Covid-19 Diary : Thursday 28 January, 2021

 

I’ve seen a number of news items this week which form part of a common theme, which I’ll call “The Stitch in Time” theme.

You know the proverb “A stitch in time saves nine”.  It applies for medical problems the same as for many other things.  Sometimes, the need for urgent treatment and response is obvious – a person suffering a heart attack or stroke is in a grave situation where literally seconds count.  We know that if there’s concern about a cancer, the healthcare providers rush you through testing and diagnosis, and quickly get you started on treatments before the cancer becomes too large and advanced.

In general terms, many ailments can be treated at various phases.  Let’s consider several possible points where a medical intervention might be possible.

1.  A prophylactic treatment to prevent becoming infected.  This is something you’d do before being exposed to the infection.  Two examples of this are having a vaccine, or starting to take anti-malarial tablets prior to arriving in a malaria-infested region.

2.  A treatment after a suspected exposure to the disease, before it becomes a problem.  That’s a bit like a tetanus shot after being cut by a rusty nail, or a series of rabies shots if bitten by a possibly rabid animal.

3.  A treatment as soon as an infection/disease becomes apparent.  Maybe an example of that is taking an aspirin if you have a headache, or a course of antibiotics if you have a sore throat.

4.  Hospitalization and more complicated treatments if a disease becomes serious.

5.  Panic-mode in the ICU, trying anything and everything, in a desperate attempt to “salvage” a patient who is facing certain death if not treated.

The thing about this series of steps is that, in many cases, if you do nothing, a disease may progress all the way through all five steps, and might ultimately end up killing the patient.

The other thing about this series of steps is that at each point, the discomfort to the patient becomes more severe, and the cost of resolving the disease becomes more resource intensive and expensive.

Now let’s start applying this model to the Covid virus.

For step one, we are now deploying vaccines.  There are also some other drugs that have demonstrated prophylactic properties which have not been used but which have been available and known about for many months, including the period of time when vaccines where still a distant and uncertain hope.

For step two, there are a number of anti-viral drugs that can be used but which are not being used.  Some anti-viral drugs have weak rather than guaranteed anti-viral effects, and so work best when a person starts taking them as soon as possible.  The official CDC/FDA statement is to do nothing except stay at home and hope you get better all by yourself.

For step three, there are again a number of anti-viral drugs that can be used, and a number of other drugs that address secondary elements of a Covid infection which can also be used.  None of these are being usedThe official CDC/FDA statement is again to do nothing except stay at home and hope the infection doesn’t become more extreme.  New drugs are coming available, and sometimes getting emergency use approvals, but they are very expensive, and available only in limited quantities.

For step four and five, things start to become complicated and costly – it is a struggle to even stay for a single night in a hospital and not end up with a $10,000 bill, and your risk of dying has massively increased; survivors might have lasting or permanent damage to their lungs, heart, brain, and other organs.  The battle shifts from a focus on simply treating the virus to now needing to treat the problems the virus causes too.

So if you were in charge of planning a public health response to the Covid pandemic, and if you had to choose only one or two of these five levels to develop treatments for, which would you focus on?

We are spending billions of dollars on vaccines – and may need to continue spending more and more billions on new vaccines to counter new virus variants, and we’re spending who-only-knows how many billions of dollars on health care costs for people who require hospitalization.

But the government and its Operation Warp Speed hasn’t spent anything on responding to people in step 1 (other than vaccines, which we know will take a year or so to get everyone vaccinated, and which we know not everyone will choose to accept), and hasn’t spent anything at all in step 2 and 3 responses.  Why not?  These could be low-cost “stitch in time” type treatments that prevent people from getting variously any infection or a serious infection, relieving the stress on our hospitals, and massively cutting the cost of a course of treatment.

The good news is the government doesn’t need to spend anything to fund the development of new wonder drugs.  There are already low-cost drugs out there, that have been amply tested over decades to show their safety, and which have recently been the subject of dozens of trials and evaluations, and written up in peer-reviewed studies.  But the government refuses to acknowledge the existence of these drugs, or if it does acknowledge their presence, it lies – yes, lies – and claims they don’t work or are dangerous.  (Well, to be fair, it is either stunning ignorance or deliberate lies, and looking at the across-the-board incompetence demonstrated so far in our various responses to the virus, perhaps stunning ignorance is as likely as deliberate lying.)

For example, hydroxychloroquine, which appears to be a wonder-drug, but which is claimed to be either too dangerous or just not effective.

Dangerous?  How many people have died from HCQ compared to how many people have died from the vaccine, or from doing nothing?  A study last year rebutted the claim HCQ was dangerous, and used evidence and facts to show it was abundantly safe, as you’d expect of a drug that is in widespread use, all around the world, by tens, maybe hundreds of millions of people for other ailments at present.

