COVID – False Autopsy Report of 50 Cases

WHO has correctly warned about an Infodemic with COVID. The biggest challenge for us as the medical community is to deal with distinguishing the scientific information from the unscientific (and possibly anecdotal) information.

I read this information floating on WhatsUp University (WA Univ.) almost 5-6 days back and did not pay much credence. However, since the creation of this group, I see this for the third time. That mandates me from researching this on Pubmed Central and Google Scholar. Pubmed Central gave zero results to “COVID and Autopsy” Whereas, Google Scholar pulled few results. I have cited references along with the full text as well.

I found a total of three publications related to Autopsy. One was a single case report from China, another 12 cases from New Orleans, and the remaining report of 2 cases from Oklahoma. I searched for an autopsy study for 50 cases and I found none. Also, I saw no doctor with this background who would have not disclosed his name or published this autopsy study of 50 cases, since it would have been well acclaimed. The WA Univ. author has not discussed the autopsy finding but is driving the readers to his preset conclusions.

My Concern:

If the author has truly done a study of 50 cases, why has he/she not published this?
Often submissions are accepted as advanced publications subject to review, he/she could have resorted to this option?
The name of the author is Dr. Fikry, a Google search does not indicate any such doctor.
Why does he want to stay anonymous? Select reasons that come to my mind are – either the work cannot be substantiated or he/she has not followed the Helsinki guidelines for research.
Research Style – Ideally, research has to follow a methodology, and a paper is written in order. I did not see that order but a direct jumping to evidence.
Should we rely on WhatsUp University for these conclusions?

References:

Interesting read on Autopsy findings in COVID-19 from Dr. Sanjay Mukhopadhyay, Director of Pulmonary Pathology at the Cleveland Clinic. https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/
https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922
The above can also be accessed from https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

I am also including the full text of the “False Autopsy Finding of 50 cases” below along with my comments in parenthesis

Full text of the Unsubstantiated (Possibly false) WhatsUp University version (author anonymous).

Thanks to 50 autopsies carried out on patients who died from COVID-19, they found that it is NOT PNEUMONIA, strictly speaking, because the virus does not kill pneumocytes of its type only but uses an inflammatory storm to create an endothelial vascular thrombosis, with the corresponding diffuse thrombosis the lung is the most affected because it is the most inflamed, but also, it produces a heart attack or stroke, and many other thrombotic diseases. Infact the protocols have left the useless antiviral therapies and have concentrated on the inflammatory and anti-clotting. (Ideally, gross findings are shared substantiated by microscopic finding, not the pathophysiology or mechanism)

These therapies must be done immediately, even at home, where the treatment responds very well to the patients. Later they are less effective. In resuscitation, they are almost useless. If the Chinese had reported it, they would have invested in-home therapy, not Intensive Care! It is a case of DISSEMINATED INTRAVASCUAL COAGUALATION THROMBOSIS (see the spelling, this is typical of WhatsUp University). So, the way to combat it is with antibiotics, anti-inflammatories and anticoagulates. (Not sure if we subscribe to antibiotics in the absence of bacterial infection, a report from New Orleans emphasizes that there was no bacterial infection).

An Italian anatomical pathologist reports that the Pergamo (I never visited Italy so I searched for Pergamo, I found no Pergamo City, but one as Bergami, Milan) hospital made a total of 50 autopsies, Milan 20; the Chinese have only made 3, which seems to fully confirm the information. Success is determined by a disseminated intravascular coagulation activated by the virus, so interstitial pneumonia would have nothing to do with this, it would have been just a big diagnostic error. In retrospect, I have to rethink these chest radiographs that were discussed a month ago as interstitial pneumonia, it could actually be fully consistent with a disseminated interstitial coagulation DICA (earlier, I shared a report of the different CT findings in COVID, those images can be reviewed by clicking the links).

People go to ICUs for thrombus, generalized venous embolism; generally, lupus. If this were the case, intubations and resuscitations would be useless if thromboembolism is not resolved first. Ventilating a lung where blood does not reach is useless. In fact, nine out of ten die because the problem is cardiovascular not respiratory. It is venous micro-thrombosis and not pneumonia that determines mortality.

