This Corolla Virus thing is starting to hit close to home. John Prine died yesterday and I can think of a lot of people I would like that virus to set up housekeeping inside besides John Prine. John wrote some poignant and funny songs and very little these days is funny and poignant. We are just starting the second week of April here and folks are dropping like flies in NY and Europe. Meanwhile back in the District of Corona the shitstorm just waxes and wanes with lies and ill formed policy proposals from both the Orangeman in chief and his democratic opponents. We are learning that the 2 Trillion $ money printing operation is vastly complex when it comes to delivering welfare checks to the slobs on Main Street but works just fine getting to the hedge fund parasites like Citadel who ran into trouble when their algorithms imploded in the recent bear market . Their senior economic adviser, a certain Ben Bernanke, was able to have his former cronies at the Fed cook up some rescue rules. I can’t prove that he called Jerome Powell singing the blues but in no time flat all those leveraged losses disappeared. There is no coordination or even intelligent discussion going on in the White House and every press conference is a litany of lies and bumbling mismanagement.
Amazingly, some of Trumps statements might actually be true. Chloroquine especially in combination with Zpak and Zinc might be a possible treatment. He also might be right about mocking a Governor’s request for 30000 ventilators. It is starting to be very obvious that being put on a ventilator for Corona pneumonia is almost a death sentence. Chinese and Italian statistics indicated that you only had one chance in 3 or 4 of surviving the typically long duration vent management required. Governor Cuomo of NY recently said that the fatality rate being put on a ventilator in NY was a staggering 80%. These figures to me hint that ventilator management for the Corona virus might be the wrong thing to be doing mainly because the longer a patient is on a ventilator, the harder it is to get them weaned off of it. I do know a bit of what I speak because I have put many hundreds of patients in my career on ventilators. It is frequently a last ditch option and I always resisted it if I could. It may be that this virus is more of a blood disease than a pulmonary disease. Support for this theory comes from a recent Chinese paper that described the possible pathophysiology of the Covid Virus. Pathophysiology is a study of how a particular disease process changes the function of a particular organ and as I understand this is still incomplete science. But it seems to indicate that the virus proteins may attack and displace the iron “heme” from one of the chains of hemoglobin in the red blood cell and if so the red blood cell can carry less oxygen and CO2 and what’s worse, the liberated iron has its own cellular toxicity. The real issue appears to be cellular hypoxia.
One of the biggest ongoing problems revolves around testing for Covid-19. There are two types of tests currently being used. One is the PCR test also abbreviated RT-PCR. This is the nasal/Pharyngeal swab test and it detects the particular RNA signature of the Covid-19 virus. It is used early on in the infection. Later on there are serological tests from blood drawing which measures the titer of the particular antibodies elaborated by the patient’s immune system as it fights the infection. High titers, high immunity to Covid-19. The importance of serological testing to measure immunity is that if a person has a high titer of antibodies it means he/she can get back to work and not have to worry about getting Covid -19 again. The more people that can get back to work the sooner the economy can resume. For example the country could issue a medallion to wear around the neck, a bracelet or some decal to put on your car or appear on your cell phone stating your immunity. Sounds great, right? Not so fast. A recent paper by the Imperial College in London has said that most of the tests they have evaluated have flunked! That really is terrible news if you don’t have serological tests you can trust. And here is another disappointment from Chinese researchers who tested 175 hospitalized patients who had confirmed Covid-19 by PCR tests. The bad news was that about 1/3 of the 175 patients had titers of antibodies too low to confer immunity9less than 500) and “several” patients had no detectable titers at all. Most of these low titer patients were less than 40 years old. The older over 50 population had far higher titers. This is potentially bad news because the younger tranches tend to get less severe cases compared to the older population but it seems to indicate that they didn’t develop immunity either! It seems to indicate that they could contract the Covid-19 again. It is possible that other modalities of the immune response such as T cells or a cytokine response might have made them better rather than a pure antibody response. It suggests that this group of 175 will need to be tested within the next year to see how antibody levels change but I didn’t see in the abstract whether that was part of their plan. Let’s hope so. It seems to indicate that it could be some time before the world gets a handle on the host responses following a covid-19 infection. The good news is that a variety of vaccines are under development using all manner of tried and proven techniques but how long they confer immunity and how specific they are to the virus and its haplotypes needs to be determined by clinical trials which take time.. Some vaccines have even proven toxic. Stay tuned for the vaccine news because it is most likely to be THE solution. Other treatments during the infection will certainly be tried and one would hope there will be treatment drugs with efficacy such as hydroxycloroquine/zinc/zpak.
One final little tidbit I read yesterday is that a Chinese study said people with type O blood types fared much better than others. Type A blood types seemed to fare much worse. The message I want to continue to hammer home is that YOU MUST NOT GET THIS VIRUS until a vaccine is developed. Stay isolated in your cave.
Wait! There’s more! It seems the corona virus can hit animals. A tiger in the Bronx zoo has it and one would have to assume pets can get it. Who knows whether the animals can transmit to humans but if a Tiger coughs in your face you need to be worried. Wear a mask if you visit the Bronx Zoo and hope the tiger has one too.
Well that is the latest news from the end of the first week of April 2020.
We are happily isolated here in Wyoming by a rotten climate and low density of people most of the year and we like it that way! Stay safe out there, wear a mask in public and get planting your garden!