Shades of Gray

Interrelated phenomenon Shades of Gray – Gene Manipulation to establish hegemony, Drug Hoarding and Vaccine Nationalism,

It is understandable, the US started vaccine and drug hoarding, contrary to the principles of humanitarian values and ethics. Hegemony and lack of transparency from China and other power are adding towards a heady mix. This initiated a sense of self.

However, scientific pursuit falls within the realms of humanitarian traits, it is not nation-specific, or unique to any ethnicity, and definitely not the fiefdom or expertise of any ideology or religion.

Having said this, despite the attitude of select countries, we should keep humanity and altruism as our highest pursuits and avoid getting muddled in the politics of nationalism, ethnicity, ideology, or religion.

Every country should attempt in advancing science, however, we should not succumb to vaccine nation, drug hoarding, or manipulating the genome of the wild viruses and or bacteria for usurping our hegemony to advance our nationalistic endeavors. We all know, Science is a double-edged sword, used rightly will lead to evolution, and unlikely use to destruction.

Dr. Shashank Heda,
Dallas, Texas

Stay Safe! It’s a cliche!

The tidal second wave of Coronavirus is surging across the globe. What went wrong? Was easing the lockdown a wrong decision? or was it our inadequacy to understand the virus behavior? Can we understand what went wrong? We each define the microcosm of the society and we contribute towards the spread via our Social Bubble or contain the Spread with our responsible behavior.

I have captured all the risks factors and how to fix our own behavior during this tidal surge of COVID wave.

Stay safe has become a cliche, like Good morning, bye etc.

Friends, this week has been extremely bothersome as the second wave has been not just huge, not just a tidal wave but a seismic wave, and a tsunami that may overwhelm our healthcare system. Not just in Texas alone, it is across the US mainland, the UK, the EU, China, India, Brazil, Mexico, etc. It is extremely scary.

What went wrong?

First – let us understand some principles of transmission of the virus. Second, let us understand our fallacies. Next, let us understand our social dynamics.

A) Virus Transmission –

A virus multiplies in 100,000 copies in one single day. Almost, one bout of coughing produces 54 million copies, that fly as aerosol and also settle as fomites. Being a tough virus, it survives in the air for almost 3 -5 hours, depending upon the ambient conditions. The warm and humid environment makes it hang around longer. It drifts with the air current or stays suspended without a drifting, with no wind current. The peak is 14 days, thereafter the virus gets neutralized in the patient.

Symptomatic patients are not the only bug spreaders, for every symptomatic patient, we have 10 asymptomatic patients who are spreading the virus. However, for asymptomatic patients, the virus cycle continues for almost 28 days. Unfortunately for us and fortunately for the virus, it is colorless and invisible and since it is invisible, we feel pseudo confidence that we are invincible.

B) Our fallacies –

We presume the virus is not there. That and given our boredom of staying inside makes us extremely prone to catching the infection. We are frustrated staying secluded, within the confines of our four walls. But you are not alone, almost over two billion people on this planet earth are secluded and claustrophobic within the confines of their home. We all know social distancing but I see several families taking a stroll without masks, not knowing that they may be inhaling the virus.

Somewhere, we presume, it is a disease of the elderly. I have seen several case reports of a death within the young and healthy. I have seen case reports of kids suffering immensely from COVID. I have seen elderly parents escaping death. This all points towards one thing – that Science has not yet definitely identified risk factors for mortality and morbidity. Thus the virus behavior remains elusive and erratic. You may get the bug, harbor it and unknowingly, you become a super spreader. I see school kids interacting with each other. How can we ensure that those they are playing with have no disease (asymptomatic carrier)?

Social Bubble – Exactly, this small social network connects us with other tiny bubbles, and this is becoming the route of spread. New Zealand is the first country to realize this and they broke the vicious cycle and almost eradicated the virus. They will, however, get reinjected, once they start air travel though.

Work Bubble – We think, we are acutely dependent on running our family for a livelihood, not realizing that those who are working can become asymptomatic carriers and transmit to vulnerable parents staying with us. Are we so careless? (@Dr. Shashank Heda, for COVIDRxExchange.Org). If we have to essentially step outside for a living, let us live under a different roof, not with those family members who are vulnerable.

What Do We Do?