Why do thrombi form? Because inflammation according to the school text induces thrombosis through a complex but well-known pathophysiological mechanism. So what the scientific literature said especially from China until the middle of March was that anti-inflammatories should not be used. Now the therapy that is being used in Italy is with anti-inflammatories and antibiotics as in influenzas, and the number of hospitalized patients has been reduced. Many deaths even in their 40s had a history of fever for 10 to 15 days, which were not adequately treated here (the history is intentionally purported to mimic COVID, check the spellings, a scientific report goes through spell check, a WhatsUp University report does not) the readers to believe this is COVID-19). The inflammation destroyed everything and created the ground for the formation of thrombi, because the main problem is not the virus, but the immune reaction that destroys the cell where the virus enters. In fact, patients with rheumatoid arthritis have never been admitted to the covid departments, because they are on cortisone therapy, which is a great anti-inflammatory. That is the main reason why hospitalizations in Italy are decreasing and it is becoming a treatable disease at home. By treating it well at home, not only hospitalization is avoided but also the risk of thrombosis. It was not easy to understand, because the signs of micro-embolism have faded even in the echocardiogram.

This weekend the comparison was made of the data of 50 patients between those who breathe badly and those who do not and the situation seems very clear (Once again, to repeat, I saw no such autopsy report of 50 cases on Pubmed Central, or Google Scholar or Google, neither did I see a city by the name of Pergamo).

With this important finding, it would be possible to return to normal life and open the businesses closed by the quarantine, not immediately, but it is time to publish these data so that the health authorities of each country make their respective analysis of this information and avoid more useless deaths and the vaccine may come later.

In Italy, from today the protocols are changing. According to valuable information from Italian pathologists, ventilators and Intensive Care Units are not required. So we must rethink investments to adequately address this disease (Do we want to jump to a conclusion without sufficient evidence?).

References:

Pathological findings of COVID-19 associated with acute respiratory distress syndrome (Link here)

COVID-19 Autopsies, Oklahoma, USA (Link here)

Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans (Click here)

https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922

https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/

Convalescent Serum and COVID-19

The convalescent serum has been used for several diseases since 1890 by Behring initial experiment with Diphtheria. Eventually, the convalescent serum has been used bacterial infections, pertussis, measles, Argentine hemorrhagic fever, influenza, chickenpox, infections by cytomegalovirus, parvovirus B19 and, more recently, Middle East respiratory syndrome coronavirus (MERS-CoV), H1N1 and H5N1 avian flu, and severe acute respiratory infections (SARI) viruses. Suffice it to say, it is as older as vaccination.

Compiled by

Shashank Heda, MD., Dallas, Texas.

Question: The serum could actually be a virus as there have been cases (documented of course) were even recovered patients were spreading the virus.

Answer: You raised a very interesting question. I appreciate your raising this. However, kindly get the references.

Keeping with the intent of dispelling myth and provide confidence to the community, I am making every attempt to provide transparency based on the existing scientific research. Below, I am attaching two excerpts along with their references.

Convalescent blood products (CBP), obtained by collecting whole blood or plasma from a patient who has survived a previous infection and developed humoral immunity against the pathogen responsible for the disease in question, are a possible source of specific antibodies of human origin. The transfusion of CBP is able to neutralize the pathogen and eventually leads to its eradication from the blood circulation. Different CBP has been used to achieve artificially acquired passive immunity: (i) convalescent whole blood (CWB), convalescent plasma (CP) or convalescent serum (CS); (ii) pooled human immunoglobulin (Ig) for intravenous or intramuscular administration; (iii) high-titer human Ig; and (iv) polyclonal or monoclonal antibodies.

== ==

Convalescent Plasma:

In the absence of specific antiviral agents and vaccines for COVID-19, clinical trials have been conducted aimed at investigating the efficacy of convalescent plasma in treating COVID-19. A very recently published study by Chinese researchers confirmed the efficacy of convalescent plasma in controlling SARS-CoV-2 (Table 1) (Roback and Guarner, 2020). The report suggested that COVID-19 patients showed signs of improvement approximately 1 week after convalescent plasma transfusion. Another clinical study involved 10 critically ill patients infected with COVID-19 from 3 different hospitals in Wuhan suggested high-titer convalescent plasma transfusion can effectively neutralize SARS-CoV-2, leading to impeded inflammatory responses and improved symptom conditions without severe adverse events. All 10 patients receiving convalescent plasma transfusion showed improvement of clinical outcomes or were cured and discharged from the hospital (Duan et al., 2020). Given the clinical effectiveness of convalescent plasma, the FDA has granted clinical permission for applying convalescent plasma to the treatment of critically ill COVID-19 patients (FDA, 2020).

