Covid-19 Diary : Thursday 5 November, 2020

There are times when I think we’ve reached the end of breaking news and developments to do with the virus.  I felt a bit of a lull over the last week or so, but now today we’re clearly back again with idiocies and contradictions and dysfunctions galore.  This has had a negative effect on my book, now grown to 400 pages, by the way.  I’m “that close” to finishing it, but I’m in an endless series of updates – I keep coming across important new studies and findings and data that I want to include.

I have completed my rewrite, it is just a case of updating throughout the text to reflect new data that keeps coming in.   And a reminder/request – I’m still seeking additional pre-publication readers/reviewers.  Please let me know if you’d like to participate as a “beta tester” of the book.

I had a recent epiphany about the virus.  Perhaps we can group things into three approaches to controlling the virus.  Developing a vaccine is one of the three.  Slowing the spread – social distancing, mask wearing, and so on – is a second.  We’re doing so-so on virus development (too soon to really say); and clearly, as you’ll see from the numbers, below, we’re doing abysmally on slowing the spread.

In my to-date primary focus on these two issues I’ve not sufficiently considered the third of these three elements.  Treating the virus.  In the US alone, we’re now approaching the quarter million fatality number, after just eight months of the virus.  That compares to 11,000 people dying of AIDS in the same time, 28,000 in car crashes, 45,000 of drug overdoses, 99,000 of strokes, and 178,000 of Alzheimers.  Only cancer (400,000) and heart disease (437,000) have caused more deaths during this period.

Shouldn’t we be more focused on virus treatments – and especially, early stage treatments to keep people out of hospitals, to avoid overloading our healthcare system, and to save such people from the distress and lasting damage many recovered sufferers now have to live with, to say nothing of the 2.5% chance of dying.

But both the CDC and NIH continue to say there is nothing to done except isolate and take it easy at home, and go to hospital only if things become serious.  Many serious medical practitioners, working on the front lines of Covid care, disagree with them.

There is a growing number of early and mid-stage treatments being approved by other countries, and with growing numbers of positive studies supporting their approvals.

Why not in the US, too?  In 2016 a new act – the Cures Act – was passed that was designed to encourage the FDA to approve promising treatments more liberally.  The FDA is definitely doing this with vaccines – it has lowered the bar for what is acceptable in terms of vaccine performance, it is collapsing a minimum six month observation period in stage three trials down to two months, and is admitting the vaccine it approves may still be dangerous (see below).

So why does the FDA (and CDC and NIH) continue to demand almost impossible degrees of proof for treatments, especially treatments using existing approved inexpensive take-at-home drugs with known and/or no side effects?

The only drug it has approved is Remdesivir, notable for most recently having been shown to be totally useless in a large multi-country trial coordinated by WHO.  Remdesivir is not only of doubtful value, it is also very expensive ($3120 for a course of treatment) and is administered through IV, typically as part of a hospital stay, so you can add another some tens of thousands of dollars onto the drug cost for the total treatment cost.  And it is reserved for late stage treatment only, it is not something everyone automatically gets as soon as they are tested positive.

The FDA’s reluctance to even grant “Emergency Use Authorizations” to other treatments has to be a major factor in the almost quarter million deaths to date.  Rather than “protecting” us from dubious and dangerous drugs, they are causing unnecessary extra deaths by restricting our access to known-to-be safe drugs that might help, won’t hurt, and are low cost and easily administered.

What is wrong with this picture and those priorities?  How can we get some rational thought and sensible decision making into the system?

Current Numbers

Few changes in the minor country list, other than Luxembourg moving up another place.  Very little in the major country list, either – an apparent calm that just means most of the major countries are all suffering equally at present, although none more so than Belgium, followed closely by the Czech Republic.

Belgium’s struggles has now seen it claim the top slot on the death list.  Argentina suddenly entered the death list, going straight to number eight, and the US moved up to seventh place.  It is not impossible it might be pushed back down to its customary eighth place by Argentina within the week.

Top Case Rates Minor Countries

Top Case Rates Major Countries

Top Death Rate Major Countries

It is worth noting that the world as a whole is now showing more daily new cases and also more daily new deaths (using a running seven day average) than ever before.

The US also is setting new records for daily new cases, although happily its death numbers are still below earlier in the year, but rising at present.

Sadly, it seems likely that the death rate, which typically is three or more weeks behind changes in the case rate, will continue rising for the next few weeks.

I Am Not a Doctor, But….

There was an interesting article doing the rounds about how a very high number of grocery workers had Covid infections in Boston.  There are two interesting elements that are not discussed, though.

The first is to consider the very small sample size (104 people).  This was not a random survey of grocery workers across the city.  It was a survey of workers in one single store.  So it is not surprising to see an apparent high concentration of cases, and it probably simply points to bad distancing/mask wearing/hygiene in that one store – one employee became infected and passed it on to many co-workers.  It is not something that can be extrapolated more broadly, not within Boston, and certainly not across the nation as a whole.

Secondly, of the 21 people infected, five had symptoms and 16 did not.  That is recorded with surprise, but what we’re not told is – how do we know the symptomless people actually had the disease?  Were they tested twice?  Did they subsequently come down with the disease?  What type of test was used?

