A Public Health Announcement about Coronavirus

Here is an excellent little video on Corona (the same one embedded in the article I posted/linked to above).

US only, per CDC:

3/30/20:  140,904 cases, 2405 deaths.

4/2/20:   213,144 cases, 4513 deaths.

GREAT NEWS!  The contagion rate had dropped from doubling every 3 days to to doubling roughly every 6 days!  Since there is still no vaccine that tells me isolation is working!  Let's keep it up.  Stay home.  The virus cannot spread without your help.

BAD NEWS!  The morbidity rate is now up to 2.1%.  More people are dying per 1000 confirmed positive diagnoses.  I'm not a healthcare professional, so take this with a big grain of salt, but I expected, and still expect, this stat to rise as hospitals get overwhelmed, doctors and nurses get infected themselves and must quarantine themselves and as we start running out ventilators and other supplies.

PLEASE stay home.


bob


.

Boy, I watched Chris Cuomo last night, he has the virus. He went from having a slight fever to a high one, sweats, breathing issues, and basically delirious at times. One sick guy. He had a young man on there who was absolutely destroyed. His husband was a doctor, and worked, even though he did not have all the necessary equipment to wear, contracted the virus, and died in no time. This is scary stuff which is why I am not bitching about my surgery. I want no part of these hospitals, especially Mass General and Brighams. They are knee deep. So we sit, amuse ourselves, clean shelves and closets ant throw things away. Something useful to do while locked up here! Take care everyone

Hey Bob

The  morbidity rate is a fake stat.

Until testing advances into the asymptomatic population we really do not know what the rate of infection is nor the likelihood of death.

Needless to say a lot of people are dying but I think the rate of death is a lot lower.

My son KJ told me his employer is going to supply masks.  He is an essential employee.  I already gave him some masks but I am glad that he will also be supplied at his place of employment.

I now know 6 people that have been infected with the virus down here in GA.

My prayers go out to them and everyone.

Stay safe.  This storm will pass by us.

dboss wrote:Hey Bob

The  morbidity rate is a fake stat.

Until testing advances into the asymptomatic population we really do not know what the rate of infection is nor the likelihood of death.

Needless to say a lot of people are dying but I think the rate of death is a lot lower.

My son KJ told me his employer is going to supply masks.  He is an essential employee.  I already gave him some masks but I am glad that he will also be supplied at his place of employment.

I now know 6 people that have been infected with the virus down here in GA.

My prayers go out to them and everyone.

Stay safe.  This storm will pass by us.

Dboss,

Quite correct.  The definition of "Morbidity Rate" is the frequency or proportion with which a disease appears in a population.  What my calculation was based upon was the deaths as a percentage of the confirmed positive cases and not of the US population.  The population of confirmed cases, as it were. If there is a better term to use I will.


bob


.

bobheckler wrote:

dboss wrote:Hey Bob

The  morbidity rate is a fake stat.

Until testing advances into the asymptomatic population we really do not know what the rate of infection is nor the likelihood of death.

Needless to say a lot of people are dying but I think the rate of death is a lot lower.

My son KJ told me his employer is going to supply masks.  He is an essential employee.  I already gave him some masks but I am glad that he will also be supplied at his place of employment.

I now know 6 people that have been infected with the virus down here in GA.

My prayers go out to them and everyone.

Stay safe.  This storm will pass by us.

Dboss,

Quite correct.  The definition of "Morbidity Rate" is the frequency or proportion with which a disease appears in a population.  What my calculation was based upon was the deaths as a percentage of the confirmed positive cases and not of the US population.  The population of confirmed cases, as it were.  If there is a better term to use I will.


bob


.

If you guys are interested, there is a pretty good article that explains the meanings and nuances of all these terms:

https://ourworldindata.org/covid-mortality-risk

It is from a really excellent site called "Our World in Data" (https://ourworldindata.org/). It has all sorts of great stuff not only on Corona virus, but all sorts of other things. Helps cut threw all the crap published on the net

I tested negative for Covid-19 Friday with a neat little serology kit from Boston BioPharma that yields results in 10-2 minutes. 90% accuracy.