Convalescent plasma collected from donors who have survived an infectious disease by producing protective antibodies is considered to provide a great degree of protection for recipients affected by the emerging virus (Dodd, 2012). Convalescent plasma has been successfully employed to treat numerous infectious diseases, including the 2003 SARS-CoV-1 epidemic, 2009-2010 H1N1 influenza virus pandemic, and 2012 MERS-CoV epidemic (Dodd, 2012, Hung et al., 2011, Mair-Jenkins et al., 2015), for which modern medicine has no specific effective treatment.

Mayo Clinic named national site for Convalescent Plasma Expanded Access Program

https://www.sciencedirect.com/science/article/pii/S0889159120305894?via%3Dihub.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175848/

https://jamanetwork.com/journals/jama/fullarticle/2763983

Mayo Clinic named national site for Convalescent Plasma Expanded Access Program

https://jamanetwork.com/journals/jama/fullarticle/2763983

Civic Liberty and Public Health

The US is the most affected country bearing 32% of global (COVID-19) disease burden. A prominent influencing factor is the fundamental percept of individual freedom, as enshrined in the constitution and supported with the first amendment. Across the US, people are protesting about the compromise of personal freedom with the Stay at Home orders. Coronavirus has challenged all frontiers of humanity, its evolution and exposed our fault lines, irrespective of the countries, economies, ethnicities, ideologies, and our model of governance.

Civic liberty or public health – How do we achieve the right balance? Finally, balance also has a context and background. While there is a tendency on part of the state to erode individual freedom, the situation with Coronavirus is obvious. The inability to impose restrictions will definitely compromise the health of the society and ultimately the individual. In fact, not doing so will abrogate the state’s duties of providing safety for the individual. The scientific principle that underlines the “flatten the Curve” is provided along with a link to the international tracker of individual freedom across the globe. Also, expert opinion from Human Rights Experts and Legal Expert from Brooking, Harvard, University of Chicago, and Columbia University is cited in my blog. Realtime R(not) factor can be tracked for your county from the link provided herein.

What is compromised? What is indispensable?

COVID has opened a dialectical discussion on individual freedom and individual freedom that can harm the wider community. Freedom of movement is enshrined in the first amendment. To a few, these are considered at odds with each other. However, it’s a matter of perception. In the case of COVID-19, the common good outweigh individual freedoms.

When can we consider individual freedom compromised?

Ideally, we can consider that individual freedom is compromised if it results in (1) enhanced surveillance powers that compromise privacy (as in China, drones, cameras, and Bluetooth trackers) (2) suspension of rights, (3) control over information; and (4) delayed elections.

None of these are used here in the US. So, it is wrong to construe that freedom is compromised. More so, the federal government has declared an emergency. Nancy Gertner, a senior lecturer on law and a retired federal judge, says that the types of surveillance measures lately used in South Korea might even be feasible here, if somewhat less likely. “The issue is whether the measures are proportionate with the purpose. Since this is a public health emergency, we’re not dealing with the usual rules and regulations.”

Testing and stepwise removal of the restriction to movement

Therefore, restrictions could ease once widespread testing for the virus becomes available. Once the Govt. ramps up the testing, then you can dovetail the precautions according to who’s vulnerable. If you’ve got no idea, you quarantine everybody. But if you can test widely you can also titrate the response. However, it worth noting that, RNA testing and not testing the antibodies, is important. Thus sensitivity and specificity of a test become important. Sensitivity is used for screening, whereas, specificity is used for diagnosis. in case of Corona, we can’t wait for the antibodies to develop since those take time to develop after the infection and before the antibodies become evident, the person is infective (even if asymptomatic) and can potentially shed the viruses. Thus, personally, I am averse to antibody testing for screening, though the opposite is currently practiced.

Lesser restrictions in favor of more fundamental freedoms is more a policy concern rather than a matter of law. Temporarily accepting lesser freedoms for the good of the country and the wider population, in general, is acceptable in order to regain fundamental freedoms of movement more quickly and permanently our, to earn a living, and to attend events and gatherings. Protests such as these are uncalled for since we don’t need proof to weigh the cost versus benefits.

How best to mitigate the concern?

Freedom of movement, due to Lockdown secondary to COVID-19, should be tied to the growing, declining curve of the infection and or testing. It cannot be blanket freedom for the entire nations. States, Counties, and Cities are displaying a distinct pattern. Those which are on the rising side of the curve, also called hotspots, should definitely have “Stay at Home” Order. Those on the declining part of the curve should be tallied with the R(not) factor (explained later). and if the R(not) is declining below one, then we should consider the removal of restrictions.

While the outcry for compromise of individual freedom is healthy, a governance and policy framework to monitor and remove the temporary restrictions on individual freedom should be tracked, monitored, and reported to provide transparency.

