s one sort of shortage that is likely to become more and more severe.  A shortage of finance money.

We’ve had friends in the industry tell us that while the good news is some interest rates are at their lowest levels for decades, they are being matched with tougher and tougher credit-granting requirements, making it harder to qualify for the low-cost loans being advertised.  We’d love to refinance our house, and pay half the interest rate we are at present, but even though we’ve a solid history of making every mortgage payment at the current 5.625% interest rate we’re paying, and plenty of equity, no-one would touch us to refinance us at a lower interest rate because we don’t meet their overall underwriting requirements.

It is a bit strange to be told “even though you are perfectly paying every month at 5.625%, we’re worried you wouldn’t be able to afford the payments if they greatly reduced”.

This article indicates the concern and tightening isn’t just about home financing.  It is about all forms of financing, with the article citing a drying up of fairly priced finance for second hand cars.  In the quoted case of Wells Fargo, they aren’t just tightening their approval requirements, they have made a blanket decision to stop almost all financing for second hand cars.

Logic?  What Logic?

Great news from Dr Fauci.  We should have a couple of hundred million doses of a Covid-19 vaccine by the start of 2021, he tells us.  Never mind that this date is one he’d earlier said was impossible, apparently he isn’t always correct about everything.

But there is one small problem with this amazing rush to manufacture so many doses of this vaccine.  Apparently overlooked is the small point that the vaccine has yet to be proven to work, and more than that, to work safely with no side effects.

My enormous concern is that, when the government finds itself with hundreds of millions of doses of a “vaccine” on the shelf, while simultaneously facing the continued struggles to get out from under the burden of the virus and all it implies, the standards for approving the vaccine will be relaxed down to a point that you could have a rabid wild weasel piss in a pot and have it approved as a vaccine.  (You could add to that the further distorting effect of the November election and the desperate desire for good news prior to then by the incumbent politicians.)

This is why I absolutely will not be rushing to be a real-world guinea pig for whatever vaccine is released.

In a separate article, the good Dr F says there is a chance that a vaccine might not give long-lasting protection.  This is something I’ve been saying all along, and he has now cited the same reason as underpins my concern – we’re trying to develop a vaccine for a virus similar to the common cold virus.  Vaccines have been developed for the common cold, but have never been widely circulated, because they typically give only 3-6 months of protection, and never even as long as a year.  The hassle of the vaccine and the trivial nature of a cold have meant there is no sense in deploying vaccines.

Would you want to be revaccinated every quarter?

There’s also a related issue that doesn’t seem to have been considered in the article.  If a vaccine only gives 3-6 months of immunity, how long do the antibodies after having had a case of the virus last?  It would seem likely they too would only last 3-6 months.  That’s a very disappointing thought, especially for people who were severely affected by an infection, giving them nothing to look forward to except more of the same in the future – probably worse, because each times, they’re older.

A person on Twitter thought that even a 3-6 month break would help us to reset the clock and rid ourselves of the virus.  I disagree.  Until the virus has been eliminated from everywhere on the planet, it remains a global risk.  If we let our guard down – as everyone desperately wishes to do – we all want to be able to stroll around, indoors and out, without a mask; to go to a bar or restaurant, no matter how crowded, and enjoy some food and drink; to go to a ball game or a concert, and so on; but as soon as that happens, the conditions are ripe for the virus to return.  It just requires one single new “Patient Zero” to arrive back into the US (or Italy or any other country) to start off an entire new wave of infections, and a resulting entire new wave of lockdowns, social distancing, and again, awful disruption and economic cost.

Meanwhile, in a global vaccine race, an English company seems to be leading the field.  AstraZeneca says it plans to distribute 400 million doses of vaccine to the UK and US this year, with shipments to start in September.  It too is getting way ahead of the curve.  Its vaccine has also yet to pass through testing and approval.

Medical

Many thanks to reader Peter, who just today completed long flights from SE Asia back to the US (one almost full, one with only 40 people on board).  He sent in this excellent treatment schedule, and here it is with more detail and links to articles about the various non-traditional treatments it is recommending.  It comes from the Eastern Virginia Medical School.

Of particular note is the treatment plan being suggested as a daily preventative or prophylactic measure for everyone, all the time.

Reader John sent in a fascinating newsletter he got from his local healthcare provider in California.  He agreed that it seemed reasonable to republish it, so here it is, with some of the irrelevant data omitted :

COVID-19….the first 60 days from the Caduceus perspective.

Caduceus started testing for Covid in mid-March. We began treating patients within days and started accepting referrals in early April. Overall we have tested over 2000 patients in our three OC testing sites and have actively treated over 85 cases with a “Covid Team” approach. Approximately half have recovered; the other half are receiving regular ongoing treatment.

Half the cases were diagnosed the first three weeks of testing, with a slowdown after April 7. Since that time, we have still had a steady flow of new cases new weekly. From the start we began meticulous record keeping.

We have heard in other areas more cases are diagnosed in men. Not with us, the gender split is 50/50. As for seniors having more cases- that has not been our experience. Over half of our cases are under 40. Only 10% are seniors over 65.

