The news of normalization with the United Arab Emirates did not come as a complete surprise to us, as low-level contacts have existed since the mid-1990s — neither party saw it in its interest to shout their existence from the rooftops. [UPDATE: it appears PM Netanyahu made a secret visit to the UAE Crown Prince back in 2018, together with Mossad chief Yossi Cohen who brokered the meeting.] Still, this is a historic first.
What precisely moved the UAE to “make things official” right now? Aside from everybody on the Arab peninsula getting nervous about Iran, Coronavirus (and particularly Israel’s research efforts on a vaccine and treatment options) is one thing; this is part of a general interest in Israel’s technological know-how, as the Gulf state tries to diversify its economy and position itself best for “the day after” their oil either runs out or becomes an obsolescent energy source.
Od yavo shalom aleinu ve-al kulam. Salaam, aleinu ve-al kol ha-olam. [Peace be upon us yet and upon all. Salaam, upon us and upon all the world.]
He also discusses the headline that “only 6%” of deaths in the USA are directly attributable to COVID19. What that means is that in 6% of cases, there is nothing but COVID19 on the death certificate. Viral pneumonia and ARDS (acute respiratory distress syndrome) on the death certificate make up some of the remaining 94%, even when these are clearly consequences of COVID19. I believe it is safe to say that the death rate from COVID19 is inflated, but not by a factor of 16.7.
Dr. Campbell also provide some context by comparing with deaths attributable to smoking (nearly half a million a year in the USA). While the percentage of smokers has gone drastically down (to 15% or less of adults in many Western countries), we are still paying the ferryman for smoking decades early.
(2) It is generally assumed that the hi-tech sector is fairly immune from the economic fallout of COVID19. Hi-tech is an outsize chunk of the economy in “startup nation” Israel. To be sure, it’s weathered the storm much better than retail, outside dining — not to mention the death blows our tourism and entertainment sectors have gotten — and some individual startups that cater to telecommuting and distance learning needs may even benefit from the crisis. But not all are unscathed. I saw a segment on our main TV news channel (embedded below) in which a lady who used to have a senior position with the Israeli branch of a German tech company (I suspect I know which one) until the branch got closed. She is keeping her head above water by turning to her childhood recipes and cooking empanadas (Argentinian-style turnovers/dumplings) in her home kitchen and delivering them around the neighborhood.
An inside source told me that, while her particular company (let’s call it Acme) is “making do”, their bottom line is affected by the economic woes of Acme’s corporate customers and prospective customers, which leads them to pare down their expenses or to avoid taking on new financial obligations unless assured to be revenue-positive in the short term — even if they really would benefit from Acme’s product.
Not even academia is fully immune: I was forwarded a letter from the president of a private college. Said president apologizes for not lowering tuition despite all teaching being via Zoom, and explains that the faculty, support staff, and administration (himself included) all took pay cuts to ensure the normal functioning of the college (including need-based tuition accommodations).
As I started plotting the sequel to Operation Flash (which will either be Episodes 4-6, or Book Two) one country that loomed large was Hungary. Science-fiction and fantasy author Yakov Merkin actually wrote his Master’s Thesis in History on the Horthy regime: this was a good jumpoff point.
(1) What came before: genesis of the Austro-Hungarian Dual Monarchy
The Hungarian Revolution of 1848
The lands of the Crown of St. Stephen (Szent Istvan) had been under Habsburg rule for some time (part since 1526, the formerly Ottoman part since 1699) when the “Year of the Revolutions” 1848 rolled around. The incapacitated Habsburg emperor Ferdinand I abdicated in favor of Franz Josef, who had just turned 18 (and would eventually rule until 1916 !). However, the Hungarians refused to let him have the Hungarian crown in personal union. When Franz Josef tried to impose his will on them, and even tried to dissolve the Hungarian Diet (which had sat since the 12th Century), Hungarians under Reichsverweser [acting head of state] Lajos Kossuth rose up and declared their independence. At first the Hungarians were able to keep the Austrian troops at bay, until Franz Josef pleaded with Russian Tsar Nicholas I to pull his chestnuts out of the fire. With the help of Tsarist troops, he was able to suppress the uprising, and Hungary remained under military dictatorship for almost two decades. Some senior Hungarian leaders were executed, others exiled. [Musical note: Their fate inspired the great Hungarian-born composer and piano virtuoso Franz Liszt’s piano fantasy “Funérailles”:]
What put an end to this situation were two humiliating Habsburg defeats in as many wars: the first in the Second Italian Independence War of 1859 (where Austria lost its possessions in Northern Italy), the second in the Seven Weeks War against Prussia in 1866. As I have explained before, the main reason Prussia did not conquer Vienna outright and create a “Grossdeutschland” there and then was that Prussian (later German) Chancellor Otto von Bismarck threatened to jump out the window if that happened: he preferred a Little Germany with a Prussian Protestant complexion over a German superstate where Catholics would be too numerous.
• The Great Compromise of 1869
At any rate, Austria found itself flat broke and on the brink of national bankruptcy. Franz Josef saw only one way out: ending the conflict with the Hungarians. This led to the 1869 Ausgleich (freely: Compromise), which created the Dual Monarchy of Austro-Hungary with two nominally co-equal partners in “real union”, not merely “personal union”.[*] The historical constitution of the Kingdom of Hungary was restored, and 10 of the “12 points” of the 1848 Hungarian revolutionaries were adopted. The border between the Austrian (“Cisleithanian”) and Hungarian (“Transleithanian”) portions of the dual monarchy was demarcated as in the Middle Ages, i.e., at the Leitha/Lajta/Litava river (names in German/Hungarian/Czech, respectively), a tributary of the Danube.
• Hungarian Jews: more Magyar than the Magyars
Hungarian Jews had enthusiastically embraced the Hungarian nationalist cause: after the Ausgleich, this only intensified. Three expressions of this can be seen:
1. The vast majority raised their children as native Hungarian speakers. (Not the easiest of languages, to put it mildly.) In the 1910 census, 77% of Hungarian Jews listed Hungarian as their mother tongue
Indeed, later antisemitic persecutors would express their frustration that “you can’t tell Jews from their surnames in Hungary”. Kohn became Kun, Kovacs (=smith), Kalman,…; Weiss became Feher (=white); Schwarz became Fekete (=black), Gross became Nagy(=big), Klein became Kis(=short), Wolf became Farkas, Weissberg could become Feherhegy or rather Fehervar (Weissburg, an actual town in the Hungarian Kingdom), …
Many Jews adopted Hungarian toponyms (names based on places, e.g. Somogyi, Komaromi, Erdelyi=Transsylvanian,…), exonyms or ethnonyms (Nemeth for German/Deutsch, Horvath for Croat, Lengyel for Pole/Pollack, Szekely=Szekler, Toth=Slovak, Olah for Wallach) that were already common among the Magyar majority, or occupational names (Kovacs, Lakatos=locksmith, Szabo=tailor,…) that likewise were just as readily found among the general Magyar population.
3. A minority of Hungarian Jews converted to Christianity. (One family known to us actually converted twice, so “former religion” would not be listed as “Mosaic”.) Those who remained in the Jewish faith were split between three denominations: 1. Neolog, a form of Conservative Judaism that commanded the loyalty of the urban middle-and upper-class Jews; 2. Orthodox secessionists who rejected Neolog reforms and indeed in large measure modernity itself, turning toward Chareidi (“ultra-Orthodox”) Judaism; 3. “Status-Quo”: a small denomination that tried to walk a middle path, and which also included what we would today call modern-Orthodox congregations.