Citations

https://jamanetwork.com/journals/jama/fullarticle/2761556?widget=personalizedcontent&previousarticle=2764283

New restrictions on civil liberties during coronavirus

Freedom and privacy in the time of coronavirus

COVID-19 Civic Freedom Tracker: https://www.icnl.org/covid19tracker/

https://news.uchicago.edu/story/fight-against-covid-19-how-much-freedom-are-you-willing-give

https://www.cjr.org/analysis/coronavirus-press-freedom-crackdown.php

Tracking Realtime R(not) factor https://rt.live/

Facts will unravel the truth

Facts alone pave the way for unraveling the truth

The US alone contributes to 29% of the global burden of COVID-19 positive cases. As against, the US, India has a paltry 0.5%. I liked PM Modi’s lockdown, despite the criticism. Any crisis moment is likely to have its collateral damage. However, a leader has to weigh the big picture and make the right decisions at the right moment. I am not a great fan of PM Modi but let us not be partisan at such critical times. Figures talk, and they talk a lot. You cannot hide those in a country like India. If the lockdown persists for another 3 weeks, India would have controlled the giant virus adorably!

Various schools of thought are rife with speculation. Some think Indians have a healthy immunity, while data from the UK points towards a specific predilection for the Asian Indian population. From the get-go, I (Shashank Heda) have been holding a grouse against China (not the Chinese ethnicity) that they have tried a more diminutive and (an unknowingly an attenuated strain) against India. Given India’s porous borders and the uncontrolled travel and social interaction, it is possible that India was already infected with a milder version sometimes back, and now Indians have an immune response to some of those Spike proteins or possibly the hemagglutinins. Time alone will reveal the telltale genetic fingerprinting and the genesis of this virus.

In the interim, it is definitely not the time to drop the guards. Let us educate our folks for –

Social distancing (no social/community/outdoor activities)
Isolation and shelter at home
Masks and decontamination precautions

Most important, they need to remember to

destress themselves,
implement a balanced life,
keep active and connected and
sleep well.

They need to be reminded that, they are not alone, 40% of the global population is going through the same routine.

Excerpts from BBC below –

“Our [infection] growth rate is highly contained although we are actively chasing the fire,” she told me. “Almost all of our testing has been driven by protocol, starting with people with travel history, contact tracing of people in touch with them and so on. The probability of getting more positive cases [from this cohort] would have been much higher.” Many are also pointing to the lack of reports about any surge in hospital admissions with influenza like illness and Covid-19 patients, which would hint at a rapid community transmission.

https://www.bbc.com/news/world-asia-india-52265061

Herd Immunity

Anthony Fauci, the well-known face of CDC, says that it is unlikely the coronavirus will ever be eradicated, though nations can bring the level of infection down to “low levels.”

According to Dr. Fauci, a combination of three-pronged strategy will provide a cautiously optimistic to control the COVID-19 menace. The three-pronged collective strategy should consist of

1. Good public health measures,
2. Degree of global herd immunity and
3. Good vaccine

What are the failures? Well, those are intrinsic inabilities. It is the collective callousness that is resulting in a raging fire of COVID-19. Faultlines differ, however, our ineptitude and complacency are primarily the cause. We are thoroughly bored in the confines of our homes, or for some, it is personal freedom, and for others, the virus is a hoax and far less believe, they are invincible, not realizing that they are the source of transmission (Carrier) of infection to unsuspecting innocents who face the morbid consequences or mortal end.

A raging debate is ongoing on Herd Immunity versus isolation. While herd immunity has been a de-facto nature’s standard for protecting the masses or herd, (not necessarily human alone), Coronavirus (SARS CoV2) has thrown this natural principle into question for several reasons –

1) It is new and has high mortality and morbidity due to its properties
2) we have no innate defense against it
3) Even the most highly industrialized nations have no capacity to accommodate sick patients.

Let us review the factors why we should not YET resort to Herd Immunity. Before getting started, let us see a live example of herd immunity being practiced to counter Covid-19. Let’s visit Sweden (Updated May 4, 2020).

“Herd immunity,” in which a critical mass of infection occurs in lower-risk populations that ultimately thwarts transmission. “relies more on calibrated precautions and isolating only the most vulnerable than on imposing a full lockdown.”

Excerpts from CNBC August 2020 –

“According to epidemiologists, herd immunity is necessary to contain a virus and is reached when enough of the population is either vaccinated or survive infection and build antibodies to ward of new infections. The virus then doesn’t have enough hosts to infect.