  1. Strict Social Distancing is not enough, we will be inhaling the bug via several routes.
  2. You all need to suspend all strolls, shopping, and other errands. Let us minimize exposure as much as we can. Can we buy online?
  3. Fomite transmission is deprecated. That means fomites do not pose as much risk as was considered previously. Please visit CDC for the guidance.

Summary: If you have let your guards down, a “new high probability” risk factor that will determine your chance of getting the infection. You can make your choices.

COVID & Spanish Flu – Comparison and Contrast

102 Not out – Approximately 102 years back, the world was ravaged by Spanish Flu (a misnomer) and today, we are reeling under COVID-19. Both pandemics caused significant pandemonium, and share a common pattern. While it is understandable to see an intermittent new ‘human – microbe’ interaction, going awry, the current pandemic has exposed our fault lines and our preparedness after 102 years. It is not about microbes and our immunity, it is a testimony of our (un)evolved human journey or rather stagnation of evolution in the last 102 years.

102 Not Out, provides a succinct comparison and contrast between the Spanish Flu and COVID-19 and a poignant story of our collective failure.

Background

1918-19 – That period must be the one coinciding with your grandparents or great parent’s birth. So, memories are only through archival records. The global toll was almost 50-100 million, whereas the US lost some 685000 people (a very high percentage for the population at that time). India had 5% mortality with over 12 million succumbing to Spanish Flu.

Spanish Flu – What is that?

Is it truly Spanish flu? It started in France and England. However, they both were at war and wanted to keep this covered. However, Spain being neutral, and news being public, it was reported transparently. It is a misnomer to call it Spanish flu. That is derisive, as Spain was neutral during WW I. It was World War I and soldiers were living in overcrowded barracks. It started in Etaples, France in 1916. It will similarly be wrong to construe that it was an element of French warfare because a similar disease was also observed in 1917 at Aldershot, England. Then too, it was commonly thought to have jumped the animal-human borders as pigs and poultry were a mainstay at these hospitals.

It never occurred to them that they would take the Influenza bug along with them while traveling back home. A disease that once was restricted to specific geography quickly became ubiquitous and spread out indiscriminately. As John Barry said, in New York Times, “None alone provides great protection, but the hope was that if most people followed most of the advice most of the time, the interventions could significantly reduce the spread of the disease, or “flatten the curve,” a phrase now all too familiar. This may sound simple, but it is not. As with a diet, people know what to eat but often stray; here straying can kill”.

3D_Influenza_transparent_key_pieslice_med

(Picture Credit – CDC illustration on influenza virus. Influenza A viruses are classified by subtypes based on the properties of their hemagglutinin (H) and neuraminidase (N) surface proteins. There are 18 different HA subtypes and 11 different NA subtypes. Subtypes are named by combining the H and N numbers – e.g., A(H1N1), A(H3N2). Click on the image to enlarge the picture).

It almost engulfed an entire then connected globe. However, the definition of connectedness, which was ignored then and which is ignored now too, is common to both the Spanish Flu and COVID-19. An estimated 500 million people worldwide were affected. It was a rudimentary period in the evolution of medicine and of course, there were no vaccines or medicines to treat the patients. The findings were, as usual, generally, healthy young adults succumbed to the illness, contrary to most diseases that took the life of the young and old. Today, we call this onslaught of infection against those with a mature immune system as Cytokine Storm. Then, we only knew it killed the young. Then too, people used hand washing, isolation, masks, avoiding public places, and quarantining those ill/suspected ill. It ravaged the economy and disrupted public life, basic civic services like garbage clean up, and postal delivery government services etc. were compromised. There was no one to cremate dead bodies; garbage was flying astray across the streets, no one to light neither lamp posts nor sufficient people to deliver the mail. City offices started digging mass graves, closed schools, public places including theaters. The truth was not transparent, trust in authorities deprecated. Then too, there was a lurking fear that ““civilization could easily disappear from the face of the earth.” Reopening then was marked by a rebound in cases.

Rebound after Reopening

Spanish Flu Rebound

In its intense and acute form, the malady lasted for almost 15 months, from the spring of 1918 to the summer of 1919. It is said that this pandemic Flu almost killed 50-100 million people. Today, we call that Influenza A or H1N1 flu. H1N1 kept lingering, again due to mutations, for 38 years until it was controlled with specific therapies.