(2) The Trianon Treaty (1920)
Rivers of ink have been poured onto pages about the 1919 Versailles Treaty and how it sowed the seeds for World War Two. Comparatively few people are even aware that, at the Grand Trianon Palace in the Versailles compound, another treaty was concluded on June 4, 1920 that disposed over the Hungarian part of the Austro-Hungarian double monarchy. Prior to World War One, the “Crown Lands of St. Stephen” (or Szent-Istvan as the Hungarians would call him) encompassed a vast territory from present-day Slovakia (to this day, Slovakia has a nontrivial percentage of native Hungarian speakers) down to Croatia and Bosnia-Herzegovina, not to mention Transylvania. Triple city names like Bratislava (a.k.a. Pressburg a.k.a. Poszony), Cluj (a.k.a. Klausenburg a.k.a. Koloszvar), … give the reader more clues: Romania has Hungarian- and German-speaking minorities in Transylvania (a.k.a. Siebenbürgen a.k.a. Erdély) to this day. See the map below [“Ruthenians” is an obsolete collective term for Ukrainians and Belarusians]:
To cut a long story short: at this conference, the borders of Hungary were redrawn based on ethnic composition. The much-reduced territory of Hungary now included a solid majority of Hungarian speakers (the criteria used for ethnicity were basically linguistic), although the areas ceded to Rumania and the newly created Czechoslovakia, in particular, included enclaves where Hungarian was the majority language.
This had some fateful consequences for Hungarian politics in the years to come. The massive loss of territory and the cession of majority-Hungarian enclaves like Szekely Land created strong irredentist sentiments. In addition:, where the Austro-Hungarian empire, for better or for worse, had been a polyglot, poly-ethnic state par excellence, little Hungary now had an overwhelmingly Magyar population. Just two medium-sized minorities remained: ethnic Germans (about 7%) and Jews (about 5%), plus about 1.8% Slovaks. Almost 90% (including essentially all the Jews) spoke Hungarian as a mother tongue.
Much of the commercial and professional class — especially in Budapest — was Jewish. While this created resentment of an economic nature, Hungarian Jews had been particularly eager to embrace Hungarian nationalism, and were considered well-integrated.
But Hungary had now staggered through the one-two punch of first the short-lived Hungarian Soviet Republic, then the massive territorial losses of the Trianon Treaty. Jews, as the most visible minority left (at least in the large cities), were a convenient scapegoat, particularly as the Hungarian Communist leader Béla Kun (born Béla Kohn) was of Jewish birth. [Kun fled to Austria, then was traded to the USSR in a prisoner exchange. He was active then in the Comintern until arrested and executed in 1938 during the Great Purges.]
The Red Terror of Bela Kun begat a White Counterterror. Eventually, on March 1, 1920, the National Assembly of Hungary re-established the monarchy. However, as the Allies would never consent to a return of king Karl/Karoly IV (who had also been the last Austrian emperor Karl I in personal union), the de facto head of state became a regent. In an overwhelming 131-7 vote, parliament elected as Regent the last commander of the Austro-Hungarian fleet, Vice-Admiral Miklos Horthy.
(3) The Horthy regime in the interwar years
The last Habsburg emperor (and hence last king of Hungary in personal union) Charles/Karl/Karoly could not come back to Austria, as the country had become a Republic in the meantime. But Hungary had not abolished the monarchy, and indeed had appointed Horthy as Regent, as we saw in Part 1. So in 1921 Karl actually tried to return by slipping into Hungary incognito and showing up at Horthy’s palace. To Karl surprise, Horthy was unwilling to aid in his restoration to the throne except by consent of the Allied powers, and eventually he had to leave unfulfilled. He tried once again to return to the throne, this time without approaching Horthy for help, but was expelled from Hungary and spent the last year of his life on Madeira.Notice however that, while Miklos Horthy’s Hungarian title is usually translated as Regent in English, the German translation (which Horthy himself used) is Reichsverweser, i.e., an acting head of state during an interregnum. (German reserves the word “Regent” for one ruling on behalf of a minor or incapacitated de jure monarch.) At the beginning of his 24-year tenure, Horthy relied much on two moderate figures: Pal Teleki and Istvan Bethlen, both prime minister at various times. Horthy was impetuous and burst out in radical speech at times, but was willing to defer to his more seasoned advisors.The far right, which had helped propel Horthy into power, quickly became alienated by him.
Yakov Merkin sees the infamous “numerus clausus law” of September 1920 (which limited the percentage of Jewish college students to their proportion in the population, i.e., about 6%) as a sop to the far right “to take the wind out of their sails”, and claims the law was only laxly enforced: two years later, the proportion of Jewish college students was again >13%, not to mention the richer families sending their children to Austria, Germany, … to study. [* ] Still, the percentage of Jewish students at the two main Budapest universities (Eötvös L. and TU Budapest) dropped from one-third in 1913 to about 8% in 1925.
Yet Merkin does see a sinister, foreshadowing aspect to the law: that for the first time it defined Jews as a separate race, and no longer as Magyars. (I.e., a transition from a cultural to an ancestral definition of “Magyar”.) Nevertheless, he stresses that people like Bethlen and Horthy strictly saw the world in terms of class rather than race: they had more of a common language with the rich Jewish industrialists and merchants than with working-class Magyar antisemites. Indeed, they distrusted the common people to such a degree that they reformed the electoral laws to limit suffrage to about one-quarter of the population, and from 1926 the Upper House of parliament was no longer elected directly but its members appointed as representatives of the nobility, the religious denominations, economic interests,… and direct appointees of the Regent. Paradoxically, these anti-democratic reforms slowed the rise to power of the far right.
Bethlen coopted Christian nationalist rhetoric while at the same time refusing to impose further disabilities on the Jews, and generally maintaining good relations with the business elite (including the Jews among them). * The Great Depression and the rise of the Arrow Cross
The Great Depression saw the country unable to pay its creditors, and eventually Bethlen and his brief successor Karolyi were forced to resign in favor of the radical rightist Gyula Gömbös (who ironically was not of Magyar but of ethnic German descent). Gömbös tried to create a military alliance with Fascist Italy and newly Nazi Germany, while Horthy remained an Anglophile, and the old guard in general became wary of Germany following the assassination of Austrian Chancellor Engelbert Dollfuss in a Nazi coup attempt. Upon the death of Gömbös in 1936, his successor Daranyi had little luck on the foreign policy front, and was eventually ousted by Horthy for being too accommodation to the Arrow Cross, the fairly newly established Hungarian Fascist party led by future dictator Ferenc Szalasi. Darany’s successor Bela Imredy actually put Szalasi in prison, which only made him more popular with his supporters. At the same time, Imredy passed (under German pressure) the first of three anti-Jewish laws. Eventually he was forced out after political opponents went Alinsky on him and produced alleged proof that Imredy himself was of Jewish ancestry, at which point he was forced to resign.As Merkin describes it, support for these laws was strong among nationalist Hungarian professionals (for whom they created economic opportunity). Yet some of the old guard nationalist politicians disliked them as “creating a double standard” as no comparable law was applied to the other principal minority (ethnic Germans, also known as Danube Swabians)! While the laws were inconsistently enforced, and the Jewish business elite suffered little damage, many lower class Jews lost their livelihood. In 1939 a further disability, and humiliation, was added that forced Jews out of the military proper and into unarmed “labor battalions”.
(4) Hungary enters WW II on the side of the Axis
Hungary becoming a military ally of the Axis paid off in terms of territory, with areas of Czechoslovakia, Romania (specifically, Northern Transylvania), and Yugoslavia being returned to Hungary. In July-August 1941, Hungary handed over about 10,000-20,000 Jewish refugees to Nazi Germany (they were transported to Kamenets-Podolsk and massacred there). It however refused to hand over native Hungarian Jews as long as Horthy was in power (deportations would only start in May 1944, after Nazi Germany had invaded Hungary and deposed Horthy). When the Wehrmacht crossed Hungary on its way to invading Yugoslavia (without the consent of its nominal ally), Prime Minister Pal Teleki committed suicide on April 3, 1941, leaving a suicide note saying, among other things:
We broke our word, – out of cowardice […] The nation feels it, and we have thrown away its honor. We have allied ourselves to scoundrels […] We will become body-snatchers! A nation of trash. I did not hold you back. I am guilty.