Then there's this:

I am not endorsing this writer's politics here and don't want his occasional pro-Trump remarks to deter anyone from appreciating the logic behind his diagnosis. Please consider.

Covid-19 had us all fooled, but now we might have finally found its secret.
by libertymavenstock


In the last 3–5 days, a mountain of anecdotal evidence has come out of NYC, Italy, Spain, etc. about COVID-19 and characteristics of patients who get seriously ill. It’s not only piling up but now leading to a general field-level consensus backed up by a few previously little-known studies that we’ve had it all wrong the whole time. Well, a few had some things eerily correct (cough Trump cough), especially with Hydroxychloroquine with Azithromicin, but we’ll get to that in a minute.

There is no ‘pneumonia’ nor ARDS. At least not the ARDS with established treatment protocols and procedures we’re familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required… They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.

The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.

Here’s the breakdown of the whole process, including some ELI5-level cliff notes. Much has been simplified just to keep it digestible and layman-friendly.
Your red blood cells carry oxygen from your lungs to all your organs and the rest of your body. Red blood cells can do this thanks to hemoglobin, which is a protein consisting of four “hemes”. Hemes have a special kind of iron ion, which is normally quite toxic in its free form, locked away in its center with a porphyrin acting as it’s ‘container’. In this way, the iron ion can be ‘caged’ and carried around safely by the hemoglobin, but used to bind to oxygen when it gets to your lungs.

When the red blood cell gets to the alveoli, or the little sacs in your lungs where all the gas exchange happens, that special little iron ion can flip between FE2+ and FE3+ states with electron exchange and bond to some oxygen, then it goes off on its little merry way to deliver o2 elsewhere.

Here’s where COVID-19 comes in. Its glycoproteins bond to the heme, and in doing so that special and toxic oxidative iron ion is “disassociated” (released). It’s basically let out of the cage and now freely roaming around on its own. This is bad for two reasons:
1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once all the hemoglobin is impaired, the red blood cell is essentially turned into a Freightliner truck cab with no trailer and no ability to store its cargo.. it is useless and just running around with COVID-19 virus attached to its porphyrin. All these useless trucks running around not delivering oxygen is what starts to lead to desaturation, or watching the patient’s spo2 levels drop. It is INCORRECT to assume traditional ARDS and in doing so, you’re treating the WRONG DISEASE. Think of it a lot like carbon monoxide poisoning, in which CO is bound to the hemoglobin, making it unable to carry oxygen. In those cases, ventilators aren’t treating the root cause; the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. The red blood cells just can’t carry o2, end of story. Only in this case, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry o2 because it has lost its iron ion. The body compensates for this lack of o2 carrying capacity and deliveries by having your kidneys release hormones like erythropoietin, which tell your bone marrow factories to ramp up production on new red blood cells with freshly made and fully functioning hemoglobin. This is the reason you find elevated hemoglobin and decreased blood oxygen saturation as one of the 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.

2) That little iron ion, along with millions of its friends released from other hemes, are now floating through your blood freely. As I mentioned before, this type of iron ion is highly reactive and causes oxidative damage. It turns out that this happens to a limited extent naturally in our bodies and we have cleanup & defense mechanisms to keep the balance. The lungs, in particular, have 3 primary defenses to maintain “iron homeostasis”, 2 of which are in the alveoli, those little sacs in your lungs we talked about earlier. The first of the two are little macrophages that roam around and scavenge up any free radicals like this oxidative iron. The second is a lining on the walls (called the epithelial surface) which has a thin layer of fluid packed with high levels of antioxidant molecules.. things like abscorbic acid (AKA Vitamin C) among others. Well, this is usually good enough for naturally occurring rogue iron ions but with COVID-19 running rampant your body is now basically like a progressive state letting out all the prisoners out of the prisons… it’s just too much iron and it begins to overwhelm your lungs’ countermeasures, and thus begins the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to all that nasty stuff and damage you see in CT scans of COVID-19 patient lungs. Ever noticed how it’s always bilateral? (both lungs at the same time) Pneumonia rarely ever does that, but COVID-19 does… EVERY. SINGLE. TIME.