Antigenic Shift versus Antigenic Drift

Influenza A and B, each has 8 genes and a variation keeps happening to make a combination each year. As investigations reveal, the 1918 pandemic started with an H1N1 strain, that kept mutating. At this moment, it is wise to understand the meaning of H and N, H stands for those proteins which are required to latch on the cell (inside) and release themselves (N proteins) when mature to infect other cells. This protein structure keeps changing slightly, called antigenic drift. Sometimes, the virus mutates significantly with major changes in the structure of the H and N proteins, called an Antigenic shift.

fcimb-08-00343-g0001

Fast Forward 2019-20 – Comparison and Contrast

It is commonly accepted believe that SARS CoV2 jumped the animal-human barrier. It too spread out from densely populated places. Like COVID-19, it took the world by surprise. No one anticipated that the global burden of death would be over 250, 000 in just 4 months. Then, there was no medicine and here again, we have no specific remedy. The mechanism of death was the same, cytokine storm prevailed then and it is reigning now. It took away the young healthy adults then, however, it is incapacitating for those young adults now, though the mortality is very high in the elderly. Then too, we used masks, isolation, and barrier protection, which we see as the mainstay of stopping the virus within the communities. We call it social distancing, back then, they called it crowding control.

What have we learned?

We see a commonality in the pattern. The biological behavior of the bugs is not changeable. The human response was almost the same. We respond exactly the same way how we responded then. We distanced from each other, we realized, it was spreading through our breath and mouth, so we used masks in 1918 and again, we are using masks. Is there anything wrong with this?

Quotable quotes from Christopher Nichols, Associate Professor of History at Oregon State University –

“The questions they asked then are the questions being asked now,”

“And while it’s very rare that history provides a simple straightforward lesson for the present, this is one of those instances. The Spanish flu tells us that social distancing works. And it works best if we act early, act fast and stick together — and base our decisions not on social or economic concerns, but on science and data and facts.”

References:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/
https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.html
https://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4
https://www.cdc.gov/flu/about/viruses/types.htm
https://www.cdc.gov/flu/about/viruses/change.htm

 

https://interactives.nejm.org/iv/playlist/index.html?media_id=siCcYW3U&pcs=sidebar

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.htmlhttps://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4https://www.cdc.gov/flu/about/viruses/types.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/https://www.nytimes.com/2020/03/17/opinion/coronavirus-1918-spanish-flu.htmlhttps://www.webmd.com/lung/news/20200420/four-lessons-from-the-1918-spanish-flu-pandemic#4https://www.cdc.gov/flu/about/viruses/types.htm

Stopping the Pandemonium from Pandemic

To me, this situation is like a war that is imposed on a country. You don’t want to lose lives whereas, you still have to fight a war. It’s a dilemma, difficult to discern. None of this was anticipated in advance, or rather, most Govt’s. were not aware of these.

Even doctors make a decision based on benefits versus cost. Most planners struggle with this dilemma and much of their decision-making nodes are based on this.

Losing life is not the option but when you factor in those folks who have run out of money and be in their shoes, we realize the hurt and the pathos of daily living. Politicians and Policy makers alike face this challenge. If they ignore, it will end up with rioting, anarchy and add further to the pandemonium created by this pandemic.

Tribal Instinct & COVID

This is the story of two tribes who want to seclude themselves to prevent coronavirus. Irrespective of whether the strategy works, State cannot impose its will on the people. It is interesting to know that the Cheyenne River Sioux Tribe had rejected an ultimatum by South Dakota’s governor to remove checkpoints on state highways within tribal reservations or risk legal action. According the head of the Tribe, the checkpoints are built to save life, not faces.

‘Individual Identity to Protect’

This becomes important for two reasons –

1) The Tribes have a right to their reservations. In an informal sense, they are a country on their own and the will of the state cannot be imposed unilaterally upon the tribal reservations.

2) Proponents of Herd Immunity insists that isolation will deprive the development of resistance to the virus. Isolation, Social Distancing and ‘Shelter-in-Place’, are social mechanism contrary to herd immunity. It is worth noting that absence of herd immunity makes the population vulnerable to further waves of COVID. Whereas, the detractors persists saying that the innate immune arm serves as the logical arm to counter new infections.