He was succeeded by the strongly pro-German Laszlo Bardossy, who brought Hungary into the war against the USSR and enacted the third anti-Jewish law — modeled on the Nuremberg Laws — which came into force on August 8, 1941. Eventually, Horthy dismissed him on March 7, 1942, in the face of mounting losses on the Eastern Front and opposition to Horthy’s plan to anoint his own son as his successor.
The new prime minister, Miklos Kallay, was more wary of Germany and sought contacts to the Allies. These efforts were intensified after many Hungarian divisions were wiped out during Operation Uranus (the Red Army pincer movement that created the Stalingrad cauldron).
And this is the situation on March 21, 1943 — the day Timeline Valkyrie 1943 forks off.
In our own timeline (I will devote a future blog post to these developments), Hungary was occupied by Nazi Germany on March 15, 1944 in Operation Margarethe, in order to forestall Hungary’s defection to the Allies. One consequence was the beginning of the Shoah in Hungary.
[*] These expat students include some scientific household names like Eugene Wigner, John von Neumann… Indeed, the broader group of expatriate Hungarian scientists and mathematicians, many of them Jewish, was sometimes jocularly referred to as “The Martians“.
Dr. John Campbell, a retired British nursing school instructor and textbook author whose videoblog on COVID19 I have been following diligently, highlights a new observational study from Belgium that caused him to change his mind about hydroxychloroquine: he was always skeptical but now believes it is effective.
The original paper “Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients with COVID-19: A Nationwide Observational Study of 8075 Participants” by L. Catteau et al., can be read here as a postprint (i.e., an accepted manuscript in press following peer review): https://doi.org/10.1016/j.ijantimicag.2020.106144
Allow me to highlight some quotes from the actual paper:
[…]Early during the amplification phase of the epidemic in Belgium, and pending results of clinical trials, off-label administration of a low-dose regimen of HCQ sulphate in monotherapy (400mg twice on day 1, followed by 200mg twice a day from day 2 to 5, i.e. a total dose of 2400 mg) was recommended as an acceptable immediate treatment option for hospitalized COVID- 19 patients . This guidance, officially released on March, 13th, was based on the following considerations: (1) HCQ was the only drug with demonstrated in vitro effect against SARS-CoV-2 available in Belgium at that time; (2) HCQ exhibited a superior in vitro antiviral effect in comparison to CQ, likely explained by the higher intracellular drug accumulated concentrations ; (3) limited pharmacokinetic data suggested that the selected dosage should have sufficient antiviral activity ; (4) chronic administration of HCQ for rheumatological disorders has not been associated with major safety signals since decades of use; (5) restricting HCQ use to well-selected COVID-19 patients monitored at hospitals appeared as a reasonable risk/benefit compromise considering the well-known dose-dependent cardiotoxicity of the drug; (6) it was advised to Belgian hospitals to administer this off-label regimen whenever possible within clinical studies.[…] Patients treated either with HCQ alone and supportive care (HCQ group) were compared to patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. […] Results: Of 8075 patients with complete discharge data on 24th of May and diagnosed before the 1st of May, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, the mortality was lower in the HCQ group compared to the no-HCQ group (adjusted hazard ratio [HR] 0.684, 95% confidence interval [CI] 0.617–0.758). Compared to the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤ 5 days (n=3975) and > 5 days (n=3487) after symptom onset (adjusted HR 0.701, 95% CI 0.617–0.796 and adjusted HR 0.647, 95% CI 0.525–0.797, respectively).
The senior authors are affiliated with Ghent University, but the sample is nationwide, namely: all hospital admissions with COVID19 in Belgium until May 24 for which proper documentation on admission and discharge could be secured, and who had been given either HCQ or just “standard of care” (i.e., patients who got other experimental treatments were excluded, whether or not they also received HCQ).
So what do the authors speculate about the mechanism?
Antiviral efficacy of HCQ in humans has been poorly studied so far with adequate methods. Questions have also been raised whether safe HCQ dosages are sufficient to reach antiviral activity in target pulmonary cells . Translating in vitro data into in vivo drug concentration in tissue appears particularly challenging for HCQ, as plasma concentrations do not appear to be a reliable surrogate . Preprint studies in animal models (non-humans primates and Syrian hamsters) also suggest that HCQ has no antiviral efficacy [36,37]. Clinical efficacy might however be mediated through immunomodulatory mechanisms , preventing the progression toward severe disease with over-inflammatory responses by dampening the cytokine storm . HCQ has indeed been shown to decrease the production of pro-inflammatory cytokines, both ex vivo and in lung explant model [5,39,40]. In the same line, use of low-dose dexamethasone (one of the RECOVERY arm) was recently reported to significantly decrease mortality in COVID-19 patients requiring oxygen . Also, HCQ has been suggested to have some anticoagulant properties that may be beneficial in preventing thrombotic events in complement to low-molecular weight heparin .
The authors also note that concerns about cardiotoxicity refer to much higher dosage regimes (12,000 mg over 10 days). I know anecdotally from a friend who got such high doses as standard treatment for acute malaria that this was not a pleasant experience. The low dosage regime considered here is normally associated with the management of autoimmune diseases like lupus and rheumatoid arthritis; anecdotally, friends and acquaintances have been taking such for years without serious adverse events. As Paracelsus so memorably wrote in 1538, “All things are poison and nothing is without poison; only the dose causes something not to be a poison” (Alle Dinge sind Gift, und nichts ist ohne Gift, allein die Dosis macht dass ein Ding kein Gift ist.)
Alarmist elements in the news media are going in overdrive about a semi-credible report from Hong Kong (based on a leaked draft manuscript by one Dr. Kelvin Kai-Wang To) that somebody who was previously cured from COVID19 now got infected again. OMG! We’ll never have a vaccine! And no herd immunity either! ZOMG we’re all gonna die! DJ Lethal Bring It On!
Not so fast, says Dr. Campbell — and rightly so.
First of all, even if this were kosher, we’re talking about an isolated case — with a little effort, you can turn up one or two cases in history where somebody was bitten to death by a Jack Russell Terrier. He mentions two additional case reports, one in the Netherlands and another in Belgium. (De Standaard reports, in Dutch, that the Belgian case was only alluded to by Leuven virologist Marc van Ranst and that there is no confirmation in the literature.)
Second, what are the specifics of the case? In brief: a 33year old man, healthy, not immunocompromised, got the virus back in March, had fever for several days and was hospitalized, then eventually discharged. Interestingly enough, he never tested positive for antibodies — but Dr. Campbell explains that about 8% of COVID19 cases do not “seroconvert”. (Nobody was testing for T-cells back then — I don’t know who, outside of the Karolinska Institute in Sweden, has a workable testing setup.)
After a vacation in Spain (also stopping over in the UK) our friend was tested upon entry at Hong Kong airport and tested positive. He was hospitalized, but remained asymptomatic, with normal temperature, 98% oxygen saturation, … CRP (C-reactive protein, an inflammation marker) was elevated, indicating some sort of inflammatory response. Viral titer kept dropping, and eventually he did “seroconvert”.
Hong Kong is a pretty high-tech medical setting, so (unusually) full genome sequencing of the virus was done for the same patient in first and second infection. This appears to indicate he got two different variants of the virus. The first strain is genetically closely related to the strains circulating in England and the USA in March, the second more closely to strains from July. The leaked draft speaks (in apparently garbled language) of a deletion of 58 amino acids in the spike protein.
