COVID19 update, April 14, 2020: vitamin D, zinc, testing; end of globalization as we know it?

(1) Roger Seheult MD in his latest update gives a clear discussion of RT-PCR (reverse transcriptase polymerase chain reaction) testing vs. antibody testing.

I spoke to an industry insider about why not more antibody testing yet? I was told that first-generation antibody testing kits achieved accuracies of around 30%, which are “worse than useless”. But accuracies are steadily improving, and we should soon be looking at something comparable in accuracy to a good RT-PCR.

In response to reader demand, Dr. Seheult also gives a link to a hydrotherapy regime that might be useful for prophylaxis and for treatment of mild cases — but only in addition to more conventional approaches: https://www.hydro4covid.com

(2) Nursing school instructor John Campbell, in his latest update, hammers a lot on the beneficial effect of vitamin D for the human immune system. In fact, he looks at the different mortality statistics for ethnic groups in NYC, and finds it fascinating that everybody comes up with socio-economic explanations while overlooking something obvious: at northern latitudes, vitamin D deficiency is quite common among dark-skinned people. (In fact, both the white and “yellow” skin types evolutionarily started as mutations that just happened to allow humans to thrive in less-sunny northern regions.)

He strongly recommends everybody who does not already enjoy abundant sunshine take vitamin D supplements to boost their immune systems — especially people with darker skin types.

On a related note, he looks at the surprisingly mild statistics of the epidemic in Australia, and notes that this militates in favor of seasonality — but again stresses the beneficial effect of vitamin D in the sunny Australian summer and early fall. (I note that South Africa too has so far dodged a major bullet.)

He also notes that homes for the elderly everywhere have appalling statistics — it takes only one or two cases to cause a major outbreak in one unless you really know what you are doing.

One more thing: out of 459 newly diagnosed cases in South Korea, 228 are imports from the USA. While he admits this will not be a representative sample of the US population (whoever still travels may be a businessman or some sort of expert), it does have implications for the Dunkelziffer/”dark case load” in the USA.

(3) Speaking of nutrition, a number of doctors advocate zinc supplements. [Full disclosure: I have been taking such since the beginning of the crisis.] This is emphatically not quack science: zinc is an essential nutrient, and in fact the most common transition metal in the body outside the bloodstream. (Iron in hemoglobin is the most common one if you include it.) Hundreds of physiological processes depend on zinc in the catalytic site of an enzyme, as a co-catalyst or modulator, or as a structural element. This includes the immune system too: I was struck between the similarity between some early COVID19 symptoms (such as loss of taste and smell) and those of zinc deficiency (presumably because Zn is mobilized in great amounts for the immune system). Here is an academic review article on the roles of zinc in the antiviral immune system.

Particularly people who live on vegetarian diets are at risk for Zn deficiency — those who primarily live on red meats or seafood least so.

(4) Urban geographer Joel Kotkin, in a must-read essay , explains how COVID19 (and whatever similar epidemics may lay in our future) will make dense urban centers less attractive to live in. He notes NYC accounts for nearly half of COVID19 mortality in the USA, greater Milan for half the cases in Italy and almost 3/5 of deaths,… “Simply put, pandemics are bad for dense urban areas, particularly those that are diverse and relatively free. This has been very much the case since antiquity. The more global and vital an urban system—Rome, Alexandria, Cairo, Venice, Florence, London, Paris—the more susceptible it is to the pandemics that seem to be occurring regularly over the past two decades. Cities no doubt will recover, particularly if real estate prices continue to fall, but the pandemics limit their upward trajectory and will continue to drive people elsewhere.”

On a related note, former director of the World Bank’s research department Branko Milanovic, https://www.standaard.be/cnt/dmf20200327_04904960 interviewed in De Standaard (in Dutch) argues that (my paraphrase) “We went for the extremes of globalization because technology enabled it. COVID19 showed such an economy is brittle.” He does see a return to some form of globalized economy the day after the crisis, but not again to this extreme extent.

It is noteworthy that such “the end of globalization as we know it” rhetoric is not the province of just the American populist “right”, but that one can hear similar voices around the globe and the political spectrum from the German establishment center-right to the left. I was (pleasantly) surprised to read a scathing article in The Guardian (!!) about the way some Chinese academic publications about the origins of the virus had to be airbrushed by CCP regime fiat. “Oceania is not at war with Eurasia.” [On a related note, Taiwan released an Email from December in which it warned the WHO about patients with a new, SARS-like lung disease.]

The American Interest looks at the long, hard road to decoupling from China. An article in De Standaard (in Dutch) entitled “[shoddy m]asks as a canary in the coalmine”, looks at the trend towards what it calls with an English neologism “reshoring” — bringing production back home to have better control over supply chain and especially quality. This process is said to have been going on for a while in Belgium, but is now being accelerated by COVID19.

Finally, feelgood story of the day: at age 107, a Dutch woman named Cornelia Ras is now the oldest person to survive a bout with COVID19 .

COVID19 update, April 12, 2020: Easter edition

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.