Two hospitalizations have been recorded from our patient population, both to the ICU, ages 62 and 69, both healthy, both recovered.  No deaths have been reported.

As for many cases being asymptomatic, nope.  Less than 10% of our cases are diagnosed symptom free.

As for what we hear about the most common presenting symptom being fever or cough? Guess again. 90% present with fatigue as the biggest symptom. Only 80% have fever at all, and almost half have parageusia (loss of taste and smell).

Early on, we saw the need for an aggressive strategy for treating even mild cases. The pattern was actually frightening with the first dozen cases.

A typical case-

• Day 1  Fatigue, maybe cough
• Day 2  Fever
• Day 3  Worsening cough
• Day 4-6  Copious fluid in chest feeling like they are drowning
• Days 7-15  More of the same, some a bit better, some worse. Air hunger, severe at times
• Days 16-21  Slow recovery

One patient suffered significant illness for 25 days. No; not a senior.
 
We find a regimen of “Double Z’s” helps a few…Zinc and Zithromycin. 
 
A “Covid Cocktail” is very helpful once a positive swab was found. … Sudafed, Promethazine, and Albuterol inhaler.  This is designed to combat mucus and open the airways.

Once a cough or air hunger develops we teach aggressive “Pulmonary Toilet” AKA Hygiene.

• • Turn, cough, and deep breathe
  • Incentive spirometry
  • Postural Drainage and percussion

As many times a day as could be tolerated, at least three.

One severe case in March was given Plaquenil AKA Hydroxycholoquine, almost as a last resort.  There was immediate improvement so we used it again.  And again.  Every case improved.  No cardiac issues.  In fairness, we have been using Plaquenil in our practice for many years for connective tissue diseases, so felt comfortable with its use.  Plus it was a five day course, whereas most lupus patients are on it a lifetime.  The risk/reward ratio seemed to favor its use.  In all we prescribed it 15 times; all 15 reported improvement.

We are aware this does not match scenarios from other centers, even the CDC, but as they say in sports – “we gotta call ‘em as we see ‘em.”

Severe cases are the hardest to treat, simply because there was no playbook for their treatment.  They universally report an air hunger, feeling of drowning, copious mucus, and the sensation of not enough oxygen even with a deep breath.  Several informed us of a near-death sensation.  The look in their eyes – even over a video visit on their phone -was haunting.  Would they all have recovered without the aggressive treatment we described?  No one knows.  Yet as victims recovered, we had the comforting feeling the “Big Guy” was guiding things.

Despite all measures we mentioned, the #1 factor in improvement is bed rest- complete and total.

Bed.  Couch.  Recliner.

Almost 25% suffered a relapse after recovery, and the number one factor in those cases was discontinuing bed rest.

We attempt to check a test-of-cure on all of our cases.  On average it takes 30 days  to turn “swab-positive” to “swab negative.”   Almost all swab positive cases are showing antibodies, but it’s taking 30-60 days to do that.  Whether the antibodies will prevent a re-infection via immunity still needs to be established.   Theoretically it should.

Mysteriously, there are another 25 patients–taking us to over 100 cases–that have identical courses to our Covid-19 cases, right down to the air hunger, copious mucus, near drowning and parageusia.  However, they are swab negative.  Multiple times.

False negatives?  Doubtful given the well established PCR technique.  A Covid mutation unrecognized by the PCR test?  That’s our hypothesis.  We are treating them identically to swab positive patients, with the exception of withholding Plaquenil.  Perhaps because of withholding it, these patients are sicker longer and have a tougher road to recovery.

As the city, county and state begin to re-open, we must prepare for a “second wave.”

Our advice based on what we have learned?

1. Avoid proximity to ANYONE sick.  Do NOT forget how easy it is to catch Covid-19 and the long 14 day incubation period
2. If you feel fatigued or have a fever, get to bed and get tested ASAP.  DO NOT attempt to fight this off by yourself.  Stay under the care of a physician
3. Social distancing, masks, hand washing, AND avoiding unnecessary travel are still wise, although unpopular.  At least until the numbers fall more
4. If you test swab-negative Do NOT become complacent and assume it’s a common cold.  You know the saying  “If it quacks like a duck….”
5. Test.  Test.  Test.  Either for the swab or antibody depending on your individual needs.

If you are a patient, we share this so you may avoid the virus and hopefully resume some type of normalcy.

If you are a physician, we share this information as part of the Hippocratic Oath we all took……”I will remember there is art to medicine as well as science. I will respect the hard won scientific gains of those physicians in whose steps I walk in, and gladly share knowledge as is mine with those who are to follow…”

Gregg DeNicola MD
CMO 
Caduceus Medical Group

Other

Here is an interesting story and history of the product that has shot to stardom over the last few months – Purell.  We note that hand sanitizer (although not the Purell brand) has become much more freely available again.

Please stay happy and healthy; all going well, I’ll be back again soon.

Please click here for a listing of all our Covid-19 articles.