Here is Dr. Campbell being interviewed about the matter on Deutsche Welle (German Wave, the German counterpart of VOA). I’m glad they decided to interview somebody a bit clear-headed, even though I don’t always agree with the good doctor.
Dr. Maria van Kerkhove of the WHO (one of the actual professionals, unlike the political hack and CCP turtle-boy at the top) calls for calm, pointing out that it’s a single report and that not even a preprint is available for people to read.
Israel’s coronavirus czar, Prof. Roni Gamzu, wants to avoid at all costs a second lockdown (unlike most of his colleagues, he’s an economist as well as a medical doctor). In this Hebrew video, he vents his frustration about the lack of compliance of the public with social distancing (including what in some other societies would be called “politely respecting others’ personal space”). At the end he says, “if I have no authority to do anything, then I don’t need to do this job”. [He’s on leave of absence as the CEO of the country’s largest hospital.]
(H/t: Keith Clinton). An interesting read from the Center for Evidence-Based Medicine about the reliability of COVID19 testing.
Update: Dr. Seheult weighs in on the matter, and via him Dr. Mina. Neither of them are particularly perturbed by this report. https://youtu.be/J9BOs_dR_bI
Update 2: Interesting video by Wendover Productions on how the epidemic has disrupted the airlines’ computer-modeled pricing system and how they are willy-nilly falling back on human intuition https://youtu.be/H_akzwzghWQ
The proposed method uses a developed breath device comprised of a nanomaterial- based hybrid sensors array with multiplexed detection capabilities that can detect disease-specific biomarkers from exhaled breath, thus enabling rapid and accurate diagnosis. An exploratory clinical study with this approach was [carried out] in Wuhan, China during March 2020. The study cohort included 49 confirmed COVID-19 patients, 58 healthy controls and 33 non-COVID lung infection controls. When applicable, positive COVID-19 patients were sampled twice: during the active disease, and after recovery. Discriminant analysis of the obtained signals from the nanomaterial-based sensors achieved very good test discriminations between the different groups. The training and test set data exhibited, respectively, 94% and 76% accuracy in differentiating patients from controls as well as 90% and 95% accuracy in differentiating between patients with COVID-19 and patients with other lung infections. While further validation studies are needed, the results may serve as a base for technology that would lead to a reduction in number of unneeded confirmatory tests and lower the burden on the hospitals, while allowing individuals a screening solution that can be performed in PoC facilities. The proposed method can be considered as a platform that could be applied for any other disease infection[…]
The group found that these polybasic cleavage sites, with their multiple protonated Arg (arginine) residues, play a major role in electrostatic attraction between the receptor-binding domain and the spike. They also found that, at least on the computer, the said sites can be “neutralized” by a Glu-Glu-Leu-Glu tetrapeptide (Glu=glutamate, Leu=leucine). Is this a potential route toward a therapeutic?
(2) Meanwhile in Israel, some statistical confusion. If you look at Worldometers, you see a sudden spike of 73 additional deaths on August 19: it turns out to be a statistical backlog of deaths at nursing homes that suddenly got dumped into the total. If you look at the official COVID19 dashboard instead, you don’t notice it unless you took a snapshot the day before, since the deaths are backfilled on the dates of death rather than all added up to the tally for August 19.
And how bad is unemployment here because of COVID19? The Employment Bureau (lishkat ha-ta`asuqa) which assists jobless with finding work) claims 20-21%, while the National Insurance Institute (bituach le’umi), which actually handles the paying out of unemployment benefits, has “only” 12%. The NII claims that their data are more accurate, since they see (mandatory) NII contributions come in and benefits go out, while many people who used to be unemployed and have meanwhile found work again don’t bother to update the employment bureau. Also, that many of those registered with the Employment Bureau don’t qualify for benefits anyhow, hence don’t really “count” as unemployed for statistical purposes.
(3) Dr. John Campbell discusses the rise in infections in France and Spain, not accompanied by the rise in mortality you might expect. In general, he sees signs everywhere that the virus is less deadly now, though he continues to be skeptical about a mutation toward a milder form.
A commenter from Spain points out that yes, there is a dramatic increase in cases among young people — but they generally don’t get so sick and very rarely die. “The older people know to watch out by now.” This jibes with what we see here.
“The mother’s body makes antibodies that can neutralize the coronavirus,” explains Prof. Albert Heck. “The fact that these are also found in breast milk is probably to protect their babies from the virus. Ideally, we will find a lot of very strong antibodies against COVID in the breast milk. Then that milk could be used to protect not only babies, but also vulnerable COVID patients.” […] The researchers hope to administer the milk in the form of ice cubes. When a patient licks such an ice cube, the antibodies will directly reach the relevant places in the mouth and nose, killing the virus particles there. Heck emphasizes: “We’re not that far yet. But this is what we’re hoping for.”
[A quick update: had a long workday, and then got a burst of inspiration and hammered out a rough outline for the Operation Flash sequel]
(1) Roger Seheult MD discusses the results of a large-scale (36,000 patients) clinical trial by the Mayo Clinic with convalescent plasma, i.e., injecting antibodies from recovered patients (sometimes referred to as “passive vaccine treatment”).
The preprint is available here https://doi.org/10.1101/2020.08.12.20169359 TL;DR summary: this may be useful if (a) given early in the disease; (b) the higher the antibody titer in the plasma, the more effective. In later disease stages, benefit is not obvious. The study had no proper control arm (placebo, “standard of care”).
Relatedly: while US media (which Instapundit these days refers to as “a psychological warfare operation against normal Americans”) are now peddling the line that reopening school is “because Orange Man Bad wants children to die”, the UK media are pushing the exact opposite message, namely that keeping children out of school and away from social contact with their peer group is more harmful. Case in point: these two screenshots from the BBC (via Seth Frantzman):
(1) A commenter alerted me to this video by Mark Felton about the time Hitler (y”sh) came close (sadly not close enough) to dying in an airplane accident.
Briefly, on June 4, 1942, he flew from the Wolf’s Lair in Rastenburg to Finland on a state visit to his ally malgré-soi, Field Marshal Gustav Mannerheim. As usual, two identical Focke-Wulf FW-200 Condors took off. Upon takeoff, pilot Hans Baur noticed the brake on the left undercarriage had jammed. Then upon landing, he was faced with a much-too-short landing strip. He braked vigorously to ensure he would not skate off the runway: this caused the failing left brake to overheat and the brake fluid to catch fire.
Could the world have been spared three more years of war and butchery, were it not for an alert ground crew member who noticed the fire and moved quickly to extinguish it? Felton’s footage shows a noticeable fire but not a spectacular one. But had the plane made a stopover in Tallinn as originally scheduled, and had no emergency braking been necessary there, then (so Felton argues) a flaming undercarriage might have been retracted upon departure for the onward flight, and… history would have looked very different.
There is an infinity of Pasts[…] At each and every instant of Time, however brief you suppose it, the line of events forks like the stem of a tree putting forth twin branches[…] One of these branches represents the sequence of facts as you, poor mortal, knew it; and the other represents what History would have become if one single detail had been other than it was.
André Maurois (1931)
(2) The Luftwaffe’s last major operation, on VE-day, May 8, 1945, was an evacuation flight to the Courland/Kurland Pocket. 33 Junkers Ju-52 “Old Aunties” and four transport-version Heinkel He-111 flew into the pocket with minimal crews (pilot and navigator) and took off with as many Wehrmacht personnel as the planes could lift. =
Any war fiction writer can imagine the elation of those taken aboard, and the despair of those that had to be left behind. But a cynic once wrote: “Despair is seeing your ship come on — and realizing it’s the Titanic.” What ensued can only be described as what American war flyers would call a “turkey shoot”, in which all except two Ju-52s, and all four He-111, were downed by Soviet fighter planes. The two surviving Ju-52 had managed to dodge out flying at treetop and then wavetop level.
