COVID19 update, June 22, 2020: Is the virus weakening from a “tiger” to a “feral cat”?; EU taking a harder stance on China

(1) Italian infectious diseases specialist Prof. Matteo Bassetti, who works at the St. Martin Hospital in Genoa, makes the claim that the virus has mutated into a weaker form, reports the Daily Telegraph (among many other outlets). Here is an archive copy: http://archive.is/1EWSp

Coronavirus has downgraded from a “tiger to a wild cat” and could die out on its own without a vaccine, an infectious diseases specialist has claimed.
Prof Matteo Bassetti, head of the infectious diseases clinic at the Policlinico San Martino hospital in Italy, told The Telegraph that Covid-19 has been losing its virulence in the last month and patients who would have previously died are now recovering.
[…] 
“The clinical impression I have is that the virus is changing in severity,” said Prof Bassetti.
“In March and early April the patterns were completely different. People were coming to the emergency department with a very difficult to manage illness and they needed oxygen and ventilation, some developed pneumonia.
“Now, in the past four weeks, the picture has completely changed in terms of patterns. There could be a lower viral load in the respiratory tract, probably due to a genetic mutation in the virus which has not yet been demonstrated scientifically. Also we are now more aware of the disease and able to manage it.
It was like an aggressive tiger in March and April but now it’s like a wild cat. Even elderly patients, aged 80 or 90, are now sitting up in bed and they are breathing without help. The same patients would have died in two or three days before.
“I think the virus has mutated because our immune system reacts to the virus and we have a lower viral load now due to the lockdown, mask-wearing, social distancing. We still have to demonstrate why it’s different now.

Wishful thinking? Though this sort of thing has been known to happen in the past. Viruses that kill off their hosts quickly (such as Ebola and MERS) don’t get to spread their genome as well as those who just make their hosts sick, so there is “evolutionary pressure”, if you like. 

[UPDATE: A reader comments: “I don’t remember where I read it, but I recall a journal article from back when I was a bio/pre-nursing major that postulated that no disease with an infection mortality rate above ~5% would ever go global despite air travel, unless artificially spread, or had a crazy long (>1month) incubation period, because any bug that deadly kills enough people that the infected population ends up quarantined almost by default, no matter where. It seemed quite logical to me.”]

There is, of course, another possible explanation. Vitamin D deficiency is surprisingly prevalent in northern Italy, especially in winter. With the summer weather and people again being able to go outside — particularly indulge in the Italian pastime of sitting outside with one’s coffee and/or pasta — people may simply be less deficient and their immune systems better able to face the challenge of the virus.

The proof in the pudding would be to sequence the genome of COVID19 from this putative “new strain” and see if it really is different in anything that would affect the spike, the replicase (a.k.a, RdRp), or another part of the viral machinery. Absent that, my money is on vitamin D.

(2) Die Welt  (in German) reports on unprecedented complications in the relations between the EU and China, in the context of an EU summit meeting in Brussels on the subject.  The misinformation/Fake News campaign to diffuse the regime’s responsibility for the epidemic is one factor, the de facto abolition of Hong Kong’s internal autonomy is another. Then there are the “reshoring” efforts to bring vital production of medical supplies and PPE back to Europe in order not to be dependent on a fragile supply chain.

The article also cites measures to impede hostile takeovers of struggling companies by Chinese state-backed “bargain hunters” . 

They say about pressuring China,  “Trump does it his way, we do it our way, [albeit] less aggressive [sic].” The journalist comments that China has thus far not gotten any significant pushback for its behavior, and that pressure from European side might make them think again.

(3) The American Chemical Society has a special virtual issue on COVID-19 research across its extensive portfolio of research journals in various areas of chemistry, plus (alas) some what I shall charitably describe as “advocacy papers” and opinion pieces. But that still leaves a lot of original research papers: one that jumped out at me was this one about the role of glutathione deficiency (see our earlier blog post)

https://doi.org/10.1021/acsinfecdis.0c00288

ADDENDUM (hat tip: Mrs. Arbel). Dr. Shelton, about 15 minutes into this video, has some advice for people enhancing their vitamin D through sunbathing: “he says after sun exposure don’t shower off the body oils on large body areas … that’s where the vitamin D is still being made for a day …”

COVID19 update, June 16, 2020: Blue-chip Oxford trial finds inexpensive steroid dexamethasone saves lives in severe COVID-19 cases; flare-ups in Israel and in China

(1) [Hat tip: Yves not-Cohen]: via De Standaard and the BBC, Oxford University reports a breakthrough in the management of severe COVID-19 cases: https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf

I have blogged earlier about anecdotal reports that steroids (for the group I was quoting, methylprednisolone) were being used in an attempt to hold “cytokine storm” at bay, and intuitively this makes a lot of sense. But now we have a large-scale clinical trial to back it up.

A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14). Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Given the public health importance of these results, we are now working to publish the full details as soon as possible.

In plain English, p=0.0003 means there are three chances in ten thousand that the difference is due to coincidence , p=0.0021 that there are 2.1 chances in a thousand of this happening. That the steroid would have no benefit in patients who show no signs yet of “cytokine storm” makes perfect sense.

