COVID19 update, May 9, 2020: Spreading reconsidered; German pathologist and Swiss doctors identify thrombosis as #1 killer in severe COVID19, Swiss clinical trial with aggressive anticoagulation treatment; meat supply chain disruptions in Germany

(1) The Daily Telegraph has a long article about an epidemiologist at St Andrews U., Scotland, who has been analyzing a number of epidemiological “contact tracing” studies on how COVID19 spreads.

https://threadreaderapp.com/thread/1257392347010215947.html

(Quote)

An analysis of such studies was recently posted on Twitter by Dr Muge Cevik, an infectious diseases clinician and researcher from St Andrews University. It was promoted by Sir Jeremy Farrar, the head of the Wellcome Trust and a member of the Scientific Advisory Group for Emergencies (Sage). “If you read one thread,make it this one,” Sir Jeremy said.

(Twitter thread unrolled here)

Dr Cevik starts with a big Chinese study that traced 2,147 close contacts of 157 confirmed Covid-19 cases. The overall infection rate was six per cent, but it was much higher among friends (22 per cent) and family members (18 per cent). In terms of location, the main risk factors were homes (13 per cent) transport (12 per cent) and dinner and entertainment (seven per cent).

Broadly similar findings emerge in several other papers. Risk of infection is much higher within households or other enclosed environments in which contact is close and sustained. In the outdoors, it falls to something in the 0-5 per cent range.

[…]A Chinese study of 392 contacts of 105 confirmed cases found that the attack rate in children was just four per cent within the home, compared with 17.1 per cent in adults, for example. The infection of spouses was super high, at 28 per cent. 

Emphasising the link with age, another study found that household members over 60 were much more likely to become infected (18 per cent) than those under 20 (five per cent).

Children, it seems, are not only better able to resist the infection within the home but also less likely to bring it back with them. A study, funded by the Australian Research Council, of 31 household clusters including children found that only 10 per cent had been sparked by children.

Using these and other studies, Dr Cevik concludes that they suggest (not prove) the following:

[emphases mine in the quote below]
  • Close and prolonged contact is required for transmission of the virus. 
  • Risk is highest in enclosed environments such as houses, care facilities, public transport, bars and other indoor spaces where people congregate.
  • Casual, short interactions are not the main driver of the epidemic. 
  • Susceptibility to infection increases with age.

(2) Die Welt has a video interview (in German) with Prof. Nils Kucher at the Zurich university hospital. 

Summarizing his remarks:

  • We got severe COVID19 completely wrong in the past. This is changing as overwhelming evidence accumulates, e.g. from autopsies, and is published
  • Severe COVID19 is not a conventional viral disease at all, but a coagulation disease
  • Endothelial cells have ACE2 receptors. The virus docks there, cause inflammation of the endothelium, this leads to release of cytokines. (Cf. “cytokine release syndrome”, a.k.a. “cytokine storm”.) Thrombosis ensues, and eventually the patient dies of embolisms
  • It has taken us way too long to figure that out, which has cost needless lives
  • The way to prevent thrombosis is treatment with [?]molecular weight heparin. Guidelines traditionally limit this to hospital settings because of the risk of hemorrhage 
  • Often patients seem to be in decent shape, are sent to home isolation with just antifebriles, and then some die of thrombotic events
  • Now we [=Zurich U. Hospital] are running a clinical trial on 1,000 ambulatory COVID19 patients. Half get standard care, the other half also get heparin injections. All are closely monitored by telephone in case something goes awry. For the heparin treatment with that patient group, the risk of hemorrhage is rated as less than 1%
  • Sadly, doing a control group creates an ethical problem if it’s a deadly disease and you are pretty sure you have the answer

Related: a Hamburg coroner, Dr. Klaus Püschel , talks about what he has learned from 192 autopsies on COVID19 patients (Under a law in the Free City of Hamburg, autopsies are mandatory for deaths from an infectious disease.)

“Of the first dozen I autopsied, seven died of thrombose, four directly of lung embolisms.” 

Those results were just published [following peer review by four experts, which takes a while] in the Annals of Internal Medicine. http://doi.org/10.7326/M20-2003

Independently of his colleague in Zurich, Hamburg University Hospital Prof. Stefan Kluge wonders if treatment of severe COVID19 patients should not primarily feature anticoagulant therapy.

[My “gut” tells me: a combination of anticoagulants and immunomodulators.]

Coroner Klaus Püschel : “This isn’t a killer virus, we’re not at war. We must not fear and should not give up.”

(3) Now even De Standaard (in Dutch) has woken up to the problem of food insecurity in the US. The article is a mixed bag: the journalist is clearly  floored by the generosity of Americans (in “nanny states” like Belgium, there is a tendency on the part of people to say, “oh, helping people, that’s the government’s job”). At the same time gets taken in by socialist snake oil peddled by the likes of “Beta” O’Rourke.

(4) On a related note, supply chain disturbances for meat are not just a US phenomenon: Here are two articles telling of outbreaks at two meat processing plants, one in Schleswig-Holstein in the North, the other in Baden-Württemberg in the South.

Consequently, meat prices are rising in Germany.

3 thoughts on “COVID19 update, May 9, 2020: Spreading reconsidered; German pathologist and Swiss doctors identify thrombosis as #1 killer in severe COVID19, Swiss clinical trial with aggressive anticoagulation treatment; meat supply chain disruptions in Germany

  1. Has any study addressed the reaction of seniors (+65 yrs) on anticoagulants (warfarin etc) as compared with those in the same age cohort not exposed to those same drugs? Also, does low dose aspirin use influence the incidence of virus-induced thrombosis?

    • Oooh, that would be a good route of research– I know my grandfather was on blood thinners for a heart condition, and there’s more recognition of the dangers of blood clots now, but then I have also heard that heart issues were one of the existing conditions that are associated with mortality… should be relatively easy to see if any of those folks were being actively treated?

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