On the same day, in the final chapter of Operation Hannibal, five convoys still managed to leave the port of Libau (presently Liepaja, Latvia) escorted by the last remaining fighter planes of Jagdgeschwader (fighter wing) JG 54. Despite Soviet fighter attacks, these still conveyed 27,700 men to Germany. The remaining 190,000 soldiers and officers (including 42 generals) surrendered to the Soviets and joined the about 2.7 million Wehrmacht POWs in their custody. [*]
[*] According to the Soviet NKVD’s own figures, about 381,067, or 13.9%, died in custody. This needs to be seen in the context of the percentage of Soviet POWs that died in Wehrmacht “custody”, which reaches 57%.
(1) Dr. John Campbell reviews three recent studies (one of which, the one from Stockholm on T-cell immunity, http://dx.doi.org/10.1016/j.cell.2020.08.017 I’ve discussed here earlier) that fairly conclusively show that yes, exposure to the virus leads to lasting immunity. This is great news both for herd immunity and for a putative vaccine.
In brief: the 122 crew of a commercial fishing vessel were tested pre-departure, both RT-PCR and antibody. Three of them had clear evidence of past recovery from COVID19-infection. Clearly, one of the crew was a false negative for RT-PCR, for in the subsequent weeks, the vessel had to return to port because a crew member needed hospitalization. At that point, 104 crew (i.e., 85%!) tested positive either for virus or for antibodies. (Interestingly, the percentage of asymptomatic infections is not given in the paper.) Significantly, the three crew members with pre-existing immunity did not get infected again, despite being aboard what amounted to an unintentional viral incubator.
(1) Dr. John Campbell’s latest update contains some news about Canada, which I haven’t devoted much attention to here.
A few highlights:
Canada so far seems to have dodged a second wave. Looking at worldometers, daily new cases are holding steady in the about 400 range, and daily deaths in the 5-6 range.
A super-spreader event took place at a “gentlemen’s club” in Toronto, where one of the “employees” (not clear whether it was a “performer”, waitstaff, or a bouncer) appears to have infected 550 people over a period of 4 days
Covid hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the usual things you see in the emergency room. The next day all those patients were gone and the only thing coming in to the hospital was covid. Practically everyone who was tested had covid, regardless of what the presenting symtom was. People came in with a nose bleed and they had covid. They came in with stomach pain and they had covid.
Then, after a few months, all the covid patients disappeared. It is now four months since the start of the pandemic, and I haven’t seen a single covid patient in over a month. When I do test someone because they have a cough or a fever, the test invariably comes back negative. At the peak three months back, a hundred people were dying a day of covid in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more. […]Basically, covid is in all practical senses over and done with in Sweden. After four months.
Read the whole thing. A bunch of other excellent posts on that blog, such as:
Related to the last point: (h/t David Bernstein): a surprisingly balanced piece from the NYT on whether perhaps “herd immunity” is closer than we thought? (Archive link http://archive.is/Ditgw ) He wonders if the author will now be “canceled” from the NYT staff 😉
(3) From an ACS Journals roundup of COVID19-related papers, two that caught my eye:
https://doi.org/10.1021/acsami.0c11425 about antiviral coatings for doorknobs and other objects. “We have fabricated and tested a coating that is designed to reduce the longevity of SARS-CoV-2 on solids. The coating consists of cuprous oxide (Cu2O) particles bound with polyurethane. After 1 h on coated glass or stainless steel, the viral titer was reduced by about 99.9% on average compared to the uncoated sample. An advantage of a polyurethane-based coating is that polyurethane is already used to coat a large number of everyday objects. Our coating adheres well to glass and stainless steel as well as everyday items that people may fear to touch during a pandemic, such as a doorknob, a pen, and a credit card keypad button. The coating performs well in the cross-hatch durability test and remains intact and active after 13 days of being immersed in water or after exposure to multiple cycles of exposure to the virus and disinfection.”
As the number of COVID-19 cases in the United States streaks toward 5 million, it may surprise you to learn that 80% of those who test positive for the disease never infect anyone else with the virus.
Instead, new research suggests the disease weaves its way, rapidly, into the population because of a confluence of events. They are largely driven by contact with people who happen, briefly, to be highly contagious in the wrong place, at the wrong time.
It is a phenomenon known as super-spreading, and experts at Seattle’s Fred Hutchinson Cancer Research Center are using complex computer simulations of viral transmission among individuals to gain a better understanding of how this virus, SARS-CoV-2, with an unknowing assist from super-spreaders, manages to wreak so much havoc in populations.
In research newly posted in medRxiv, a team led by Fred Hutch postdoctoral scientist Dr. Ashish Goyal, infectious diseases physician Dr. Joshua T. Schiffer and epidemiologist Dr. Bryan T. Mayer reports some surprising insights using a computer model that compares the behavior of COVID-19 with influenza.
Read the whole thing.
(2) Large cities hardest hit. I already linked to the Telegraph’s report on London earlier. Now:
Yes, there’s crime, and insane law (non-)enforcement decisions that contribute — but these are much less of a factor in the exodus from London. Last time I was in NYC and heard rents (residential and office) in midtown Manhattan, and later when I found out that San Francisco was even less affordable, I remember thinking of Stein’s Law: “that which cannot go on forever won’t”. The guy writing about NYC hits the nail on the head: we’ve had a 5-month “proof of concept” to show that yes, Virginia, you can do most financial, publishing sector,… jobs just fine from your spare bedroom in Podunk, North Florida, as long as you have high-speed internet. (And, depending where you are relative to hurricane alleys, a reliable backup power supply.) Were I (G-d forbid) running a magazine or a publishing company, I’d have moved long ago to more affordable quarters where what I could afford to pay my staff would pay the bills a lot better.
Of course, lots of prime jobs leaving the big city means an entire (precarious) ecosystem of support jobs dies. Another ecosystem will benefit: people working from home will likely invest in their home office spaces, or otherwise gussy up the residence they now spend day and night in.
* the Babylon Bee can officially retire in 2020: no satire can compete with reality for sheer absurdity. Case in point:
* (H/t: Jeff Duntemann). An article in The Tablet by neuropsychiatrist and bestselling popular science author Norman Doidge about how politicization has now crept into even biomedical research. As far as I am concerned, the jury is still out on hydroxychloroquine, but the whole “cannot work because Orange Man Bad” makes me sad for what my profession is turning into. (Yes, I am a scientist by day, certifiably mad according to some.) There is nothing I can add to the words of Henri Poincaré, so I shall quote them once again in a slightly different translation:
Thought must never submit —
neither to a dogma,
nor to a political party,
nor to a passion,
nor to a special interest,
nor to a preconceived idea,
nor to anything other than the facts themselves —
because when thought submits, it ceases to be.
—Henri Poincaré, Le libre examen en matière scientifique (1909), my translation of: “La pensée ne doit jamais se soumettre, ni a un dogme, ni a un parti, ni à une passion, ni à un intérêt, ni à une idée préconçue, ni à quoique ce soit, si ce n’est aux faits eux-mêmes, parce que, pour elle, se soumettre, ce serait cesser d’être.“
That letter is a marvelous little glimpse of how ordinary people responded to the end of the biggest and most calamitous war in human history. Follow the links to the letter. It’s worth your time. Really.
This date, August 15, 1945, is commonly regarded as the end of World War Two. Technically, Aug.15 only marks its de facto end: the de jure end would follow on September 2, with the official signing of the Japanese Instrument of Surrender aboard the USS Missouri.