— — — — — — — — — — — — -
Once your body is now running out of control, with all your oxygen trucks running around without any freight, and tons of this toxic form of iron floating around in your bloodstream, other defenses kick in. While your lungs are busy with all this oxidative stress they can’t handle, and your organs are being starved of o2 without their constant stream of deliveries from red blood cell’s hemoglobin, and your liver is attempting to do its best to remove the iron and store it in its ‘iron vault’. Only its getting overwhelmed too. It’s starved for oxygen and fighting a losing battle from all your hemoglobin letting its iron free, and starts crying out “help, I’m taking damage!” by releasing an enzyme called alanine aminotransferase (ALT). BOOM, there is your second of 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.

Eventually, if the patient’s immune system doesn’t fight off the virus in time before their blood oxygen saturation drops too low, ventilator or no ventilator, organs start shutting down. No fuel, no work. The only way to even try to keep them going is max oxygen, even a hyperbaric chamber if one is available on 100% oxygen at multiple atmospheres of pressure, just to give what’s left of their functioning hemoglobin a chance to carry enough o2 to the organs and keep them alive. Yeah we don’t have nearly enough of those chambers, so some fresh red blood cells with normal hemoglobin in the form of a transfusion will have to do.

The core point being, treating patients with the iron ions stripped from their hemoglobin (rendering it abnormally nonfunctional) with ventilator intubation is futile, unless you’re just hoping the patient’s immune system will work its magic in time. The root of the illness needs to be addressed.

Best case scenario? Treatment regimen early, before symptoms progress too far. Hydroxychloroquine (more on that in a minute, I promise) with Azithromicin has shown fantastic, albeit critics keep mentioning ‘anecdotal’ to describe the mountain, promise and I’ll explain why it does so well next. But forget straight-up plasma with antibodies, that might work early but if the patient is too far gone they’ll need more. They’ll need all the blood: antibodies and red blood cells. No help in sending over a detachment of ammunition to a soldier already unconscious and bleeding out on the battlefield, you need to send that ammo along with some hemoglobin-stimulant-magic so that he can wake up and fire those shots at the enemy.

The story with Hydroxychloroquine

All that hilariously misguided and counterproductive criticism the media piled on chloroquine (purely for political reasons) as a viable treatment will now go down as the biggest Fake News blunder to rule them all. The media actively engaged their activism to fight ‘bad orange man’ at the cost of thousands of lives. Shame on them.

How does chloroquine work? Same way as it does for malaria. You see, malaria is this little parasite that enters the red blood cells and starts eating hemoglobin as its food source. The reason chloroquine works for malaria is the same reason it works for COVID-19 — while not fully understood, it is suspected to bind to DNA and interfere with the ability to work magic on hemoglobin. The same mechanism that stops malaria from getting its hands on hemoglobin and gobbling it up seems to do the same to COVID-19 (essentially little snippets of DNA in an envelope) from binding to it. On top of that, Hydroxychloroquine (an advanced descendant of regular old chloroquine) lowers the pH which can interfere with the replication of the virus. Again, while the full details are not known, the entire premise of this potentially ‘game changing’ treatment is to prevent hemoglobin from being interfered with, whether due to malaria or COVID-19.

No longer can the media and armchair pseudo-physicians sit in their little ivory towers, proclaiming “DUR so stoopid, malaria is bacteria, COVID-19 is virus, anti-bacteria drug no work on virus!”. They never got the memo that a drug doesn’t need to directly act on the pathogen to be effective. Sometimes it’s enough just to stop it from doing what it does to hemoglobin, regardless of the means it uses to do so.