Most scientists think 60% to 80% of the population needs to be vaccinated or have natural antibodies to achieve herd immunity, Dr. Mike Ryan, executive director of the World Health Organization’s health emergencies program, said last month. ” from CNBC August 11, 2020.

I am strongly convinced for Herd Immunity because that’s the only mechanism for mass protection at the lowest cost (understanding the collateral damage). Herd Immunity, should not be construed with the development of commensals, or symbiosis between the bugs and the host. Of note, let us understand the process of herd immunity and commensal development from an evolutionary basis. For these bugs (those existing in GI tract) the external environment is harsh and toxic. They cannot exist outside and so have taken refuge inside the host. Eventually, the host and the bugs take a symbiotic relationship or often, at least don’t harm the host unless in rare circumstances. Summarize to say that there is no evolutionary angle to this novel coronavirus. It is de-novo, not an adaptive organism.

Herd Immunity and Vaccination

Second, from the perspective of spreading immunity – understand that the collateral damage it may cause is irrespective of the value of the individual. At a theosophical and spiritual level, who are we to decide a 78-year-old should die or survive? We only have to create a judicious system to protect if we know the risk is higher in this population.

Biologically and from the perspective of Epidemiology, Herd Immunity, especially as it plays from a vaccine perspective, offers lesser chance unless a vaccine is introduced. It provides better protection when a vaccine is introduced in the population. They both have a synergistic effect. In fact, the lesser a population is vaccinated, the lesser the herd immunity phenomenon.

Despite, not knowing this Coronavirus ever existed, I strongly feel that Herd Immunity is best for general mass protection if the morbidity, as well as the mortality, are low and this is considering the varying Rho factors for various bugs.

UK and Sweden tried Herd Immunity and failed. In a partial sense, the US unknowingly imposed the principle of herd immunity (by not imposing the lockdown) and paid the cost. Today, the UK, the US, and Scandinavian countries all are reversing their stand on herd immunity. This is because of the grim reality of 20000 plus deaths in the US and several thousand deaths in the UK. Those sticking to Herd Immunity have taken a heavy toll because –

This is a new virus (as against the others which evolve) whose least quantity infects (S protein configuration, antiviral suppression, and cytokine storm)
There mortality and morbidity significantly high for the state to prepare and manage this huge tide.

Excerpts from Kevin Kavanaugh from the link cited below –

“Mitigation strategies can decrease a contagion’s R0. To decrease the total number of individuals with active infections, the R0 will have to be less than one. So, on average, each infected person spreads the virus to less than one person. When this happens, the epidemic will eventually burn out.

Herd immunity strategies rely on a significant portion of the population to become immune to stop the spread of the virus. The higher the R0, the larger the percentage of the population who must become immune before the total number of those with active infections decreases and the epidemic burns out. An R0 of 5 to 7 will require 80% to 85% of the population to become immune before the number of infected will start to decrease. Thus, it can be argued that without mitigation, the R0 will be far too high to be able to stop this epidemic with herd immunity. Almost all of the population would have to contract the infection before the epidemic would stop, which probably will not happen. The availability of a vaccine to prevent infections with pathogens having a high R0 is of utmost importance.

Other concerns are that immunity to coronaviruses which cause the common cold only lasts between 1 to 2 years and there is mounting evidence that cats and dogs may become infected, giving concerns of an animal host.

Thus, without a vaccine, this virus will be with us for some time. Herd immunity may slow the expanse of the epidemic, but it is not likely to meaningfully stop it without mitigation strategies. And there is significant concern that those who currently recover could be re-infected in the near future. Strategies of social distancing, not gathering in large crowds, wearing masks and protecting those at increased risk are required to manage this epidemic.Returning to life as usual with the dependence on herd immunity in a non-vaccinated population to control spread is almost certainly a false narrative”.

Thus, I feel, our ultimate recourse is our own defense – innate and adaptive complimented by herd immunity. The only reason, we are not resorting to herd immunity exclusively is because of the morbidity and mortality associated with this virus.