After MacArthur, further signatures were affixed by Fleet Admiral Chester Nimitz (9:12am), and by representatives of all the Allied combatants in the theatre [list taken from t:
And thus the bloodiest war in history (in absolute numbers) finally came to an end. Japan and Germany, in due course, would take their place as peaceful, respected members of the family of nations, becoming economic powers nearly as strong as they were once militarily. [*]
Some Japanese holdouts on formerly occupied islands, unaware that the war had ended, kept up guerilla activities. Lt. HIROO ONODA, in the Philippines, only surrendered on March 9, 1974 (!) after his former commanding officer personally flew out (at the behest of Emperor Hirohito) to formally relieve him from his orders. (Lt. Onoda survived until 2014: his story inspired the concept album “Nude” by progressive rock band CAMEL, which I happen to be a big fan of.) The following is a taste from the album.
[*] Germany made, and continues to make, a serious effort — with fits and starts as they may have been at times — toward Vergangenheitsbewaltigung (coming to terms with the past). Would that I could say the same about Japan…
(0) Commonalities: both masks shipped via DHL from Israel. As I live in Israel myself, mine were shipped within a day of ordering and appeared the next day.
Both types are intended for moderate-term reuse: they can be washed in warm water and some dishwashing soap (once a week, or after wearing it in a dodgy setting), and are both supposed to last at least a year.
Disclaimer: I bought both mask types at retail price and was not offered any incentives by either manufacturer.
(1) OK, Sonovia first. This mask is based around two layers of a cotton-like fabric into which nanopores have been sonicated, then nanoparticles of zinc oxide deposited into them. The fabric was originally developed for other purposes (preventing the spread of ‘hospital bugs’ in a healthcare settings), then repurposed for COVID19 prevention.
Sonovia masks come in at least 3 sizes: children’s, female, and male. Mrs. Arbel got a perfect fit with the female mask, I got a decent fit with the (larger) male version. The ear loops are adjustable for better fit. The specimens I reviewed did not come with a nose clip, which is a cause for ‘leaks’ unless the mask fits like a globe: apparently, healthcare vlogger “Sandy” was sent a beta of a newer version in which a pliable nose clip is embedded in the fabric.
The Sonovia is quite comfortable to wear even during exertions, much more so than the N95 masks I normally would wear outside the house or my office at work. I wore it on several long power walks and while shlepping groceries on foot from a supermarket a fair distance away (in our fairly hot climate): I wasn’t nearly as winded as when wearing my usual N95.
The price is a bit steep ($65 including free shipping via DHL), but drops significantly when ordered in quantities.
(2) Argaman BioBlocX is a somewhat different kettle of fish. This is a 5-layer fabric mask: the outermost layers on both sides are hypoallergenic CottonX treated cotton, the layers below that a more aggressive Argaman Accelerated Copper layer, and the middle layer a Respilon nanofiber filter membrane.
The adult size accommodates both male and female faces. It comes not with ear loops but with adjustable head straps, and a nose clip is embedded in the top. With a little practice, it is possible to get a decent seal.
The fabric was comfortable enough that I could wear it through a 2-hour in-person meeting I could not avoid. (I have pretty sensitive skin.)
That said, I definitely would prefer not to wear this one during physical exercise or physically taxing work: breathing felt about as hampered as when wearing an N95 without an exit valve — not because of a “CO2 buildup” as somebody who ought to know better claimed [a CO2 molecule is about 0.23 nm long], but simply because more pressure is required to exhale and inhale.
But there ain’t no such thing as a free lunch: having 5 layers, including a nanopore layer, to breathe through simply cannot be as unrestricted as two layers of treated cotton.
Incidentally, one could probably wear this one during home improvement or other DIY projects where a mask against particulate matter would normally be indicated — and they would likely be as effective as an N95 for that, albeit more reusable. (There’s a reason the only places I’d seen N95 masks available for purchase before the pandemic were home improvement stores.)
(3) Bottom line?
We will probably continue to wear our Sonovias as our main day-to-day mask and keep the Argamans on hand for higher-risk environments (e.g., crowded stores if we cannot visit them during off-peak hours, HMO polyclinics, in-person meetings with people not in our “bubble”).
If you do not care to plunk down money for both, but already have N95 masks on hand, one alternative could be to wear the Sonovia as the main mask and place an N95 over it when some extra protection seems indicated.
(1) “A Stanford study shows that in severely ill COVID-19 patients, “first-responder” immune cells, which should react immediately to signs of viruses or bacteria in the body, instead respond sluggishly[…] That difference may stem from how our evolutionarily ancient innate immune system responds to SARS-CoV-2, the virus that causes the disease. Found in all creatures from fruit flies to humans, the innate immune system rapidly senses viruses and other pathogens. As soon as it does, it launches an immediate though somewhat indiscriminate attack on them. It also mobilizes more precisely targeted, but slower-to-get-moving, “sharpshooter” cells belonging to a different branch of the body’s pathogen-defense forces, the adaptive immune system.
“These findings reveal how the immune system goes awry during coronavirus infections, leading to severe disease, and point to potential therapeutic targets,” said Bali Pulendran, PhD, professor of pathology and of microbiology and immunology and the senior author of the study” according to a press release in popular language about an article that just was published in SCIENCE. http://doi.org/10.1126/science.abc6261
Back to the press release: “
The findings suggest that in cases of severe COVID-19, bacterial products ordinarily present only in places such as the gut, lungs and throat may make their way into the bloodstream, kick-starting enhanced inflammation that is conveyed to all points via the circulatory system.
But the study also revealed, paradoxically, that the worse the case of COVID-19, the less effective certain cells of the innate immune system were in responding to the disease. Instead of being aroused by material from viruses and bacteria, these normally vigilant cells remained functionally sluggish.
If high blood levels of inflammation-promoting molecules set COVID-19 patients apart from those with milder cases, but blood cells are not producing these molecules, where do they come from? Pulendran believes they originate in tissues somewhere in the body — most likely patients’ lungs, the site of infection.
“One of the great mysteries of COVID-19 infections has been that some people develop severe disease, while others seem to recover quickly,” Pulendran said. “Now we have some insights into why that happens.”
(2) Scott Atlas MD of Stanford, an outspoken critic of lockdown measures, joins the White House coronavirus task force. Unlike the writer, I wouldn’t count on Anthony Fauci being “out”, but some counterbalance is clearly needed. Israel’s current “corona czar”, Roni Gamzu MD, is likewise no fan of lockdowns. I supported ours during the first wave, but it is increasingly looking to me like we just set ourselves up for a bigger second wave.
(3) Miscellaneous updates:
* Dr. John Campbell discussed the Russian “Sputnik V” vaccine, which is apparently getting beta-tested in production.
That’s aggravating enough when Microsoft does this sort of thing with a Windows release: here it’s downright worrisome.
The principle on which the vaccine is based, as Dr. Campbell explains, seems plausible: splice a COVID spike protein into an innocuous adenovirus and administer that, in order to induce a T cell response. But lots of drug candidates that seem perfectly sound on paper/in the lab/on the supercomputer have a way of falling flat when applied to actual humans.
* (via The Spectator “evening blend”: [I wish their editor would learn how to properly permalink scientific papers]) An advance article in the Journal of Infectious Diseases considers mouth wash as a post-exposure prophylactic. https://doi.org/10.1093/infdis/jiaa471 The abstract:
The ongoing SARS-CoV-2 pandemic creates a significant threat to global health. Recent studies suggested the significance of throat and salivary glands as major sites of virus replication and transmission during early COVID-19 thus advocating application of oral antiseptics. However, the antiviral efficacy of oral rinsing solutions against SARS-CoV-2 has not been examined. Here, we evaluated the virucidal activity of different available oral rinses against SARS-CoV-2 under conditions mimicking nasopharyngeal secretions. Several formulations with significant SARS-CoV-2 inactivating properties in vitrosupport the idea that oral rinsing might reduce the viral load of saliva and could thus lower the transmission of SARS-CoV-2.