The study’s authors tout this as the first drug that actually saves lives. Indirectly, Remdesivir and other antivirals may do so if given early in the disease progression, by preventing escalation to cytokine storm: once you get there, you have missed the boat for antivirals and need to focus on stopping the patient’s immune system from killing him.

That dexamethasone is a dirt-cheap drug that has been in common use for decades is of course a nice bonus.

(2) Related, via The Epoch Times (an expat Chinese newspaper fiercely opposed to the regime) a report by the British Heart Foundation about TRV027, an experimental drug by Trevena that restores the angiotensin II vs. angiotensin 1-7 balance (which the virus disrupts through binding to ACE 2 receptors) and thus tries to prevent excessive blood clotting at the source.

Also related, US Senate testimony  by Pierre Kory MD of the COVID19 Critical Care Group.

 

(3) Israel, after a lull and after essentially fully reopening, is now seeing a flare-up of about 200 cases per day. In part this can be ascribed to more intensive testing efforts: past data indicate we had about 10 undocumented asymptomatic or mild cases for each documented case.  (Yesterday, 13,425 were tested, of which 196 found positive.)

The head of the research division of the Maccabi HMO (one of the four authorized Health Maintenance Organizations in Israel, and one of the “big three”) explains to The Times Of Israel that this time around, most of the cases are children or young people (which are less vulnerable), and that many of the children are asymptomatic.

 

In Tel Aviv, which is seeing the fastest spread of the virus, some 57 percent of Maccabi members who tested positive in June are aged 18 or under, Anat Ekka-Zohar told The Times of Israel. There is a similar pattern in other central Israeli cities where cases are growing, she said. In Peta[c]h Tikva the figure is 77%, in Jaffa 60% and in Bnei Brak 43%.

Lots of the current adult carriers are aged 45 or under, Ekka-Zohar said. Some 73% of Maccabi members nationally who tested positive in June are 45 or under, and in Tel Aviv, the figure is 79%.

Maccabi, which is responsible for the health of 2 million Israelis, says that just 1.3% of the people it found to be infected in June are aged 75 or older, Ekka-Zohar said.

Looking at the figure for the 65-plus age group, which is considered the most at-risk of serious illness or death if infected, Ekka-Zohar said it stands at 6.7% for June cases. In April, that age group accounted for around 12% of Maccabi’s cases, she added.

The fact that the most vulnerable aren’t being infected in large numbers bodes well, Ekka-Zohar said, commenting: “It’s not going to provoke a crisis in terms of the number of hospitalizations or in terms of ventilators.”

 

(H/t: Mrs. Arbel.) A somewhat PG-13 rated piece of local humor about masks: the caption says “wearing your mask like thisis like wearing your underpants like that. [And underneath] Please wear your mask correctly.”

Israeli mask humor

(4) “Nothing to see here, move along.” The regime is now blaming “European salmon” for a new coronavirus outbreak in Beijing?! Yeah right — if you believe that, I have some beachfront land in Arizona for sale. Most likely, this is just the 2nd wave of the epidemic they claimed they had under full control. Remember this piece of advice by a Hong Kong resident (warning: language alert).

COVID19 update, May 4, 2020: French evidence that epidemic got to Europe in December; intriguing hydroxychloroquine find; Michael Levitt interview

(1) Via reader Yves [not Cohen], a French media report that COVID19 was found in a blood sample taken from a lung patient at a suburban Paris hospital on December 27, 2019. [Hand-corrected DeepL translation]

Invited on the set of BFMTV on Sunday, May 3, Professor Yves Cohen, head of the intensive care unit at the Avicenne hospital in Bobigny (Seine-Saint-Denis), and at the Jean-Verdier hospital in Bondy (Seine-Saint-Denis), claims to have had a patient infected with Covid-19 at the end of December 2019. […] “We had a positive case at Covid-19 on 27 December 2019, when he was hospitalised with us at Jean Verdier,” he explained on the air. An analysis of the serological PCR tests carried out on the 24 pneumonia patients in December and January in these two hospitals led to this conclusion.[…] Dr Olivier Bouchaud, an infectiologist at the same Avicenne hospital, confirms this information. “PCR samples taken from a patient clearly show that he [tested positive for] Covid. We did have a first case in France on 27 December,” he adds. […] Professor Cohen mentioned that the infected patient had been ill for 15 days and that he had infected his two children, but not his wife. This person had not made any recent trips. For Doctor Bouchaud, “this does not necessarily mean that he is patient zero in France. But it does suggest that more research is needed to find out”. […] So far, the first officially recorded cases in France are those of three people, on January 24: a Frenchman of Chinese origin and two Chinese tourists who stayed in Wuhan, the original focus of the epidemic which appeared in December.

This, together with the earlier report that COVID19 was found during autopsy of a Santa Clara County patient who had died early February (which places the infection roughly at mid January), pushes the COVID19 timeline further back. [The French story is of course being picked up in Chinese propaganda media as “proof” that the virus did not come from China. Mais bien sûr, et je m’appelle Napoléon Bonaparte.]