Anyway, enough of the rant. What’s the end result here? First, the ventilator emergency needs to be re-examined. If you’re putting a patient on a ventilator because they’re going into a coma and need mechanical breathing to stay alive, okay we get it. Give ’em time for their immune systems to pull through. But if they’re conscious, alert, compliant — keep them on O2. Max it if you have to. If you HAVE to inevitably ventilate, do it at low pressure but max O2. Don’t tear up their lungs with max PEEP, you’re doing more harm to the patient because you’re treating the wrong disease.

Ideally, some form of treatment needs to happen to:
Inhibit viral growth and replication. Here plays CHQ+ZPAK+ZINC or other retroviral therapies being studies. Less virus, less hemoglobin losing its iron, less severity and damage.

Therapies used for anyone with abnormal hemoglobin or malfunctioning red blood cells. Blood transfusions. Whatever, I don’t know the full breadth and scope because I’m not a physician. But think along those lines, and treat the real disease. If you’re thinking about giving them plasma with antibodies, maybe if they’re already in bad shape think again and give them BLOOD with antibodies, or at least blood followed by plasma with antibodies.

Now that we know more about how this virus works and affects our bodies, a whole range of options should open up.

Don’t trust China. ... (disclaimer: not talking about the people, just talking about the regime). They covered this up and have caused all kinds of death and carnage, both literal and economic. The ripples of this pandemic will be felt for decades.
Fini.

worcester wrote:I tested negative for Covid-19 Friday with a neat little serology kit from Boston BioPharma that yields results in 10-2 minutes. 90% accuracy.

Then there's this:

I am not endorsing this writer's politics here and don't want his occasional pro-Trump remarks to deter anyone from appreciating the logic behind his diagnosis. Please consider.

Hi Worcester,

I am afraid the logic of the article is flawed. First, consider that hemoglobin is kept inside red blood cells, it is not in plasma or extra-cellular space. Thus, for the corona virus to interact with hemoglobin and strip iron from the heme, the virus must enter the cell. However, the virus itself never enters the cell. Instead, the virus dumps its RNA genome into the cell. Basically, the virus recognizes and binds to an enzyme, ACE2, that sits on the surface of some cell types. This interaction causes the viral membrane to fuse with the cell membrane. When this fusion happens, the RNA genome is dumped in the cytoplasm. Once in the cytoplasm the virus RNA code is converted into a subset of the viral proteins. These proteins then make more copies of the viral genome, which are then packaged into the virus shell and eventually secreted. The assembly of the virus occurs inside the endoplasmic reticulum and golgi apparatus vesicles, and thus even the newly assembled virions are in an entirely separate compartment from the hemoglobin. Thus, the actual virus is never even in the same compartment as hemoglobin. There are a number of other problems as well. First, red blood cells do not have the ACE2 enzyme on their surfaces. Thus, the virus cannot get into red blood cells. In contrast, the epithelia of the the lungs and digestive track have tons of ACE2 on their cell surfaces, consistent with their susceptibility to the virus. Even if the virus somehow got into red blood cells, remember that red blood cells lose the nucleus as part of their maturation pathway. As a result, they also don't have ribosomes to manufacture viral proteins in the cell, nor can they code for the rest of the cellular machinery the virus would need to reproduce.

IF you look carefully at the "mechanism" proposed for the drug, against both malaria and corona, there is no actual mechanism presented - it cleverly says absolutely nothing at all. Also, as an aside, malaria is a parasite, not a bacteria. Thus, while I agree that intubation is scary and dangerous, the jury is still out on hydroxychloroquine. If it does help, it likely helps by attenuating the overly aggressive immune response against the virus that actually causes damage and death. However, this possibility is never mentioned, and indeed there was not a single link to any peer reviewed study. I think this is fake news whose intent was related to politics as much as to human health.

Shamrock, I can't speak to the biochemistry you have presented, but I did see a video from a NYC emergency care MD who supported all the symptomatic observations and conclusions about oxygen deprivation hypothesized in the article I posted.