Not effective?  This claim relates to using HCQ to treat late-stage patients with severe infections.  But everyone knows HCQ is not so good for such people, and the people who use this as an excuse for not considering HCQ are strangely ignoring its clearly demonstrated benefits for people in the very early stages of an infection.  Why are they ignoring this?

As for ivermectin, patients – and even their doctors too, now – are having to go to court to get hospitals to agree to allow the patients to be given ivermectin.  Ivermectin, the same as HCQ, is in use by tens/maybe hundreds of millions of people around the world, is remarkably safe, and seems to be even better than HCQ when it comes to combatting Covid.

How many of the 440,000 people who have died of Covid, so far, in the US, would still be alive today if there’d been a widespread program of dispensing either or both these drugs to people?  Probably more than half, possibly more than three-quarters, maybe even 90%.

If we take the most conservative of those numbers – 50%, that comes to 220,000 people who have needlessly died.  So far.  In the US, alone.  Death is not the only negative consequence that we should be concerned about, too.  Many more of the 26 million people in the US who have now had a Covid infection have suffered and will continue to suffer lasting damage to their lungs, heart, brain, and other organs.  How many million of those people are needlessly doomed to a lower quality of life for the balance of what may also be a shorter lifespan in total?

There is an abundance of facts to support the effectiveness of these two drugs, and of many other drugs too (I list over a dozen in my book).  Here are a couple of fact summaries :

Hydroxychloroquine (Links here and here)

Ivermectin (Links here and here)

The cost of these two drugs is about a dollar or so per dose.  A person might require two to eight doses during a course of treatment.  Doses are given in pill form – no need for IV transfusions or anything unpleasant and expensive.

Meanwhile, the FDA is continuing to review experimental new drugs about which nothing is known, and the only data in support of them comes from the big-pharma companies that have developed them.   Surely an existing drug, which has decades of use history to prove its safety, and dozens of independent trials to prove its value, would be more persuasive and compelling to authorize, especially if the drugs are inexpensive, easy to administer, and plentiful.

Why is the medical establishment so extremely opposed to these life-saving drugs?  There’s no downside to using them at all.  Heads, the patient recovers.  Tails, you’ve wasted a few dollars, and the patient is no worse.

Here are some examples of the medical establishment doing the exact wrong thing at present.  These examples have come in so far this week, there are plenty of others from previous weeks.  Tragically, there seem likely to be plenty more next week, and in subsequent weeks, too.

This is not a case of doctors knowing best.  It is a case of administrators not knowing what is right, correct, and proper.  Many doctors – those open-minded enough to actually review the facts – have come out in favor of HCQ, ivermectin, and other treatments, and are finding, every day in their clinics, that these drugs are saving the lives of their patients.

This is not me – a non-doctor – arguing against doctors.  It is a case of front-line doctors arguing against other doctors and administrators, with us as the meat in the sandwich and suffering the consequences.  Surely, we as patients should be allowed a voice in determining our treatments?  That is usually the case with other types of ailments, why, when it comes to this virus, are we ignored?  It isn’t as though the drugs are habit-forming or hallucinogens or illegal.  Both HCQ and ivermectin has been approved by the FDA, and – in theory – once a drug has been approved for a specific use, doctors may freely prescribe it for other uses too (what is termed “white labeling”).  Why the refusals to the ridiculous point of needing court orders to overrule?

Moving on to other topics…..

A question I couldn’t answer :  A reader asked me about a problem.  She has a daughter overseas who wants to return home to the US.  But the US – and many other countries too – now require a negative Covid-test before traveling.  The problem is her daughter had the Covid virus a while ago, and is now clear and free of it.  But the PCR test can continue to report a positive result for three months after a person has been infected and recovered!  (The question – what can her daughter do if the travel-test incorrectly shows positive?)

What makes this all the more frustrating is that sometimes the PCR test shows a person correctly as now being clear of the virus, but other times it gives a positive result.  Another reader mentions that in Thailand, if you get a positive test result, the military come and take you to a quarantine location.  He believes you have no chance of trying to “explain” the positive result, or of asking to get a second result in case the first result was wrong (as is thought to be the case more often than we’d hope for with the so-called “gold standard” PCR testing).

The false hope of vaccines :  Keep in mind you might still get infected by the virus after having been vaccinated.  The vaccines merely claim that you won’t become seriously unwell.  You still might get infected, and you still might be infectious in turn, and you still will test positive.

