Happy Easter to my Christian readers. Below are a few COVID19 updates.
(1) Dr. Seheult from MedCram, who is actually a pulmonologist himself, weighs in on the “to ventilator or not to ventilator” debate in Episode 53 of his COVID19 video series. He references a paper by an Italian team that distinguishes two “phenotypes” of clinical presentations in severe COVID19 patients: about 20-30% are “type H” who fit the classic criteria of ARDS and can benefit from intubation, while the remainder are “type L” who are best managed with noninvasive techniques.
Dr. Seheult also cites a “white paper” on COVID19 case management by a colleague. Most interesting for some of us, perhaps, are the prophylaxis recommendations:
- Vitamin C 500 mg BID [=twice a day] and Quercetin 250-500 mg BID
- Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1-2months, reduce the dose to 30-50 mg/day. [Full disclosure: I started doing this two weeks ago. Especially people on vegetarian diets, who often have zinc insufficiencies, should take supplements. Zinc plays an essential role in hundreds of processes in the body, including the immune system. If you exclude iron in hemoglobin, zinc is actually the most common transition metal in the human body.]
- Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 1-2 mg at night [this appears to be primarily to ensure adequate sleep, which affects immunity]
- Vitamin D3 1000-4000 u/day (optimal dose unknown). Likely that those with baseline low 25-OH vitamin D levels and those living [north of the 40th Parallel] will benefit the most.
(2) An article in the Israeli business paper GLOBES looks at the “underworld” of medical equipment procurement. (H/t: Mrs. Arbel)
(3) Immunosuppressant drugs in COVID19? Erik Wingren brings this case in Washington State to my attention: https://komonews.com/news/coronavirus/experimental-drug-helped-critically-ill-emergency-room-doctor-recover-from-covid-19 The drug administered here is https://en.wikipedia.org/wiki/Tocilizumab, which was actually FDA-approved in 2017for the management of cytokine release syndrome, (“cytokine storm”) as a side effect of CAR-T cell immunotherapies. It is increasingly becoming clear that, while most younger patients weather the disease well if they are symptomatic at all, a small subgroup appears to be predisposed to cytokine storm — in plain English, a massive overreaction of the immune system that does more harm to the body than the disease itself. In such situations (only!), immunossuppressants may actually save lives. (Cytokine storm appears to have accounted for the majority of deaths in the 1918 “Spanish Flu” pandemic — which explains why young and otherwise healthy patients were often more at risk than ) For more on cytokine storm in influenza more broadly, see this paper and that paper.
(4) A fairly large-scale (440 patients) clinical trial is in progress at the Erasmus Hospital in Rotterdam, the Netherlands with plasma antibodies from healed patients. (This is technically known as “passive vaccination”.)
(5) No, it’s not just Trump: in an op-ed in the German center-right daily DIE WELT, entitled “Diese WHO gefährdet ons” (This WHO endangers us) a human rights activist blasts the WHO, its leadership, and its execrable behavior in the early part of the crisis. As she puts it, the current WHO chair knows he owes his job to Chinese support and has been a devoted piper playing the tune called by his meal ticket.
But what’s more, DIE WELT reports in its lead article that the German domestic intelligence & counterespionage service, the Verfassungsschütz (Constitution Protection ) registers intensive influence and recruitment operations of German civil servants and elected officials by the Chinese regime. The goal is to get them to parrot the Chinese propaganda line that the country is a leader in combating the outbreak and helping the whole world do so, and that the virus did not come from China. “Together, let’s write a fairy tale,” (Wir schreiben gemeinsam ein Märchen) Die Welt comments sarcastically
UPDATE 1: Denmark is reopening in stages starting Wednesday April 15. In the first step, kindergartens and primary schools will be reopened, as their charges are least at risk from the consequences of an infection. The country has seen hospital occupancy drop since the beginning of the month.
In Austria some shops reopen this Tuesday, followed by other stores, restaurants and hotels in May.
Children go back to Norway’s kindergartens on 20 April and junior schools a week later.
In Bulgaria farmers’ markets are reopening. In the Czech Republic, shops selling building materials and bikes are back in business and rules have been relaxed for open-air recreation areas.
Spain, which along with Italy has been hardest hit by Covid-19, aims to allow non-essential workers back to work from Monday and will hand out protective masks at stations.