COVID19 mini-update, September 4, 2020: death rate reconsidered; bradykinin hypothesis; vitamin D reduces likelihood of ICU admission

A must-see video from Dr. Seheult today:

He touches on three topics.

(1) The claim that “only 6% of COVID deaths are really COVID”. He uses the non-COVID example of a diabetic who dies of septic shock after he gets a cut on his arm and develops necrotizing fasciitis (“flesh-eating bacteria”), then when antibiotics fail to stop the infection goes into septic shock, renal failure, and cardiac arrest. What is the proximate/immediate of death? What are the contributory causes? What is the root/underlying cause of death? He shows an example death certificate: in this case, the immediate cause is ARDS (caused by COVID19 pneumonia), and the underlying cause (listed at the bottom) is COVID19. Pneumonia and ARDS are not “comorbidities” as the term is medically understood; if the patient had, e.g., also cancer and diabetes type 2, those would be comorbidities.

This is not to say that there haven’t been abuses of the system, like logging deaths from gunshot wounds as COVID19. Nor is it to deny that the public health authorities in especially the US have squandering public trust and goodwill by poor communication, lack of transparency, and by blatantly placing political expedience before public health.

But if mortality were really only 6%, then excess deaths would only show as a small blip compared to the average over the past several years. (And this is, indeed, how the COVID19 mortality in Belgium was revealed to be inflated.) But as Dr. Seheult shows, in the USA excess deaths are higher than what can be accounted for through COVID19: I suspect the difference is collateral damage from the deferral of care for diseases other than COVID19. (Wisely, medical systems in countries like Germany and Israel never went into “COVID19 only mode”.)

Panic is a poor guide in a public health crisis, but so is wishful thinking.

(2) The Bradykinin hypothesis: this paper was recently published https://elifesciences.org/articles/59177

elucidating the many biochemical and genetic connections through supercomputers. Reader “Jim in Norcal” sent a link to this popularized write-up.

One side-product of the study (which I will comment on in more detail later) is that vitamin D will be highly beneficial.

(3) Speaking of which, a recent clinical trial from Spain (Accepted manuscript ahead of publication) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/pdf/main.pdf

considers high doses of calcifediol (a vitamin D metabolite given to people who have trouble absorbing actual vitamin D) vs. only standard of care for hospitalized COVID19 patients. (Interestingly, the local standard of care included hydroxychloroquine and azithromycin:

Procedures All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days. Eligible patients were allocated at a 2 calcifediol:1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol treatment group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly[…]

) From the Results section of the abstract:

Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p<0.001. Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95%CI 0.002-0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95%CI: 0.003- 0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.

https://doi.org/10.1016/j.jsbmb.2020.105751

4 thoughts on “COVID19 mini-update, September 4, 2020: death rate reconsidered; bradykinin hypothesis; vitamin D reduces likelihood of ICU admission

  1. Thanks for the follow-on on bradykinin. Whether true or not, it does a fascinating job of accounting for lots of the details.

    “The claim that only 6% of COVID deaths are really COVID”, you make an excellent point that we need to be clear-sighted, flexible, and not get into hardened, especially politicized positions.
    Still, I think there is some value to the stat. If you are on apps like FaceBook or NextDoor you’ll find that HUGE numbers of people believe that becoming infected with Covid is a virtual death sentence.
    Seriously.
    I was reading a post from a lady on ND this morning. She is terrified that unless we are all wearing masks the second we step out of doors her 21 year old son will die. In my county, about 12,000 people in the age group 0-29 have been infected. Of that number, 0 have died. The “fear porn” has taken root.

  2. But as Dr. Seheult shows, in the USA excess deaths are higher than what can be accounted for through COVID19: I suspect the difference is collateral damage from the deferral of care for diseases other than COVID19.

    No non-emergency care in most (all?) places for weeks does tend to result in bad outcomes, and stuff like New York not allowing anybody who can’t be revived on site to be taken to a hospital, but wasn’t there a nation-wide spike of mortality after 9/11, just from the stress?
    This was the closest I found: https://pubmed.ncbi.nlm.nih.gov/27407085/

    I know it came to mind when I found out NYC had a roughly hundred-a-day jump in heart attack calls, and (of course) a huge jump in at-home deaths. (Which came up when they “fixed” it by adding all of them to the COVID-19 deaths.)

    • I know stress does a number on the immune system– I’ve gotten sick more in the last six months than in years before, and I’m not even pregnant.

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