As long as countries continue to base their admission rules on PCR type testing, travel is and will continue to be a risky gamble.  The vaccines do not help you at all in terms of making travel easier.  This article, for example, says that New Zealand won’t open its doors to vaccinated travelers because of the concerns that vaccinated travelers might also be infected and infectious.

The bottom line?  You travel internationally at your own peril at present.  Indeed, since writing the above, here’s official confirmation, should you wish it.

To end these opening comments on a lighter and very different note, here’s an item headlined “Travel group, airlines oppose quarantine for U.S.-bound air passengers“.  Could we suggest a better and more accurate headline would be “Airlines and travel group put profits before safety”.

Current Numbers

In the US, Hawaii displaced Vermont and now is the state that has been least affected by the virus.  UT and RI swapped places at the other end of the case list.

Strangely, Hawaii and Vermont swapped places, but the opposite way, in the death list.  Vermont is now the state with the lowest death rate.

In the country lists, not a lot of changes, other than the UK shooting up two places in the death rate list.

US Best and Worst States

RankCases/MillionDeaths/Million
A week agoNowA week agoNow
1 BestVT (16,955)HI (18,039)HI (232)VT (276)
2HI (17,473)VT (18,467)VT (269)HI (287)
3MEMEAKAK
4ORORMEME
5WA (39,338)WA (40,881)OR (437)OR (458)
47TN (102,177)TN (105,076)MS (1,904)MS (1,998)
48RI (102,690)UT (106,815)RI (1,960)RI (2,024)
49UT (103,080)RI (107,380)MA (2,018)MA (2,082)
50SD (120,262)SD (121,849)NY (2,151)NY (2,221)
51 WorstND (126,460)ND (127,686)NJ (2,338)NJ (2,398)

 

Top Case Rates Minor Countries (cases per million)

RankOne Week AgoToday
1Andorra (121,279)Andorra (126,447)
2Gibraltar (115,214)Gibraltar (121,182)
3MontenegroMontenegro
4San MarinoSan Marino
5LuxembourgLuxembourg
6SloveniaSlovenia
7PanamaPanama
8LithuaniaIsrael (68,376)
9Israel (63,372)Lithuania (66,727)
10Lichtenstein (63,238)Lichtenstein (64,806)

 

Top Case Rates Major Countries (cases per million)

RankOne Week AgoToday
1Czech Republic (85,574)Czech Republic (89,983)
2USA (75,872)USA (79,303)
3Belgium (58,897)Portugal (67,330)
4Portugal (58,463)Belgium (60,218)
5Spain (54,754)Spain (59,710)
6NetherlandsNetherlands
7Sweden (53,575)Sweden (55,700)
8UK (52,047)UK (54,980)
9FranceFrance
10BrazilBrazil
11ArgentinaArgentina
12Italy (40,194)Italy (41,640)

 

Top Death Rate Major Countries (deaths per million)

RankOne Week AgoToday
1Belgium (1,771)Belgium (1,802)
2Czech Rep (1,397)UK (1,515)
3Italy (1,394)Czech Rep (1,487)
4UK (1,389)Italy (1,446)
5USA (1,266)USA (1,336)
6Peru (1,182)Spain (1,236)
7Spain (1,177)Peru (1,218)
8Mexico (1,113)Mexico (1,184)
9France (1,102)France (1,144)
10Sweden (1,078)Portugal (1,140)

 

I Am Not a Doctor, But….

Here’s an interesting article which suggests that government involvement has either harmed or, if not actually harming, not helped in essentially every part of the Covid response to date.  The disgraceful mess about testing, and the interesting point that both the Moderna and Pfizer vaccines were developed back in January are particular points of note, and Operation Warp Speed didn’t actually speed up the trials in the most effective way by allowing “challenge” testing where vaccinated people are exposed to the virus.

What were all the billions of dollars to help big pharma develop vaccines spent on if the two vaccines now approved in the US were both developed in January?

The more we learn about the virus – and there’s still a huge amount we don’t know – the worse it gets.  As I’ve observed before, invariably, every new discovery is a “bad” thing rather than a good thing.  In this article, still more symptoms of the virus are suggested.

Some people are never happy unless they’re unhappy.  They’re always finding something new to worry about; usually things that most of us never pause to think about at all.  As an example, here’s an article suggesting cats and dogs may need to be vaccinated to stop the spread of the virus, but the giveaway “tell” that this is an absurd nonsense is the phrase “it’s not an obvious risk yet”.

Should we actually be wearing three masks?  That’s what some “experts” are now claiming.  I doubt that their studies supporting that claim have considered that the more mask material you have to breathe through, the more likely the air flow will escape in and out around the sides of the mask, an outcome that might mean that multiple mask layers do more harm than good (unless they are 100% sealing around your face).