I don't really understand your reluctance to recognize Hydroxychloroquine as an effective treatment for Covid-19, so if you have reasoning on this, I would like to hear it. Six thousand M.D.s from around the world have recently stated that they have found HCQ to be the most effective treatment for the disease. If I can find the NYC doctor's video and the statement from the 6000 doctors I will send them to you.

Please understand, I have no dog in this hunt. I make no money selling O2, ventilators, or HCQ. I am just looking for the truth, and if you have information that will lead to effective treatment, I will embrace it. Thanks for your feedback.

Worcester - you've got me all wrong. I have nothing against HCQ. There is a lot I actually like about it. First, it has been around forever, and is pretty damn safe. Second, it seems to clearly help with inappropriate immune responses, which is ultimately what kills in Covid-19. I really hope it pans out. And for the record, if I got Covid-19 and developed serious symptoms I would be knocking down children and old ladies to get a bottle of HCQ!

That being said, the mechanism the guy proposed sounds pretty bogus for the reasons I outlined above. Again, it may be effective, but if so, it will probably be for different reasons. At this point, there is simply not enough data to say how effective it is. Without a large randomized trial, it is just not possible to say any observed effects are statistically significant. Consider that when all the data is in, probably less than 1% of the people who get Corona will die. Out of 100, 99 will get better whether they take the drug or not. Thus, to see if the drug has an effect, you need a large randomized study. Does that mean I think it shouldn't be used? Hell no. It is safe, anecdotally it helps, why not??? However, it is just not certain whether it works, and if it does, how well it works. This is super important. If people think there is a simple cure, they may not take this thing seriously. Hence, like you, I just want the truth. Unfortunately the truth is rarely black or white. Nonetheless, I want the truth in all its infuriating grayness.

Regarding hypoxia - when the lungs are damaged, the area for gas exchange (get rid of CO2 pick up O2) is greatly reduced. As a result, the hemoglobin in the blood is not saturated with 02, and thus cannot supply tissues with O2. Hypoxia.

Really sorry if my previous post came off poorly. My friends and family tell me I am a know-it-all, and I have heard this enough that it must be at least partially true (this anecdote I believe). So I hope you didn't take my post personally. Just want truth. Hope we're cool...

Since you are a clinician, I would love to hear your take on intubation for Covid-19 patients. Is it the right way to go, or does intubation actually further damage the lungs???

Shamrock, Since I practice traditional Chinese medicine (not a popular group right now) I don't really know about intubation, other than that respiratory therapists are much needed and in short supply right now. I doubt the good respiratory techs damage lungs often with intubation, but the added pressure may. I do know a good bit about hyperbaric oxygen chambers however, and though they can be helpful for those with O2 issues, they are way too big and bulky to make them at all a practical solution for masses of people.

No need for a mea culpa. It is good to call bullshit out when you see it.

Here's the test i took: available from -
https://www.bostonbiopharma.com/

IMHO this is the way we should go. Test widely. Identify the infected and those who have recovered and developed antibody immunity.
Worcester


Position Paper

The Testing Debate for COVID-19: PCR vs. Rapid Antibody Test: How Rapid Antibody Testing can Identify Potential Immune Patients Quickly

Rashid A. Chotani, MD, MPH, FRCPH, Chief Science Officer & VP Medical Affairs, Carelife Medical

