COVID19 update, May 16, 2020: evidence hydroxychloroquine works better with zinc added; how Taiwan succeeded; Niall Ferguson on his disgraced namesake

(1) When I reported on the failed hydroxychloroquine (HOcq) trial, a number of commenters asked “what about zinc?” It is indeed so that the early reports of success by both Didier Raoult [director of IHU-Méditerranée in Marseille, France] and by Williamsburg, NY community doctor Zev Zelenko included zinc supplementation.
Now the latest video of Roger Seheult MD highlights a retrospective study with zinc+HOcq (plus azithromycin) about which a preprint just was published. And guess what: results there look a good deal more promising if administered early in the disease. That is strongly suggestive of HOcq’s role being that of a zinc ionophore (and, at least in vitro, Zn2+ inhibits with the RdRp, a.k.a. replicase, that copies the viral RNA) https://www.medrxiv.org/conte…/10.1101/2020.05.02.20080036v1  https://www.youtube.com/watch?v=WZq-K1wpur8

(2) Two COVID19-related videos worth watching from the Hoover Institute

(2a) Vice President Chen Chien-jen, Taiwan, himself a reputed epidemiology professor, describes Taiwan’s response, and how they quickly contained the epidemic without lockdowns.

https://www.youtube.com/watch?v=-3Ry6eiKvvw

(2b) Niall Ferguson, the British-born Harvard University historian, discusses the British and American responses to the epidemic, the economic falloutk, and his now-disgraced near-namesake of the “2 million will die” model.

Neil Ferguson (the modeler) reminds me of the Talmudic maxim:

Scholars, be careful with your words, lest you [lead your pupils] to a place of bitter waters, and they drink from it and die — and thus the Name of Heaven will be desecrated.

Pirkei Avot 1:11

ADDENDUM: Quillette has an article from Paulina Neuding, who lives in Stockholm: “Sweden Has Resisted a Lockdown. But That Doesn’t Make it a Bastion of Liberty” [This is aside from issues with its healthcare system reported on earlier.]

In reality, Sweden’s response to the pandemic has less to do with freedom and individual responsibility, and more to do with the country’s tradition of consensus and social control. Its choice of a uniquely lax approach to the pandemic should not be mistaken for a sudden turn toward individual freedom.

The Swedish strategy, devised by a team of government experts headed by chief epidemiologist Anders Tegnell, rests on the assumption that [(a)] COVID-19 cannot be contained, and that [(b)] other international experts are overestimating its fatality rates. Herd immunity is viewed as the inevitable end point, and it is assumed that such immunity can be achieved relatively quickly and at a cost in human lives that will not be too high.

“We have been a bit careful [about] the words [herd immunity] because it can give the impression that you have given up, and that is not at all what this is about… We will not gain control of this in any other way,” Tegnell explained in an interview in March.

[…] Though polls show that most Swedes trust the state consensus, a minority would prefer to have their families self-isolate, but cannot because they risk intervention from social services. Imagine being a Swedish parent who belongs to a high-risk group, and to face the choice between possibly contracting the virus through your child’s school, and that of being reported to the authorities for the offence of homeschooling.

Sweden’s COVID-19 death rate hovers high above that of other Nordic countries, which have chosen a more restrictive strategy. As of this writing, Sweden has 22 deaths per 100,000 citizens—more than five times as many as Norway (four per 100,000) and three times as many as Denmark (seven per 100,000), even though all three countries saw their first fatalities on roughly the same date. But collectivism is deeply ingrained in Swedish culture—for good and ill—and many view it as bad form to question the authorities in the midst of a crisis.

Even though Sweden has taken a path that is extreme compared to virtually all other EU countries, there is limited overt political opposition, and scientists who have criticized the strategy have been victims of vicious attacks on their characters, and are rejected at public events. The rector at a leading Swedish university even saw it necessary to declare in a blog post (available in English) that employees who had publicly criticized the government’s COVID-19 response would not be censored for doing so. That he even saw a need for such a public statement is telling of the current mood in the country.

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 .