(2) In the middle of an article about an Italian pharmacist who claims she has uncovered the main mechanism behind severe COVID19 this interesting nugget can be found:
“Chiusolo told the Post, the Italian Society of Rheumatology interviewed 1,200 rheumatologists throughout Italy to collect statistics on contagions. Out of an audience of 65,000 chronic lupus and rheumatoid arthritis patients who systematically take hydroxychloroquine, only 20 patients tested positive for the virus [and none of those ended up in the ICU or died].”
Time for a little back-of-envelope calculation. According to Worldometers, Italy has 210,717 documented cases out of a population of 60.2 million, or 0.35% of the population. This is almost certainly a gross underestimate, but 0.35% of 65,000 lupus and rheumatoid arthritis patients would be 228 — more than ten times the observed number.

An interesting control would be to check patients on some other long-term mild immunosuppressor drug (steroids? Multiple Sclerosis patients on Copaxone? Reader Laura R. suggests https://en.wikipedia.org/wiki/Methotrexate )

(3)

Mike Levitt, 2013 Nobel Prize winner in Chemistry, getting interviewed about COVID19 on UnHerd. I disagree about 30% of the time (and he should hire a fact-checker — his claim that Germany did not go on lockdown is peculiar to say the least), but a lot to chew on. 

He has a rather interesting way of expressing mortality: weeks-equivalent of annual all-causes mortality. He estimates COVID19 will end up being about 4 weeks worth, which may be an easier number to grasp and keep in their head for people who don’t juggle data all day in their day jobs.

(4) Via Instapundit: a long WIRED article “inside the early days of China’s coronavirus cover-up”. https://www.wired.com/story/inside-the-early-days-of-chinas-coronavirus-coverup/

Seasoned journalists in China often say “Cover China as if you were covering Snapchat”—in other words, screenshot everything, under the assumption that any given story could be deleted soon. For the past two and half months, I’ve been trying to screenshot every news article, social media post, and blog post that seems relevant to the coronavirus. In total, I’ve collected nearly 100 censored online posts: 40 published by major news organizations, and close to 60 by ordinary social media users like Yue. In total, the number of Weibo posts censored and WeChat accounts suspended would be virtually uncountable. (Despite numerous attempts, Weibo and WeChat could not be reached for comment.)

Some people say this is China’s Chernobyl. On the contrary. While both disasters happened under totalitarian Communist regimes, COVID19 makes Chernobyl look like a kitchen ketchup spill. 

(5) Bloomberg looks at how the Hawaii tourist industry (about 20% of the island’s economy[*]) has been devastated by the pandemic. At least they have the naval and other military presence to keep the rest of their economy going, plus some agriculture.

[*] indirectly it’s more, of course. In another illustration of Bastiat’s timeless essay “That which is seen and that which is not seen” (original title: Ce qu’on voit et ce qu’on ne voit pas), the sudden drop in purchasing power of those working in the tourist industry has a knock-on effect in other sectors.

UPDATE: what does the milder version of the disease feel like? In this article from March 12, a woman age 37 from the Seattle area shares her experiences:

Schneider revealed how she first began experiencing flu-like symptoms on Feb. 25. The symptoms occurred three days after she attended a party that was later identified as the place where at least five others caught the bug.

“I woke up and I was feeling tired, but it was nothing more than what you normally feel when you have to get up and go to work, and I had been very busy the previous weekend,” she said.

She felt a headache coming on around noon, along with fever and body aches. This was enough to cause her to leave her office at her biotechnology firm and head home.

The marketing manager napped but woke with a temperature that peaked at 103 degrees Fahrenheit that night.

“And, at that point, I started to shiver uncontrollably, and I was getting the chills and getting tingling in my extremities, so that was a little concerning,” she said.

She took over-the-counter flu medication, and called a friend to be on standby in case she needed to be taken to the hospital, but the fever receded over the following days.

Schneider wrongly assumed she didn’t have COVID-19 because she didn’t experience the usual symptoms such as coughing or shortness of breath.

She was up to date with her flu shot, but thought her illness was due to a different strain. When she visited her doctor, she was instructed to go home, rest up and drink large amounts of fluids.

The way she began to suspect she had something more serious was via social media. A friend on Facebook posted that several folks from the party had developed similar symptoms. These people went to their doctors, where they tested negative for the flu, but were not offered coronavirus tests because they were not showing the common signs of coughing and difficulty breathing.

Smartly, Schneider enrolled in a research program called the Seattle Flu Study in hopes of getting to the bottom of her sickness. She was mailed a nasal swab kit by the researchers, which she mailed back. Then began a wait of several days.

On March 7, she got a call with the bad news: She had tested positive for COVID-19. Surprisingly, Schneider felt relieved. “I was a little bit pleasantly surprised, because I thought it was a little bit cool,” she told the AFP, adding that she found it interesting from a “scientific perspective.”

Her symptoms had already subsided by the time she was diagnosed.