Syed S. Ashraf, MD, FHM, Chief Administrative Officer, Carelife Medical

Fatima Aziz, MD, Senior Medical Director, Carelife Medical

Terry Clark, MD, Executive VP & Chief Medical Officer, Boston Biopharma

Charles Haviland Mize, MD, Bear/Badger Expeditionary and Retrieval Medicine

Knowledge and clarity empower rational action. The COVID-19 pandemic demands a powerful response, but the absence of a clear understanding of the virus has hamstrung governments' ability to act. The COVID-19 pandemic has now affected over 200 hundred countries and caused disease in over one million, resulting in close to 53,000 deaths. According to the Johns Hopkins Coronavirus Resource Center, United States has the largest number of cases (over 245,000) with close to 6,000 deaths and an epicenter of the disease in New York State (~ 93,000 cases and over 2,500 deaths). The quarantine, staying-home and social-distancing measures instituted throughout the states will help curb the epidemic. These measures are important and powerful tools to slow viral transmission. In of themselves, however, they do not help decision-makers determine the true extent and spread of the disease, nor how best to prepare to meet it. Rapid screening for disease is the cornerstone of curbing an outbreak, because such screening affords an understanding the epidemiology of the virus. Armed with this knowledge, public health policymakers are in a stronger position to more accurately assess and implement strategically meaningful interventions.

The nation struggles with the question “To Test or Not” for COVID-19. Testing for SAR-CoV-2 in the US appears to be controversial. The concerns arise from a poor understanding of the testing process and the consequences test results may have on staffing and employment. Fundamentally, however, the implications of testing are far-reaching and concern more than the single individual and a single test. Widespread testing is what enables us to discern disease incidence and prevalence, and to determine who has recovered from infection and is now immune. The faster we can clear individuals from active disease state, the faster we can mitigate the socio-economic downturn and social disruption. In order to do so, we need the ability to clearly identity the following categories of patients:

1. Exposed and now infected (at risk)

2. Infected but asymptomatic (infectious to others)

3. Infected and symptomatic (sick and infectious)

4. Infected and recovered (developed immunity)

Testing that can place patients into one of these categories will allow us to understand if someone is contagious (shedding virus) or non-contagious (not shedding virus). Furthermore, such testing will inform us if an individual has developed a certain level of immunity.

Multiple testing modalities are being used or have recently been developed, to include RT-PCR for viral RNA and rapid antibody testing. Neither of these tests are perfect; alone can provide neither 100% sensitivity nor specificity. PCR tests for viral presence, which can vary between patients depending viral load and the patient’s degree of exposure. Variability in viral load as well as poor swab technique during testing can lead to false negatives. Administration of the test puts staff at risk because it requires removal of a patient’s mask and can cause the patient to sneeze or cough. Furthermore, recent studies have demonstrated that PCR, which has been considered the “Gold Standard,” has a high false negative rate, up to 30%. This false negative rate suggests that a third of covid-19 suspected individuals tested negative by PCR may continue to carry and transmit COVID-19 unaware of the risk they pose to others. Moreover, PCR testing requires special equipment and special training, and can provide results only days after testing. By contrast, serologic immunoassay via IgM/IgG is a simple point-of-care, cost-effective test using a finger-stick blood drop. It provides results within minutes and can be used to conduct serial monitoring of populace to see who has been exposed to COVID-19. Importantly, antibody testing allows clinical decision makers to determine who is now clear of active disease and can return to work.

We have been using a rapid antibody IgM/IgG test by Boston Biopharma that has been FDA-approved for sale and is under evaluation for emergency use authorization like most rapid tests available currently. After consideration of the sensitivity/specificity of the PCR test, the inherent danger of spreading the virus during the nasal swabbing, and the test’s cost and inconsistent turnaround time, we believe that a rapid antibody test is the better tool to empower our public health. The antibody test for IgM and IgG detects the humoral response (in immuno-competent people) and exposure prevalence. Known immunologic graphs correlate IgM rise with symptom development in covid-19 patients (roughly ~4-7 days since exposure event) and, additionally, the IgM response may be present in asymptomatic patients. IgG indicates longer-term immune response.

It is important to note that no test on its own can determine patient infectious status. To be effective, testing must be conducted within a clinical screening and evaluation process. Based on our experience, antibody testing is easier to administer, is a better point-of-care (POC) tool, and adds further critical information to that of RT-PCR alone.