Citations:

https://www.nationalreview.com/2020/05/coronavirus-crisis-sweden-refused-lockdown-other-countries-following/ (Updated May 4, 2020)

https://www.infectioncontroltoday.com/covid-19/viewpoint-have-you-heard-about-herd-its-covid-19-fallacy (Kevin Kavanagh)

https://www.historyofvaccines.org/content/herd-immunity-0 (Animation)

https://www.aap.org/en-us/aap-voices/Pages/It-Takes-a-Herd.aspx (A simple scientific version)

https://www.technologyreview.com/2020/03/17/905244/what-is-herd-immunity-and-can-it-stop-the-coronavirus/

https://watermark.silverchair.com/cir007.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlIwggJOBgkqhkiG9w0BBwagggI_MIICOwIBADCCAjQGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM2OVG8xg2pfYzNM-QAgEQgIICBSi7ifrpZhiYGndgs3xVawidKzRobUyILH54jTeTTCVvKXxKjfGTstEXY_TVc27do_oKohDgo0nlz3sEmDDDyXdf08bkvBxpUii7mooK0y4Cuonz8aMhK7uIcSVRndSJMKxsIbyrpXVSlgjnaCC387cZvR4qtxWfBcQqadTp1SmLZjw2qFgFm-w6W5Z6lzhNeAo9T4z-I9fVbPBPIlHS5ja0OrR19tlb7-bqbhxSlHujS0BnE5vGEjkB3yukP_2fTAR-2tir3Kje3j0Ae8jjDw2jV2AcCxjCxI6d-AdHTOKaB0JDka3AtdPccwhK-aHmteNLQCqnf9LAPbKHp075g79itw-qyLDc2ymz3IQg5lAWgKu1KO_vMkbCwkdr0Mx196-Rta8ssMWA7BxYySK2_hzcXcNicgsyy63sjXK6VHTy5UZNgSOw_F80rslfOgrCeP_yU-lFkMXB0Ll_2PRTXV5npNHbi0CwP0C-2oaGBpAUKeLycCOIDphV7F7bKQSlaKW4kgRf-XH3bqtsjnezQWGk2NllH4l_ErIujEUBev0hTMAaTPTIEMXc6OO429S6zwpF8JHpzdsmPLDXypaadLjseQk3Goikt2WmOKQB50WdqkYMYSWlcO2SUxMDA7_HZi_SkZhRPIigFE9Ocgo23y5UxAjHk3C6k5HRTbN0mQSmmKEA4Ag

Click to access f26ca43be04880eaf4ad046a1f9408cb2e11.pdf

https://www.sciencedirect.com/science/article/pii/S1074761320301709

Absolute Isolation Works Absolutely

As of this writing the total deaths in the US have mounted to 10,335. Never before mankind had seen such a fast moving, swiping infection. We knew Ebola, we knew Marburg viruses, and a few Prion diseases but collectively, we had never faced such a dreaded disease with high mortality. We were caught almost unprepared or at least we ignored with complacency. I have shared my thought on why isolation is important to contain this disease and how countries like Singapore, South Korea and japan are dealing planning isolation and intelligence in dealing with this crisis.

Absolute Isolation Works Absolutely

As noted in my earlier blog, viruses are obligate parasites that need (MUST) a host cell to survive. They go through their phases of replication and eventually, after not getting proper host cells to infect, die a natural death.

I have had many folks across the geographies asking me a few questions?

Why is the incidence of Coronovirus so high in the US?
Are certain ethnicities (such as Indians) immune to the Coronavirus?

I will emphasize the control of Coronavirus based on the viruses’ obligate dependence on live cells for survival. We all know that if we practice Isolation absolutely, we should be assured of not having the disease.

Two situations preclude our ability for Isolation –

Our needs for Essentials
Fundamental Sense of Liberty

I owe you all a clear and concise write up on the best practices and pragmatic guidelines on “How to Manage Essentials” giving an end to end perspective, that provides the best way to avoid getting the virus inside your home. Give me until later this late evening to fulfill that commitment.

Let us talk about the “Sense of Liberty”. The US, the EU, and most developed nations have an enshrined fundamental Right of liberty to move. Isolation or ‘Shelter in Place’ equals to ‘House Arrest’ for them. The later nullifies isolation and thus provides a continuation of the propagation of the virus by allowing it to jump from people to people (aerosol, airborne, contact and fomites).

Special intervention in community level

So after the rise of an emerging disease, goverments have a special responsibility to balance between civil liberties and special measures for protecting susceptible populations. However, three components of “scientific“, “voluntary” and civil liberty should be considered as guiding principles for decision-making and operating each special protective measure at the community level (cited).

Aerosols Airborne Fomites

I see a dichotomy based on the above two practical limitations that are increasing the spread of Coronavirus in the US. Select countries like India and Japan are strongly considering the imposition of emergency. Whereas, many have implemented strict isolation even if the idea of isolation has emerged from behind the Iron Curtain of China.