Whether sloshing with Listerine or an equivalent right after you suspect you’ve breathed in an expletive-load of coronavirus will stop you from getting the disease seems dubious to me, but there is increasing evidence that a reduced viral load increases your “rapid response” immune system’s chances of getting rid of it before it can do much harm. And mouthwash is definitely in the realm of “if it doesn’t help, neither will it hurt”.
(4) (h/t: Erik Wingren) Personal fitness trackers (in this case, the Whoop) can play a role as early warning systems for COVID19 illness — in this case, respiration rate going up without concomitant signs of running, climbing,… https://www.whoop.com/thelocker/predict-covid-19-risk/
In combination with oximetry, this would be even more useful: as I understand it, Apple Watch would have this built-in already (as well as continuous glucose monitoring) if it weren’t for FDA approval issues. At any rate, a finger oximeter costs as little as $20-$30 on Amazon (search link for information only) and yields both oxygen saturation levels and pulse rate within a fraction of a minute.
The treatment, based on a chemical compound called Opaganib, has already shown very promising result in compassionate use carried out a the Shaarei Zedek Medical Center in Jerusalem, as Gilead Raday, RedHill’s Chief Operating Officer, told The Jerusalem Post.
[… Like for the original Remdesivir, r]esearch on the potential of the compound was carried out in connection with the Ebola pandemic. “Strong evidence emerged that Opaganib provided inhibition of the virus replication. However, by the time we got that data, the epidemic had subsided so we did not continue with the process,” he recalled.
[…] “Researchers compared the impact of giving Opaganib to patients hospitalized in severe conditions who required oxygen supplementation to outcome of patients in in similar conditions who were not given the treatment. They found that while a third of the latter progressed to require mechanical ventilation, none of the former did. In addition, the patients who received the treatment improved much faster and had a better inflammatory response.”
Intriguingly, unlike remdesivir, opaganib can be administered orally, which makes it potentially valuable for prophylaxis
* A new clinical trial that looked at hydroxychloroquine for post-exposure preventive use was just published in the New England Journal of Medicine. While a difference in outcomes (in this case, progression to disease) was seen between the control group and the HOCQ group, the difference (owing in part to the relatively small group) did not rise to the point of statistical significance
* a recently published “proof of concept” trial looks experimentally at the effectiveness of various mask types. In brief, fitted N95 masks do best, followed by multilayer surgical masks, while fleece masks are actually worse than no mask at all (as they break up large droplets into smaller ones that actually spread more easily in the air).
(3) A reflection. Hospital-acquired infections, according to CDC data, kill about 70,000 people a year in the USA. So far, COVID19 has killed “only” twice that number. Somehow, while you do see the occasional story about “superbugs” (hospital bacteria resistant to all or near all known antibiotics) in the news, it does not add up to even half a percent of the coverage COVID19 has gotten.
I am by no means saying the problem is being ignored: researchers are hard at work trying to develop novel antibiotics, and on another front, novel approached are being introduced to block the spread of infections, such as applying antimicrobial coatings to possible “fomites” (objects that can act as a vector for bacterial transmission, such as shared telephones or medical devices). [*]
(4) A review of the Sonovia and Argaman masks will follow once our Argaman masks arrive. But just one practical tip if you are considering buying the Sonovia: you may be tempted to buy the male or female sizes in bulk to save money. Don’t — the female mask will be a poor fit for almost all adult males, and conversely.
(Argaman are one-size-fits-all but don’t do quantity discounts.)
And all the “public health” people complaining about this can go [f-word] yourselves. You squandered all your moral authority rushing to line up in favor of the Black Lives Matter protests because you valued politics more than health. Now nobody will listen to you, because you’re a joke. If people die because you squandered your credibility, that’s your fault. You’re not disgraces to your profession, you’ve made your profession a disgrace.
[*] AS AN ASIDE, one often overlooked fomite in healthcare settings are tablet computers (iPads etc.). Applying an antimicrobial coating of copper, zinc, or silver nanoparticles is generally not a practical option, but an apparently quite safe way of sterilizing them is exposure to UV-C light. Another practical trick I heard about is to encase the iPad in a Ziplock bag, wipe that down frequently with disinfectant solutions, and replace the bag whenever it clearly is compromised.
On Dr. Seheult’s MedCram channel, Dr. Michael Mina (Harvard) explains what’s wrong with COVID19 testing today, and how to change it from what he calls “the Nespresso model” to “the instant coffee model”: a less sensitive but very inexpensive ($1 a test) saliva-based paper reagent strip test that gives answers in 15 minutes and could feasibly be used for daily screening. This test will be less sensitive than RT-PCR (which costs dozens of times as much) but gives a feasible means of detecting the people with the highest viral load, most likely to be infectious. Thus, for people in high-risk professions and settings, one could conceivably carry out daily screening.
Anyway, here is the short (5 min.) version of the video:
(1) So what other coronaviruses are there in humans? So far, seven such viruses have been found to be pathogenic in humans. Three of these can be fatal: SARS-CoV-1 (the original 2002-3 SARS virus), MERS (Middle East Respiratory Syndrome virus), and of course SARS-CoV-2, the causal agent of COVID19.
So what about the other four? These turn out to cause about 15% of all common colds. Over 200 different viral types (half of them rhinoviruses) are associated with common colds. Rhinoviruses account for the majority of all common cold cases; influenza viruses a for another 10-15%; adenoviruses (a group of non-enveloped DNA viruses) account for another 5% or so, besides causing conjunctivitis and some forms of viral gastroenteritis (“stomach flu”).
In temperate climates, common-cold coronaviruses (CCCoV) are seasonal; in tropical climates they act year-round. They are:
HCoV-NL63, first identified in The Netherlands. which accounts for almost 5% of common respiratory illnesses. “Associated diseases include mild to moderate upper respiratory tract infections, severe lower respiratory tract infection, croup and bronchiolitis.” The severe cases are rare and usually involve young children, the elderly, and immunocompromised patients
HCoV-HKU1, first identified in Hong Kong. This one is presently quite rare
HCoV-229E, which is fairly common: apparently as many as half of young children have had a previous infection with this one. While it’s associated with some severe clinical outcomes, there is almost always another pathogen involved too: a single case of ARDS (acute respiratory distress syndrome) without involvement of another pathogen has been documented.
As Matt Ridley has argued, OC43 may be a hint of what will be the endgame for SARS-CoV-2: evolutionary pressure for viruses is toward a more virulent (shorter incubation time, faster entry) but less deadly form, as killing off the host doesn’t help the spread. So it may well become “the fifth CCCoV”.
(2) Two Israeli companies market antibacterial and antiviral face masks claiming to protect against COVID19: SonoviaTech and Argaman (the Hebrew word for the color crimson). Full disclosure: I have no commercial or scientific links to either company, although I know some of the people involved by reputation.
Note that neither mask was developed for this purpose: both companies are in the business of developing solutions for the prevention of hospital-acquired bacterial infection. (As so many “hospital bugs” are increasingly resistant to every antibiotic we can throw at them, bactericidal solutions to prevent infection are becoming increasingly topical, especially in operating rooms and ICUs but not just there.) The initial impetus for Argaman was actually when the founder (a cancer survivor) was in chemotherapy — he remembered thinking everybody coming in would be immunocompromised, and wouldn’t the Cupron copper-infused antibacterial fabric he helped develop come in handy for antibacterial face masks…
From what I understand, Argaman’s tech is based on a combination of Cupron and an N95-type filter. Sonovia instead appears to be based on lacing a cotton-like fabric with nanocavities through sonication [Bar-Ilan U. Professor emeritus Aharon Gedanken, a pioneer in this area, is a consultant to the company], then depositing nanoparticles of zinc oxide and copper into the cavities.
