COVID19 update, July 5, 2020: new large, successful hydroxychloroquine trial; China did not actually notify WHO of outbreak on 31 December 2019; vascular dementia sequelae in elderly survivors; aerosol transmission and why risk much less outdoors

Happy Fourth of July weekend to my American readers, and belated happy Canada Day to my Canadian ones.

(1)  (via Matt Margolis): New large-scale (over 2,500 patients) hydroxychloroquine (HOcq) trial in Henry Ford Health System (in the Detroit area) finds definite benefit to HOCQ. The paper was just published online, following peer review but prior to copy-editing, in the International Journal of Infectious Diseases.

https://doi.org/10.1016/j.ijid.2020.06.099

In a nutshell, 13% of patients who received HOcq alone died, compared to 20% of those who received the HOcq-azithromycin combo, 22% of those who received azithromycin alone and 26% of patients who received neither drug. The researchers then carried outr “propensity matching”  — that is, the creation of equal-sized “HOcq” and “non-HOcq” subsamples designed to be similar in terms of age distribution, race, pre-existing conditions, … to  create an “all else being equal” comparison. (This is known in the medical statistics lingo as “eliminating confounding factors”.) They then obtained  the following Kaplan-Meier  survival curve (Figure 2 of the paper):

Quoting from the article text:

“The benefits of hydroxychloroquine in our cohort as compared to previous studies may be related to its use early in the disease course with standardized, and safe dosing, inclusion criteria, comorbidities, or larger cohort. The postulated pathophysiology of COVID-19 of the initial viral infection phase followed by the hyperimmune response suggest potential benefit of early administration of hydroxychloroquine for its antiviral and antithrombotic properties. Later therapy in patients that have already experienced hyperimmune response or critical illness is less likely to be of benefit. […]
Limitations to our analysis include the retrospective, non-randomized, non-blinded study design. Also, information on duration of symptoms prior to hospitalization was not available for analysis. However, our study is notable for use of a cohort of consecutive patients from a multi-hospital institution, regularly updated and standardized institutional clinical treatment guidelines and a QTc interval-based algorithm specifically designed to ensure the safe use of hydroxychloroquine. To mitigate potential limitations associated with missing or inaccurate documentation in electronic medical records, we manually reviewed all deaths to confirm the primary mortality outcome and ascertain the cause of death. A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment. This finding may be explained in two ways. First, our patient population received aggressive early medical intervention, and were less prone to development of myocarditis, and cardiac inflammation commonly seen in later stages of COVID-19 disease. Second, and importantly, inpatient telemetry with established electrolyte protocols were stringently applied to our population and monitoring for cardiac dysrhythmias was effective in controlling for adverse events. Additional strengths were the inclusion of a multi-racial patient composition, confirmation of all patients for infection with PCR, and control for various confounding factors including patient characteristics such as severity of illness by propensity matching.”

(2) Laura R. A geriatric nurse, messaged the following:

Mortality of COVID-19 is not my biggest worry. I’m a long-term and skilled care nurse, and hold a CDP (Certified Dementia Professional, which indicates some training, but much more experience). All indications show that COVID-19 can cause brain damage in survivors. Non-severe disease with simple anosmia may not cause long-term sequelae, but I fully expect there to be a huge wave for demand for memory care for people with vascular dementia in the next five years, as home caregivers become overwhelmed.

https://www.washingtonpost.com/health/2020/07/01/coronavirus-autopsies-findings/

https://doi.org/10.1016/S2215-0366(20)30287-X

“Neurobiology of COVID-19”, Journal of Alzheimer’s Disease, 76,(1), 3-19, (2020) http://doi.org/10.3233/JAD-200581

(3) (Via Instapundit) WHO Quietly Changes COVID Timeline following Republican Questioning. “The World Health Organization quietly changed its timeline of the coronavirus pandemic’s first days on Tuesday, clarifying that the Chinese Communist Party never informed the organization of the pandemic on December 31, despite previous claims to the contrary.” 

“In the new timeline, which the WHO says has been updated “in light of evolving events and new information,” the organization reveals that its Chinese Office “picked up” an online statement — which has since been deleted — made by the Wuhan Municipal Health Commission describing cases of “viral pneumonia.” The WHO says it also received open-source intelligence suggesting there was “pneumonia of unknown cause” in Wuhan.