Disagreement over testing methodology stems from the evolving understanding of COVID-19 and the varying knowledge of virology by those crafting the public response. It is clear that a stay-home policy without a means to survey the US population and “clear” individuals of active disease state would be detrimental to the American economy and would create further social disruption and anxiety. This toll on staffing is especially important in the healthcare setting. The use of social distancing and isolation measures in democratic nations have yielded favorable outcomes and have been able to “flatten the curve.” However, the ability to identify individuals who are IgM (-) and IgG (+) is critical if we are to return to some normalcy and reassure labor force mobility. Table 1 describes the various scenarios and the potential outcomes.

At present, there are no definitive nor specific therapeutic agents or vaccines, despite the tremendous commitment to their research and development. While we wait, the disease continues to cause significant morbidity and mortality. Antibody testing affords another benefit: the identification of patients who have recovered from the infection and who are able to provide their own antibodies to others in the form of convalescent plasma. During the 2014 Ebola outbreak, convalescent plasma was recommended as an empirical treatment, and a protocol for treatment of Middle East Respiratory Syndrome (MERS) coronavirus with convalescent plasma was established in 2015. Other studies for viruses such as SARS-CoV, H5N1 avian influenza, and H1N1 influenza suggest the effectiveness of transfusion of convalescent plasma. (1,2,3,4,5) A recent uncontrolled case series of 5 critically ill patients study published by Chenguang Shen et al in JAMA suggests that convalescent plasma transfusion may help in the treatment of critically-ill patients with COVID-19. While awaiting confirmation in randomized clinical trials, the approach continues to hold much promise. (6)

Conclusion:

Rapid POC antibody COVID-19 specific testing is the best means at our disposal to improve our epidemiologic understanding of the virus and to empower a robust public health response. The ability to determine immunity will enable us to safely restore our economy. This will further permit safe and cost-effective way to create a registry of immune individuals whereby enabling collection of convalescent plasma, a possible treatment for patients critically ill with COVID-19.

References:

1. Kraft CS, Hewlett AL, Koepsell S, et al; Nebraska Biocontainment Unit and the Emory Serious Communicable Diseases Unit. The use of TKM-100802 and convalescent plasma in 2 patients with Ebola virus disease in the United States. Clin Infect Dis. 2015;61(4):496-502.

2. van Griensven J, Edwards T, de Lamballerie X, et al; Ebola-Tx Consortium. Evaluation of convalescent plasma for Ebola virus disease in Guinea. N Engl J Med. 2016;374(1):33-42.

3. Florescu DF, Kalil AC, Hewlett AL, et al. Administration of brincidofovir and convalescent plasma in a patient with Ebola virus disease. Clin Infect Dis. 2015;61(6):969-973.

4. Zhou B, Zhong N, Guan Y. Treatment with convalescent plasma for influenza A (H5N1) infection. N Engl J Med. 2007;357(14):1450-1451.

5. Hung IF, To KK, Lee CK, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis. 2011;52(4):447-456.

6. Chenguang Shene et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4783.

Rashid A. Chotani, MD, MPH rashid@carelife.md | Office: 703-854-1298 | Mobile: 571-425-9730

Table 1

Worcester, a good antibody test would be a game changer. It looks like once somebody gets Covid-19, they are immune to future infections. An antibody test would allow someone to know if they have been exposed and developed immunity. If they have, then they should be free to join the world again without risk of infecting themselves or others. PCR tests may still have a role. They can tell you whether virus is still present in a person, and thus whether that person might still be infectious, whereas antibody tests only say that somebody had the virus at some point. For both tests though, it is essential that they discriminate between Sars cov-2, the virus that causes Covid-19, and other related corona viruses that are somewhat common, e.g. cov-63.

Serology tests are 90% accurate. The PCR tests are a bit less accurate, but combined they provide a very high level of accuracy. Why this is not the #1 new business in the USA boggles my mind. Proper widespread testing would be so very helpful to us all.