The Bhilwara Model

The Bhilwara Model for containment of COVID-19 refers to imposing a curfew in the district including suspension of essential services, extensive screening, and house-to-house surveys to check for possible cases, and detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected. A similar model was followed in Singapore, South Korea, and Taiwan. Singapore had gone a step ahead and deployed its intelligence sleuths to extract the contact tracing, whereas, the draconian Chinese Govt deployed Bluetooth tracing abandoning the privacy laws (they do not exist in China, except while the couple is conjugating, I believe!).

The success of the Bhilwara model is attributed to controlling an outbreak within the first four days of the initial incidence (remember the Rho factor.

Absolute isolation works absolutely. Yes, it does but can we forego our sense of liberty? Can we minimize our needs and limit our consumption? Please visit my next blog on “Managing the Essentials”.

Also read – Support your service folks (maids, handyman, lawnmowers etc.) https://mymilieu.org/2020/04/02/supporting-service-folks-during-crisis/

Why is Coronavirus highly infective? https://wp.me/p7XEWW-1go

Additional Reading:

How do I know if I have a Coronavirus infection? Before reading further, I strongly advise and recommend that this should not be construed as advice. Your best recourse is your doctor or health care professional.

Doctors in China used a triage system for fast screening. This was published in the Lancet. Below flowchart from the Lancet.

COVID Symptoms Flowchart Lancet JPEG

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117787/

. 2020; 8(1): e41.

Published online 2020 Apr 1.

PMCID: PMC7117787

Epidemiological and Clinical Aspects of COVID-19; a Narrative Review

WHY is COVID-19 HIGHLY INFECTIVE?

The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction).

Keeping my promise of sharing ACTIONABLE INFORMATION, let me start with why COVID is so infectious.

Airborne Dispersal

MOSTLY, if not ALWAYS INFECTION: After exposure to COVID-19 (Highly Infective). The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction). Visit this Youtube for learning the virus replication. https://www.youtube.com/watch?v=J4BN4dARpio

What do I do as a common man?

Isolation (lockdown), using masks and following all CDC, WHO, NIH, State, and Local guidelines. Build a staging area outside the home, do not get the virus inside the home. All essentials should be cleaned appropriately before those get ingress into your home. Presume everything from outside is contaminated until cleaned.

2) Lysogenic phase: Breaking the cells after making thousands of copies (lysogenic phase). Please visit https://www.youtube.com/watch?v=sQ0ShukSA5I.

What do I do as a common man?

Clean after contamination. I follow the below steps – outer clothes removed in the Garage and set for laundry immediately, shower with soap/shampoo, nose blow, and peroxide gargles. The last two steps remove any adhered viruses from inside the nose and throat.

3) Early Symptoms: Step 1 follows in thousands of new normal respiratory cells. Fever, Nasal Congestion, loss of smell (because the olfactory cells are affected). Cells start producing exudate (copious secretions).

What do I do as a common man?

Get tested and isolate from other caregivers from the family and friends. Stay isolated (if mild symptoms and or test positive) until results are available or at the least 15 days after the lasts symptoms. If required, seek immediate help. DO NOT SELF MANAGE (explanation later).

4) Initial Phase of Lung Congestion: The virus travels inside to the Lungs and infects the respiratory lining cells. Visit the below video to learn more https://www.youtube.com/watch?v=4HPlSm94czk. Also, see https://www.youtube.com/watch?v=Xj1nUFFVK1E.

5) Cytokine Storm: Huge secretion of fluids (doctors call this as Cytokine Storm) blocking oxygen exchange. Ventilators are required to support oxygenation. However, I have had first-hand reports that it is painful to watch patients struggling to breathe even on ventilators.

What do I do as a common man?

Seek early help, Please do not self-treat? Why – You may have a sudden catastrophic fluid collection in the lungs. What else do I do? Of course isolation and other guidelines to be used as required)

6) Acute Respiratory Distress Syndrome and Mortality/Morbidity: This is the most dreaded step.

What do I do as a common man? Be careful at the initial steps (1-3) (Shashank Heda, MD).

COVID19 Local Statistics

Rule of Thumb –

Folks, my neighbor taught me one simple rule of thumb – What is essential? Can I survive without this? If I can, then it is not essential.

Can we – STRINGENTLY FOLLOW THIS?

ISOLATION (LOCKDOWN)
PROPER DECONTAMINATION
EARLY PROFESSIONAL HELP
SPREADING AWARENESS (ask questions if required)
SUPPORT SERVICE FOLKS
No COMPLACENCY (THAT I HAVE BETTER IMMUNE SYSTEM THAN OTHERS)

Stay Safe!