The additions clarify the WHO’s previous timeline, which simply stated that on December 31, “Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia in Wuhan” — implying the report was made to the WHO. In its initial report on the outbreak, the WHO said its China office “was informed” of the unknown pneumonia cases, without clarifying that the information was not provided by the Chinese Communist Party.

The lack of clarity led multiple outlets — including Axios, the Washington Post, and the BBC — to report that Chinese authorities told the WHO’s China office about the outbreak on December 31. ” 

Quite erroneously, as it turned out. 

(4) My Belgian correspondent “Y.” sent me this Dutch informational video from the advocacy group SmartExit.nu. (The top level domain for Niue also happens to mean “now” in Dutch.)

(English translation: https://www.youtube.com/watch?v=asjKXK44fN4  )

In brief: it discusses the main ways for the virus to spread, and places most of the blame on aerosols. Garden-variety masks are not terribly useful against aerosols, and neither is keeping a 1.5m distance, but… good air circulation and vigorous air refreshing help a lot. Best of all is to be outside.

Y. comments: “This explains why various mass outdoor parties and events in Brussels, as well as massive demonstrations, did not trigger renewed outbreaks here. And the whole ‘climate’ push for ‘passive buildings’ with almost zero ventilation turns out to be a bad idea.”

(Apropos the Washington State choir rehearsal that became a super spreader event, a (critical) commenter to the video adds this CDC link.)

Related, this just in via Instapundit: 239 experts with 1 big claim: the virus is airborne

(5) https://www.jpost.com/health-science/how-to-avoid-catching-coronavirus-633952

The Coronavirus National Information and Knowledge Center, which is overseen by the IDF Intelligence Corps in cooperation with the Health Ministry, released a report Sunday that reviews international recommendations for the kinds of activities that are high- to low-risk. The punch line is to “avoid the ‘three Cs,’” as a poster in Japan offers: closed spaces with poor ventilation, crowded places with many people nearby and close-contact settings such as close-range conversations.
 
The Jerusalem Post has put together a priority list of “safe” and “less safe” activities based on lists published by international health networks and publications that were used by the IDF to compile Sunday’s report.

The full report is here (in Hebrew). The following infographic taken from  it might be useful

(6) Naftali Bennett, former Minister of Defense, leader of the Yamina party and a successful hitech executive before entering politics, published an open letter with a 15-point plan to revamp Israel’s coronavirus response.

Happy Fourth of July: story segment, “To Look For America”

As fans of Sarah A. Hoyt (the Beautiful but Evil Space Mistress) know, her Darkship series of novels is set in a future in which most of Earth’s landmass has become uninhabitable following biological warfare. A remnant of humanity survives in “Seacities”, artificial islands. These were originally supposed to have been under the “enlightened” rule of genetically engineered technocrats, but as has happened time after time when people let themselves be ruled by their betters “for their own good”, things took a darkly dystopian turn.
A remnant among the remnant passes along, from generation to generation, secret knowledge of a place where there were no “betters” ruling you, and where government was but with consent of the governed. Some believed this place called “America” was a myth, other that it had actually once existed, yet others that it still existed somewhere. The believers call themselves “USAians”.

The following is an Independence Day excerpt from a story I wrote in that universe, for a forthcoming anthology edited by the BbESM herself. As often happened, the inspiration came from a song — video embedded at the end

Happy Fourth Of July!

Illegitimi non carborundum!


New Rotterdam
Somewhere in the North Sea
A distant future.

[…] We gather in a hidden back room of one of the entertainment complexes. The ceramacrete floor had been painted in a black and white tile pattern. Two pillars mark the eastern wall of the room. A tattered flag with red and white stripes, and stars on a blue field, hangs between them.

“Is the Lodge covered?” our Master of Ceremonies asks.

The Tiler makes a show of checking the locks and ritually answers, “the Lodge is covered.”

“Then let us start our Work.”

Some ten years ago, a new religious movement had started here. I’m told there are “USAian” groups in many other Seacities, no two of them fully alike in their rituals. Here in the Seacity of New RotterdamSome of ours are supposedly borrowed from a secret society that used to exist since about the 18th Century.

A few groups clinging to pre-Biowar faiths are frowned upon but authorized. We aren’t, but the Overclass and the Lawkeepers tolerate us as long as we’re quiet and don’t openly recruit new members. My guess is they’d rather have us discreet and be able to monitor us, than go underground completely.

