COVID19 update, May 3, 2020: Medical bureaucrats vs. frontline medicine; Israel vs. Belgium; agriculture turns away from globalized agribusiness and toward local market

(1) John Hinderaker of Powerline contrasts the hidebound “academic medicine types” who dominate the medical agencies and healthcare bureaucracies with the more daring doctors on the frontlines of the epidemic. 

He specifically refers to a story I have been covering here at some length: the changing understanding of the severe COVID19 disease picture as primarily “immune systems killing the patients in order to have them”. (The milder disease picture without lower lung involvement — which accounts for the overwhelming majority fo COVID19 cases — is typically a self-limiting ailment ranging from a mild cold to a nasty bout of flu.)

A group of critical care physicians representing the University of Tennessee, the University of Wisconsin, Eastern Virginia Medical School, the University of Texas and a number of other institutions have formed the Front Line COVID-19 Critical Care Consortium and released a bulletin setting out a recommended treatment protocol. The protocol is based largely on the fact that it is not the virus, but the body’s reaction to the virus, that kills patients:

[I]t is the severe inflammation sparked by the Coronavirus, not the virus itself, that kills patients. Inflammation causes a new variety of Acute Respiratory Distress Syndrome (ARDS), which damages the lungs.

Practicing doctors are highly familiar with inflammatory conditions and a number of known treatments have been adapted to COVID-19. The linked bulletin advocates early intervention–the key–using Vitamin C, heparin, Methylprednisolone and Hydroxychloroquine.

Dr. Paul Marik, Chief of Pulmonary and Critical Care Medicine at the Eastern Virginia Medical School, published a Critical Care COVID Management Protocol along similar lines. As a preventive measure, Dr. Marik recommends a combination of Vitamin C, Vitamin D, zinc and melatonin. Dr. Malik notes that “[w]hile there is no high level evidence that this cocktail is effective; it is cheap, safe and widely available.” For what it is worth, I have been following this regimen for some time.

Interestingly, in my own field of science (as in many others), it is precisely the academics who push for innovation, and the industrial users of the science and tech who are hidebound. However, frontline medicine is a different matter than, say, analytical chemistry: if you have patients dying on you — and what “the book” tells you isn’t working — you start trying to think outside the book. The much-maligned steroids actually do a lot of good in acute autoimmune or allergy attacks (I’ve gotten them following a suspected allergic reaction to an antibiotic). Sure, you don’t necessarily want to rely on steroids for long-term case management if you can help it, — but here you’re trying to stop a patient from getting killed by a massive immune over-response.

(2) The director-general of Israel’s health ministry positively evaluates the outcome of Israel’s containment/mitigation strategy: we actually have one of the lowest case fatality rates in the developed world. “If we hadn’t been tough, we’d have been in the same boat as Belgium”, he said. Belgium has a slightly larger population than Israel, and so far has 7,844 dead, compared to just 230 in Israel.

To be fair, of course, Israel has several factors on its side that Belgium didn’t:

  • a much sunnier and warmer climate — this both reduces the ability of the virus to spread (as the DHS study showed, virus deposits on surfaces are neutralized by bright sunlight)   *and* the additional vitamin D boosts the immune system of humans
  • Israel has a much younger population pyramid than Belgium (or Germany, or…) — which in and of itself will reduce mortality (in Germany, just one percent of dead are below age 50).
  • Israeli can seal its borders with comparative ease
  • War and terrorism being a permanent risk in Israel, both its medical systems and its population may be more primed to respond to calamities

This is aside from Belgium counting many deaths as “of COVID19” that were really from other causes, “with” actual or suspected COVID19. (Otherwise, it is impossible to explain why its absolute mortality exceeds that of next-door Germany, which has 7x the population.)

(3) Miscellaneous updates:

  • De Standaard (in Dutch) looks at the changing agricultural landscape in Belgium and The Netherlands. Farmers are getting second thoughts about big agribusiness on low margins, becoming dependent on export markets halfway around the planet , which demand is now at zero while people in the next town or county want to buy vegetables. “Locavores” (eating local) is an expensive snobbish trend in some parts of the USA, but quite feasible in Northwest Europe. 

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