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Based on the latest research from Nature and Cell BioSciences and analyzing the data (first hand) from Texas, I see it important to be all the stricter with isolation. Let me take a few issues individually.

Why SARS-CoV2 (COVID-19) is so dangerous?

Primarily because of the

1) Ridge on the S protein that allows it for tighter binding to the ACE2 receptor on the human cell
2) Suppression of antiviral immune response and
3) Concurrent activation of the pro-inflammatory response
Simply speaking – SARS-CoV2’s S protein (Spike protein) after binding with the ACE2 receptor on the human cell, changes its conformation to and goes into a tight affinity, primarily because of the ridge present on the S protein. That makes the SARS-CoV2 very infectious. Now, add to that, the florid inflammatory exudate (cytokine storm) and you get a double whammy. SARS-CoV is known to be exceedingly potent in the suppression of antiviral immunity and the activation of proinflammatory response.

Researchers are working to block the affinity of S protein or reduce the affinity. Another direction for research is controlling the cytokine storm. Our Milind is working on the Stellate Ganglion Block. You should bring him back here to ask more about them later.

Excerpt from Nature below (citations removed, reference link included) – A key to tackling this epidemic is to understand the virus’s receptor recognition mechanism, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor – human ACE2 (hACE2). SARS-CoV-2 receptor-binding domain (RBD) (engineered to facilitate crystallization) in complex with hACE2. Compared with the SARS-CoV RBD, a hACE2-binding ridge in SARS-CoV-2 RBD takes a more compact conformation; moreover, several residue changes in SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD/hACE2 interface. These structural features of SARS-CoV-2 RBD enhance its hACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus closely related to SARS-CoV-2, also uses hACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV, and RaTG13 in hACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies targeting receptor recognition by SARS-CoV-2.

(Simplified – @ Shashank )

https://www.nature.com/articles/s41586-020-2179-y

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074995/

The origins of SARS-CoV-2 and COVID-19. To make a long story short, two parental viruses of SARS-CoV-2 have now been identified. The first one is bat coronavirus RaTG13 found in Rhinolophus affinis from Yunnan Province and it shares 96.2% overall genome sequence identity with SARS-CoV-2 [3]. However, RaTG13 might not be the immediate ancestor of SARS-CoV-2 because it is not predicted to use the same ACE2 receptor used by SARS-CoV-2 due to sequence divergence in the receptor-binding domain sharing 89% identity in amino acid sequence with that of SARS-CoV-2. The second one is a group of betacoronaviruses found in the endangered species of small mammals known as pangolins [4], which are often consumed as a source of meat in southern China. They share about 90% overall nucleotide sequence identity with SARS-CoV-2 but carries a receptor-binding domain predicted to interact with ACE2 and sharing 97.4% identity in amino acid sequence with that of SARS-CoV-2. They are closely related to both SARS-CoV-2 and RaTG13, but apparently they are unlikely the immediate ancestor of SARS-CoV-2 in view of the sequence divergence over the whole genome. Many hypotheses involving recombination, convergence and adaptation have been put forward to suggest a probable evolutionary pathway for SARS-CoV-2, but none is supported by direct evidence. The jury is still out as to what animals might serve as reservoir and intermediate hosts of SARS-CoV-2. Although Huanan seafood wholesale market was suggested as the original source of SARS-CoV-2 and COVID-19, there is evidence for the involvement of other wild animal markets in Wuhan. In addition, the possibility for a human superspreader in the Huanan market has not been excluded. Further investigations are required to shed light on the origins of SARS-CoV-2 and COVID-19

Supporting Service Folks during Crisis

We all have lawnmowers, handyman, maids, and others working with us regularly. During this COVID-19 crisis, all have a significant reduction in their work or most like you, are lockdown. It is frustratingly painful to run families during such times.

Service Support

Unfortunately institutionalizing any charitable donations in the US, suck up 80% of the revenue for their operations and maintenance. So, after giving a thought, I realized, the best way is to support our service folks directly, rather than any institutional donation. My best suggestion would be to support your folks. On the contrary, my support on the farm was busy with work to take care of him. I did not offer anything to him since he is already on the job.

Recently, I unconditionally paid money to my handyman and maid. Both were extremely thankful. My handyman just moved to Georgia and he was broke. It came at the best time. Our maid has to run a family of 3 kids as a single mom. She was extremely thankful. Both offered to work after this is over. However, I made no conditions for this support. Though I did not promise, I will do a similar amount in the next 2-3 weeks.

If you haven’t done it, now is the time to think of supporting, little in your own way. Let us support them to support their families. Indirectly, it helps the economy keep going.