Both mask types are intended for extended reuse (as long as 1 years, with gentle washing once a week). Thus, despite their fairly steep prices ($50 apiece for Argaman regardless of quantity; Sonovia is more expensive for single masks but cheaper in bulk) they will save money in the long term over N95.
Veteran ER nurse “Sandy” has posted video reviews of the Sonovia and Argaman masks. (Here she suggests a useful improvement to the Sonovia — an adhesive nose clip which they will apparently add to future versions.)
I got curious about them and ordered a 3-pack of female-sized Sonovia masks, which arrived yesterday, and will order the Argaman as well. I will post a review of both after I receive the Argaman.
August 6, 1945, 8:15:17 seconds, a solitary bomb was released from a single B-29 over Hiroshima…
[Lyrics: Peart; music: Lee, Lifeson]
Imagine a time When it all began In the dying days of a war A weapon that would settle the score Whoever found it first Would be sure to do their worst They always had before…
Imagine a man Where it all began A scientist pacing the floor In each nation, always eager to explore To build the best big stick To turn the winning trick But this was something more…
[CHORUS:] The Big Bang took and shook the world Shot down the Rising Sun The end was begun It would hit everyone When the chain reaction was done The big shots try to hold it back Fools try to wish it away The hopeful depend on a world without end Whatever the hopeless may say
Imagine a place Where it all began They gathered from across the land To work in the secrecy of the desert sand All of the brightest boys To play with the biggest toys More than they bargained for….
Imagine a man When it all began The pilot of Enola Gay Flying out of the shockwave On that August day All the powers that be And the course of history Would be changed for evermore
Three days later, another bomb on Nagasaki made it clear that this was not a one-off thing. (The Japanese had no way of knowing that this exhausted the entire stock on hand, although more A-bombs were forthcoming.) On that same day, the USSR furthermore invaded Japanese-occupied Manchuria.
Japanese emperor Hirohito had been searching for some time for a formula to end the war that would not founder on the “death before dishonor” Bushido [=way of the warrior] mentality. Intentionally or not, the bombs on Hiroshima and Nagasaki offered him just that. Just days later, on August 14, 1945, Hirohito announced surrender in a radio speech that, significantly, contains the following passage:
Moreover, the enemy has begun to employ a new and most cruel bomb, the power of which to do damage is, indeed, incalculable, taking the toll of many innocent lives. Should we continue to fight, not only would it result in an ultimate collapse and obliteration of the Japanese nation, but also it would lead to the total extinction of human civilization.
Such being the case, how are we to save the millions of our subjects, or to atone ourselves before the hallowed spirits of our imperial ancestors? This is the reason why we have ordered the acceptance of the provisions of the joint declaration of the powers. [… I]t is according to the dictates of time and fate that We [, the Emperor] have resolved to pave the way for a grand peace for all the generations to come by enduring the unendurable and bearing what is unbearable.
The Daily Telegraph on how Boris Johnson was convinced to hastily slammed the brakes on British reopening based on a minor fluctuation in data. Such are the dangers of somebody who’s not used to dealing with data and measurement uncertainties looking at numbers like they are sacred scripture…
The US mainstream media narrative is that Trump is hell-bent on opening the schools because Orange Man Bad. Considering how pathetically dumbed-down public school curricula are these days, I was at best ambivalent about this one.
Turns out the fiercest advocate of school reopening is not Trump, but… CDC director Robert Redfield, citing an increase in suicides and overdose fatalities that well exceeds COVID19 mortality in that age bracket, and which he attributes to the lack of a social framework for these children and teenagers.
Republican Texas Sen. Ted Cruz introduced a bill on Tuesday that would prevent state and local governments engaged in religious discrimination from receiving federal funding during the coronavirus pandemic.
Fascinating article (via David Bernstein) about how severely dysfunctional immune responses in otherwise healthy young(ish) people to COVID19 (and other infections) may be due to subtle genetic defects.
In the same online science magazine, a subject I’ve been discussing here repeatedly: the tricky math of herd immunity (once you move beyond the simplistic 1st-order model).
And the WSJ on the emerging consensus on how COVID19 is spread: it boils down to the three Cs of Japanese infographics. enClosed spaces, Crowded, and close-in Conversations.
(1) Has the second wave in Israel peaked? At least, that’s what the graph of active cases in Worldometers seems to show:
The media here have breathlessly been reporting “record” numbers of daily new cases, fueling speculation about the need for a 2nd lockdown (which nobody in their right minds wants). And indeed, daily numbers of new verified cases reached the 2,000 level — and now hold steady there (at least, if you smooth out the weekday/weekend reporting variation with a 7-day moving average):
What the media failed to notice was that the rising wave of new cases some weeks ago is now echoed by a rising wave in recoveries. For a variety of bureaucratic reasons, these numbers fluctuate strongly — with the somewhat anomalous result that on July 22 and 23, respectively, 3484 and 6944 new recoveries were logged by the Ministry of Health COVID19 dashboard (In Hebrew, but numbers are numbers).
At the lowest “active cases” point between the two waves, May 28, we had 16,872 verified cases, 284 deaths, for a 1.68% CFR (case fatality rate). As of the end of August 1, we had 72,218 verified cases and 526 deaths (0.73% CFR). If we use May 28 as the cutoff point between the waves, that translates to 55,346 cases but just 242 deaths, or a 0.44% CFR — about a quarter that in the first wave.
Now the new “coronavirus czar”, Prof. Roni Gamzu, has announced that the reproductive number of the infection in Israel has dropped to around one. He expects the death toll to keep rising for the next three weeks, then to stabilize.
(2) A few biographic details on Roni Gamzu extracted from his Hebrew Wikipedia entry. He was born in 1966 in Israel to immigrant parents from Iran. (This was before the Khomeini revolution, when Israel had good relations with the Shah’s regime.) Following IDF service (as an officer), he studied medicine first at Ben-Gurion University of the Negev, then at Tel-Aviv university (TAU), whence he got his MD in 1994, and two years later his Ph.D. in medicine for research in the area of fertility. He added to this a Master’s degree in health administration, an MBA, and a law degree, all from TAU. Somehow he also found time to get board certified as an OB-GYN following an extended residence.
Since 2002 he was a deputy director for economics, and since 2008 the director of the general hospital, at Ichilov Hospital (a.k.a. Sourasky Medical Center), the largest hospital in Tel-Aviv and one of TAU’s two main teaching and research hospitals (Tel HaShomer being the other).
From 2010 until 2014, he served as director-general of the Health Ministry; in 2015, he succeeded Prof. Gabi Barabash as the CEO of Ichilov Hospital. He has dual professorial appointments at TAU, the primary one in the economics department, the secondary one in the medical school.
It is clear, with his combined medical and economics/public health administration background, he comes to the job with a different mindset than most healthcare professionals: he explicitly said that the economic damage of the epidemic worries him more than the medical fallout. (It is being estimated by the Finance Ministry that it will take Israel’s economy 5 years to recover from COVID19.)
Among other things, he apparently nixed the plan for a second lockdown during the High Holidays (when the whole country shuts down anyway), and he even mulls opening the country in mid-August to visitors from countries designated “green” on the COVID scale.
The family name Gamzu presumably derives from the Mishnaic Era sage, rabbi Nachum of Gimzu, who was also known as Gamzu because it was his wont to respond to every setback with “gam zu le-tova” (that too is for the better). One day he was conveying a present to the king when he was robbed. “Gam zu le-tova”, he said once again. And indeed: unbeknownst to rabbi Gamzu, the gift had been substituted, and when the two robbers offered their stolen tribute to the king and the latter found only worthless junk, the monarch was not amused and sent both robbers to the chopping block….