Our Scriptures, “The Words that Make People Free”, are passed in secret from one group to the next—hand-carried by broomers between Seacities. I can barely believe that before the Biowars, there was a worldwide network that allowed everyone to share information with whoever they wanted, worldwide and indeed beyond. Not anymore.

Our services are short and to the point—mostly we recite The Words that has been handed down through the centuries. We don’t carry individual copies but memorize the texts through recitation. 

The Speaker intones, and we repeat:

“When in the course of Human Events…” and the text goes on to explain how, and why, the people oppressed by an ancient empire had decided to declare their independence and start a new Land of the Free.

“…that all men are created equal & independent, that from that equal creation they derive rights inherent & inalienable, among which are the preservation of life, and liberty, and the pursuit of happiness…”

The preservation of life… The preservation of life… As was our custom, we meditated on the meaning of those words.

What do we really have of those “inalienable rights”? The pursuit of happiness? Of course, the needs of keeping a Seacity going means not everyone can ‘pursue happiness’ at work. But when not working, we can ‘pursue’ what some call ‘happiness’ by having sex in every anatomically possible configuration, and we can even use some designer drugs. Just don’t do or say anything that inconveniences the Overclass too much—then you end up in the Lawkeepers’ cellars, or worse.

And life? The preservation of life?

What exactly was [my superior] doing?

***

The formal service is now over. Some members have brought some refreshments—they also mean we have a cover. In case the Lawkeepers raid us, we were celebrating a birthday.

One of us brings out a bootleg media player and makes it play back a recording of a song called “America”. I have heard it many times before — two men singing wistfully about somebody hiking for days from a mysterious place called Saginaw to look for America, but never finding it. They even mention spies wearing cameras concealed in various archaic pieces of clothing — that bit could have been talking about New Rotterdam itself.

But the version we are hearing now is by a different group. Three men sing in harmony, the lead singer naturally and warmly in a register that most men can only scream in, or sing in falsetto.   The guitar player tinkles exuberantly and virtuosically. And the bass, with  a bright, half-electronic half-organic sound, goes back and forth between a deep, bombastic strut and high, playful countermelodies. There is a joyfulness, a sense of purpose about this version that is missing from the other one.

It then hits me. The mythical America, freedom, and natural rights must ever be searched for. The search will never fully end, but it must begin with each of us.
[…]


COVID19 update, July 2, 2020: Joel Kotkin and “neo-feudal” tech oligarchy; masks in the OR; the COVID age/risk calculator; Dr. Hansen on what he learned working in COVID ICU

(1) “One man’s meat is another man’s poison” (or, in Dutch, “The death of one is the bread of another”). Certain tech companies that either supply work-from-home infrastructure, or are easily adaptable to WFH themselves, did very well for themselves during the crisis. Demographer Joel Kotkin fears this will exacerbate trends already in progress: the triumph of the [tech] oligarchs. His article plays off his most recent book, “The Coming of Neo-Feudalism: A Warning to the Global Middle Class” — a must-read that I will review in a separate article.

(2) Erik Wingren (thanks!) drew my attention to a 10-year old paper on mask use in the operating room  (cited here)

Use of Face Masks by Non-Scrubbed Operating Room Staff: A Randomized Controlled Trial

https://doi.org/10.1111/j.1445-2197.2009.05200.x


Background: Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks.

Results: Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89).

The article elicited a comment back in the day that not all surgeries are the same: in particular, orthopedic surgery (except for laparoscopic procedures) needs a much higher level of bacterial safety than the usual soft-tissue surgery, in part because infections in the bone are very hard to treat with antibiotics. https://doi.org/10.1111/j.1445-2197.2010.05412.x

(3) Dr. Seheult on Remdesivir availability

After R&D, and after giving away its supply on hand, it is now producing for resale. A 5-day course for a patient will cost a bit over $3,000. 

He also mentions the Covid-age calculator here, developed by an insurance company. The web app estimates your “COVID-Age”  based on your chronological age, your body mass index, your HbA1C reading (a measure for the health of you sugar metabolism), whether M or F, how much you smoke per day,… cholesterol levels, blood pressure,… and yes/no to several pre-existing conditions.  Whichever item you don’t know, you can leave blank. (Interestingly, Mrs. Arbel pointed out, blood group is not an input item, despite the fairly well-established difference between blood groups A and O.)