Meanwhile in the last two days I submitted applications for two Federal Covid-19 related loans and grants. Those here in business may want to check out these two sites:

#1 -
https://home.treasury.gov/system/files/136/Paycheck-Protection-Program-Application-3-30-2020-v3.pdf

This loan covers payroll spent from February 15, 2020 to June 30, 2020 and 25 % of rent and utilities. The loan is forgiven to the extent that you have not laid off employees. The max loan amount = 250% of your average monthly payroll. A minimum of 70% of the loan must be paid toward wages, the rest can go towards 25% of the cost of rent and utilities.

#2 - This one appears to be the very easiest and quickest to get. A $10,000 grant.

https://www.sba.gov/funding-programs/loans/coronavirus-relief-options/economic-injury-disaster-loan-emergency-advance

Lab tests indicate which patients will develop a cytokine storm which leads to severe Covid-19 illness. Those so detected need to suppress their immune systems to recover. Here's why:

https://www.foxnews.com/media/california-doctor-develops-process-for-identifying-extreme-covid-19-cases-and-how-to-treat-them

As of 4/9/20, per CDC:
4/6/20 - 330,891 cases, 8910 dead
4/9/20 - 427,460 cases, 14696 dead.

Good News!  The rate of infection is still dropping.  It is now increasing only 29% every 3 days instead of even the 38% we saw last week (MUCH better than doubling every 3 days).

Bad News!  The death rate is now up to 3.4% of confirmed cases.  

If we can stop the infection rate from increasing the deaths will slow naturally as people recover and fewer get sick (and our hospitals get less overwhelmed).

The reduction in the rate of infection once lockdowns were implemented across the country shows it works.  STAY HOME!!  The virus has no legs, no wings.  It cannot move without you.


bob


.

bobheckler wrote:As of 4/9/20, per CDC:
4/6/20 - 330,891 cases, 8910 dead
4/9/20 - 427,460 cases, 14696 dead.

Good News!  The rate of infection is still dropping.  It is now increasing only 29% every 3 days instead of even the 38% we saw last week (MUCH better than doubling every 3 days).

Bad News!  The death rate is now up to 3.4% of confirmed cases.  

If we can stop the infection rate from increasing the deaths will slow naturally as people recover and fewer get sick (and our hospitals get less overwhelmed).

The reduction in the rate of infection once lockdowns were implemented across the country shows it works.  STAY HOME!!  The virus has no legs, no wings.  It cannot move without you.


bob


.

+1

In a time when so many things seem out of control, staying home whenever possible is one thing you can control.

bobheckler wrote:The virus has no legs, no wings.  It cannot move without you.
bob.

Quote of the day.

I hope all are doing well! I just wanted to give everyone a heads up on what is going on with my family. My wife (hospice nurse) was exposed to a Covid 19 patient without her knowledge. Last week she started to get really ill. On Saturday I took her to a testing site at the University near our home. The doctor said it could take two days to two weeks for results. We are still waiting. Last night she was going down hill. I called the doctor. He had written a script for XOfluza on the 11th which we saw no change. Last night he sent a script in for Vermectin and Azithromycin which was a game changer. I was told the Vermectin is a drug for scabies. She was able to drink more than 2 sips and hold it down. This morning her fever broke and she ate some real food.

My daughter is doing much better and we are very thankful.

This is a brutal virus! I thought my wife was giving up! She said she cant do this anymore. She never complains about anything. The Covid patient she was exposed to died 5 days later. No one told my wife the patient was exposed and waiting testing results.

That is such great news about your wife. I had read the Vermectin worked. Good to have a first hand report.

He wrote the script for 6 pills a day. She started with 2 pills last night and within an hour she was able to drink more than 2 sips. It was amazing!

Vermectin 3mg 6 pills a day 500 mg Azithromycin once a day she was prescribed

Jerzey,

Great to hear your wife is recovering and your daughter is doing better!

Your family has had more than it's share. I hope the sailing becomes smooth from here.

Regards

Very happy that your wife and daughter are doing okay. This is scary stuff. You all have been through enough. Take care of yourself.....and wish them speedy recovery


Rosalie