We’ve also seen recent pictures, supporting articles advocating we should at least be wearing two masks, that raise an interesting question.  If you have two dissimilar masks, which should be the outer mask and which should be the inner mask?  The picture we saw (but don’t have rights to share it with you) showed a person wearing two masks in what we believe is the wrong order.

I’m surprised the “experts” haven’t discussed this vital point.  My suggestion is to have surgical masks closest to your skin, and more conformal type masks as the outer layer.  That way, the outer mask holds the surgical mask closer to your face.  But, if the surgical mask is on the outside, it usually doesn’t adequately seal around the inner mask and so is almost useless.

Vaccine News

We’ve been astonished at the haphazard approach to trialing with the AstraZeneca/Oxford vaccine, and have several times pointed out that we view the “official” results claimed as being far from convincing.

Apparently the German government agrees with us, at least in part.  They’ve pointed out the lack of sufficient data regarding its effectiveness on people older than 65, and so, while approving it for general use by younger people, specifically say it should not be taken by the 65+ group.

At present, we see the hierarchy of vaccines as being :

  • Pfizer – the best
  • Moderna – almost as good
  • AstraZeneca – deservedly at the bottom

Moderna says it is working on a “booster shot” to strengthen its vaccine’s effectiveness with the South African mutation.  That’s a statement that demands further explanation.  Will it be a single shot or a double shot like with the main vaccine?  Can the booster be mixed in with the original vaccine, or must it be taken separately?  If it must be taken separately, is there an official window of time for when it should be administered?

We see this as a half good/half not-so-good thing.  Will we need boosters for other strains of the virus too?

Meanwhile, Pfizer seems to think a booster won’t be necessary with its vaccine.

We’d love to see the details of both Moderna’s and Pfizer’s testing that explains their thinking.  Harking back to the discussion above about the impossibly high level of proof the medical establishment is demanding for HCQ and IVM, shouldn’t we hold the vaccines to the same standard?  Why are we so forgiving of vaccine proof weaknesses (hello, AstraZeneca!) but having zero tolerance for anything other than an impossibly 100% perfect proof of HCQ/IVM effectiveness?  Why did the FDA say it would approve any vaccine that was even only 50% effective, but refuses to approve treatments that are up to 90% effective?

This is a good updater on other vaccines that are coming through the development process.

On Sunday we’d criticized the seriously-under-achieving goal of 100 million doses in 100 days (ie 50 million people).  Now we’re told the government’s new objective is to vaccinate all 332 million of us by the end of summer.  That’s a great goal.

Timings And Numbers

Another week with good news.  After reporting 43 states with declining rates of new cases on Sunday, the count slipped to 40 on Monday, then 43 on Tuesday, and 45 on Wednesday and today.  Vermont seems to be the least-good state at present.

Closings and Openings

Governor Newsom in California is obviously getting anxious about the recall movement to remove him from office.  On Sunday we reported how California has decided not to share the data it uses to decided what level of lockdown to implement, because it is too complicated for us to understand (or so they say).

And now, the reason for not sharing the data might have become apparent.  With no explanation, California has shifted from very locked down to almost not-locked down at all.

Wouldn’t you think that Gov Newsom and his team would want to celebrate the good news and describe it in rich detail?  We do hope the relaxation of measures isn’t just about trying to kill the recall effort.

Logic?  What Logic?

We had to laugh about this – last yr, the Czech Republic closed its borders and wouldn’t allow Germans in, due to concerns they might be bringing Covid infections with them.  Now, the boot is on the other foot, and the Germans are demanding Czech residents show a recent clear Covid test before they’ll allow them into Germany.  The Czech Republic is upset about this.

What goes around comes around….

The story of our response to the virus over the last year can be summed up in a single sentence.  We’ve been too slow to institute insufficient social distancing measures, and too fast to remove them again.  That’s why the case number curve goes up, then drops and flattens a little bit, then rises again, and so on, as you can see.

The latest example of this is states relaxing their most recent round of restrictions, at the same time that the new more infectious virus strains are taking root in our communities.  This makes no sense.

 

One final item.  It sounds like an April Fool’s Day joke, but it is no laughing matter.  Some people have observed that the “stick a Q-tip high up in your nose” types of tests aren’t very comfortable.  Maybe they will be pleased to learn that China has now developed a new type of test that doesn’t require sticking anything up your nose at all.

Instead, they are now rolling out anal swab tests, with something a great deal larger than a Q-tip being inserted some distance into one’s rectum, rolled around, and then taken out, well coated with “material” for testing.  Details here.

 

Please stay happy and healthy; all going well, I’ll be back again on Sunday.

 

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