The write-up shamefully tells us none of these things, so I’ll guess.  I’ll guess there was no subsequent follow-up and no second test, and I’ll further guess the people were tested with PCR testing, which was probably just set too high, as is often the case.  In the absence of further data one way or the other, it seems likely that many/most of the symptomless people with positive test results were merely experiencing false positives from a test known to be prone to giving false positives.

So, rather than deserving major scare headlines about a generic danger to both employees and customers in grocery stores, the reality is this is a statistically insignificant study in a single store that likely had confounding factors built in to the test, and which may be suffering from faulty test results.

Vitamin D continues to go up my list of important things to optimize.  Here’s a study showing that 82% of people hospitalized for Covid-19 in Spain had significantly low Vitamin D levels, compared to 47% of a control group of people from the same area.  Vitamin D3 capsules are inexpensive and easy to take; it might be a good idea to optimize your Vitamin D level, particularly as we head into winter.  In my book, I pass on the suggestion of 50 mcg/2,000 IU of Vitamin D as a daily supplement.

Remdesivir has had an amazingly easy path to FDA approval – not only amazingly easy, but possibly also ill-deserved.  This article is a disappointing read and raises major questions about what the FDA is doing and why.  The linked-within-the-article Science Magazine article adds further detail.

Talking about agency perfidy, and in case you were in danger of forgetting the complicit nature of WHO in inexcusably keeping the world ignorant of the threat of the Covid virus, this article is a good reminder.

I mentioned in my opening comments that of the “triad” of responses to the virus, we are demonstrably and utterly failing at one element – control/containment, we’re ignoring the second element entirely (early treatment), and the outcome of  the third element – vaccine development – remains as yet unknown and uncertain.

Two new points about our hopes for a vaccine.  The first is a new mutation of the virus has been discovered in Denmark, in mink, so the country killed all 15 million mink in a hope to keep the mutation out of the human population.  How successful that drastic action may be remains to be seen, and I’d be surprised if the mutation doesn’t get loose – it has already infected twelve people (that we know of).

The big concern about this mutation is a fear that the currently being developed vaccines may not be effective against the mutation.

Just ponder that for a moment.  We know this virus does mutate, and while most mutations so far have been minor and, we’re told, don’t threaten the efficacy of a vaccine, apparently this mutation is significant.  If we’ve had one such mutation (that we know of) already, does that mean we can continue to expect one every eight or so months?  Is this another limit on the life of any vaccination – not only might it wear off quickly, just because it does, but it might be suddenly invalidated by a new virus mutation too?

The second concern is almost farcical, if it weren’t deadly serious (almost literally so).  After a vaccine has been approved, “at risk” people who are vaccinated will be given a smart phone app they can use to report any serious side effects.  The thing is, the FDA is shortening the required minimum six months of monitoring test subjects in a normal Stage 3 trial down to only two months, and they are in effect saying they don’t know if there might not be some as yet undiscovered serious side effects.  So they’re asking all of us to become part of what is, I guess, a Stage 4 trial.

Does that make you want to rush out and be vaccinated?

Here’s another supporter of early treatment rather than sitting back, doing nothing, and hoping for the best.  Let’s hope someone in our public health bureaucracy reads the article.

DC’s mayor has come up with a sure-to-fail idea.  Politely asking visitors to be tested subsequent to arrival in DC.  Not only is her plan nonsense from an epidemiological point of view, but what level of compliance does she really expect?

Timings And Numbers

We’ve been seeing a mere two states with dropping numbers for several days, then on Wednesday, it dropped to one, and again, just one single state again today.  Well done, Mississippi.  And not so well done for the other 49 states (and DC too).

Britain is struggling to get its numbers down from their present terribly high levels.  It has been trialing a new “everyone can be tested” idea.  The only problem is the trial is suggesting the tests administered are missing more than half of all infected people.

That’s a puzzling statistic – how is it that the well-validated test started performing so poorly, and how do we know the people it said weren’t infected actually are?  The article doesn’t tell us.

Closings and Openings

One of the more contentious issues (well, that is difficult to say – everything to do with the virus is contentious) is whether schools should be open or closed.  This article tells us that more than 61,000 school children caught the virus last week, a new record high number.

Maybe 99.9% of the children will suffer no lasting effects from their infections, but how many parents and other older people will these 61,000 children pass their infection on to?

Shortages

Eight months in to this crisis, and we still can’t produce enough N95 masks for essential health-care workers, let alone any for the rest of us. Why is this so difficult?  This article tells us they’re getting in short supply again (assuming there was ever a time when they weren’t scarce).

Logic?  What Logic?

England is going back into a lockdown mode to try and stop its runaway virus thread.  Last time it did that, case numbers were five times lower than they are now.  So, the new lockdown – do you think it will be stricter, the same as last time, or much more permissive?

Yes, of course, showing the same uncanny instinct to do exactly the wrong thing as we have demonstrated so clearly in the US, England is making its new lockdown much less restrictive than last time.  Does that make sense?

Virus?  What Virus?

Talking about England’s new lockdown, this article and photos show how people acted the night before the lockdown started, with new case numbers higher than ever before.  Maybe this is part of the reason why England’s numbers are climbing so high?

Other

We’ve commented before about “fecal plumes” that are created when you flush a toilet.  That may be a concern because Covid viral particles are found in feces.  But we’ve never been able to show you exactly what a viral plume is.

Until now.

The linked article’s plea is to please put the lid down before flushing.

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

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