And based on this “COVID-Age”, the app then tells you your risk of needing hospitalization, of ending up in the ICU, or of dying. I entered some data for a random 25-year old female in excellent health, and got as output:
Hospitalization1.6%. ICU Admission0.21%. Mortality0.03%

Just manipulating the age, while leaving everything else constant, got
Age 50 Hosp. 4.5%  ICU 1.2%. Mort. 0.17%
Age 70, Hosp. 7.4% ICU 2.9% Mort. 0.63%
Age 80, Hosp. 8.9% ICU 4.1% Mort. 1.2%

Related, reader “Tullius Cicero” sent me this infographic:

(4) Dr. John Campbell, while generally apolitical, doesn’t have kind things to say about the WHO

(5) And this sort of thing makes one wonder why the American public has started tuning out experts. As Insta, linking this op-ed, points out, “TRUST IS PUBLIC HEALTH’S MOST IMPORTANT ASSET, AND THEY SQUANDERED IT WITHOUT A THOUGHT IN THE NAME OF EXPEDIENCY.”

(6) Dr. Mike Hansen on what he learned treating COVID-19 in the ER:

Today was a bit of a bumper crop for COVID-19 news: tomorrow I will likely skip a day unless events require otherwise.

COVID19 update, July 1, 2020: skipping phase 3 trial, China vaccinates entire army; Hong Kong loses autonomy; Israeli volunteer for “vaccine challenge trial”; how to recondition N95 masks

(1) I had somehow missed this bombshell: China skipped the Phase 3 clinical trial for its vaccine altogether and is now vaccinating its entire “People’s Liberation Army”, reports the Daily Telegraph. Dr. Campbell comments in his daily update. Epoch Times commentator Joshua Philipp (at 4:00 into the video) notes that, in parallel, it will be tested on 9,000 volunteers in Brazil: if these trials are successful, the vaccine will be manufactured in Sao Paulo and distributed free of charge. Free? Timeo DanaosSinos et dona ferentes. Keep watching for some insight on ChiCom influence operations in Brazil from, admittedly, a stridently anti-CCP commentator.

(2) While everybody was preoccupied with COVID19 and with the US riots, China’s sham parliament rubber-stamped the extension of China’s national security law to the Hong Kong Special Administrative Region, de facto (if not de jure) abrogating the “One Country, Two Systems” agreement. The UK is extending an offer of residence, with a path to citizenship, to the 3 million Hong Kongers with “British National Overseas” status.

(3) “Infect me”. The Times of Israel has an interview with Keren P., a US-born army veteran who just graduated as a mechanical engineer from the Technion. She is one of 61 Israelis who have volunteered to be “guinea pigs” in a vaccine challenge trial through the 1daysooner nonprofit. In a “challenge trial”, people are first vaccinated, then deliberately exposed to the pathogen under controlled circumstances.

(4) Following the sharp rise in new infections in Israel, the relevant Knesset committee has greenlighted the renewal of “track and trace” by Israel’s domestic security service, the Shin Bet.

(5) Can you recondition an N95 mask? An article in ACS Nano studies the question experimentally. https://pubs.acs.org/doi/10.1021/acsnano.0c03597

Quoting from the abstract:

We investigated multiple commonly used disinfection schemes on media with particle filtration efficiency of 95%. Heating was recently found to inactivate the virus in solution within 5 min at 70 °C and is among the most scalable, user-friendly methods for viral disinfection. We found that heat (≤85 °C) under various humidities (≤100% relative humidity, RH) was the most promising, nondestructive method for the preservation of filtration properties in meltblown fabrics as well as N95-grade respirators. At 85 °C, 30% RH, we were able to perform 50 cycles of heat treatment without significant changes in the filtration efficiency. At low humidity or dry conditions, temperatures up to 100 °C were not found to alter the filtration efficiency significantly within 20 cycles of treatment. Ultraviolet (UV) irradiation was a secondary choice, which was able to withstand 10 cycles of treatment and showed small degradation by 20 cycles. However, UV can potentially impact the material strength and subsequent sealing of respirators. Finally, treatments involving liquids and vapors require caution, as steam, alcohol, and household bleach all may lead to degradation of the filtration efficiency, leaving the user vulnerable to the viral aerosols.

ADDENDUM: CovidAGE risk calculator by Sanford Health (via Dr. Seheult)