I agree, one of the strategies for countering bugs is to make them commensals and coexisting with them. However, this cannot be enforced. When the state decides to impose its will on the minority, it infringes not just on their rights but their existence.

Excerpts from National Geography

Native Americans are especially vulnerable to COVID-19 due to underlying health issues such as diabetes and heart disease, as well as crowded multigenerational homes. On reservations, where roughly half of Native Americans live, not everyone has indoor plumbing or electricity, making it difficult to follow the guidelines to wash hands regularly in hot water. As a result, Navajo Nation, the largest reservation in the United States, has an infection rate nearly as high as that of New York and New Jersey. As of May 11 there have been 102 confirmed deaths.

‘Blood memory’

The indigenous Native Americans from several states have truly bloody memory from the past panemics. Smalpox is an example, during which their tribes lost significant number of natives. Some elderly haven’t yet come to terms with those deaths yet.

When you have social structure that is so intricate, interrelated and interwoven, it is necessary to create checkpoints to isolate. 

Contagion and Contact

History has ample examples of secluded cultures, ethnicities, and congregations being wiped out after interaction with those having an advantage of a wider swath of commensals. If we understand history, we understand the reason for this tribal instinct. If we lose the context of history, an unilaterally impose our will of integration, we will lose them again.

The entire civilization in the Americas was lost to guns and bugs. The Incas, the Mayas, Aztec, and the other smaller tribes. We know how the Spanish conquistador bought plague and other diseases from the then most filthy continent on the face of the earth. Another example is the now reigning tribes in the Amazon. And the most notable are the tribes from the Andaman, an archipelago in the Indian Ocean.

Is it our tribal instinct to expose the entire population to SARS CoV2 better or is there tribal instinct better in safeguarding their cluster and ethnicity?

Shashank Heda,
Dallas, Texas

https://www.nationalgeographic.com/history/2020/05/indigenous-spiritual-leaders-offer-wisdom-during-the-pandemic/

South Dakota governor tells Sioux tribes they have 48 hours to remove Covid-19 checkpoints
https://www.cnn.com/2020/05/09/us/south-dakota-sioux-tribes/index.html

New Hypothesis for Cause of Epidemic among Native Americans, New England, 1616–1619 ; Emerg Infect Dis. 2010 Feb; 16(2): 281–286; John S. Marrcorand John T. Cathey;  doi: 10.3201/eid1602.090276; PMCID: PMC2957993; PMID: 20113559

https://www.nativewellness.com/

Indian mortality in northwestern

2011_vol_2 SAARC Cultures

Prehistoric and Historic Interface

depopulation_of_native_america

‘Catch 22’ with COVID

Covid-19 has pushed us into a situation of ‘Catch 22’, it has exposed the fault lines on several facets on which our modern society, and especially the 21st century, are built. It has questioned the entire edifice of the foundation of humanity, especially as it exists in an integrated global dependent economy.

Covid-19 has pushed us into a situation of ‘Catch 22’, it has exposed the fault lines on several facets on which our modern society, and especially the 21st century, are built. It has questioned the entire edifice of the foundation of humanity, especially as it exists in an integrated global dependent economy.

We have polar perspectives – on one side, we have New Zealand, a small nation, that stopped everything including the virus. New Zealand is not alone state, most smaller well-managed nations were able to thwart the wave of pandemic including Romania, Japan, etc.

On the other end of the polar extreme, we have huge behemoths like the US and China, where despite the controls, the pandemic has been difficult to control.

Of course, economies suffer and to speak the ideal, mankind cannot be restricted to isolation, from itself (social network, families snd friends) and from nature. That has not been, and for millennia has never been the lifestyle irrespective of the civilization. We are definitely in a quagmire, a piquant situation of making a choice, and irrespective of the choice we opt for, we will have to pay collateral value.

That’s why I call it ‘Catch 22’, a situation that has exposed our fault lines.

Planners and politicians are facing this dilemma and resolve but none of our intelligence, native natural or artificial, will help us through this. I remember an important saying by Albert Einstein, that this problem cannot be solved with the same mindset that created it. We have to rise and evolve to a different plane to understand and solve this. (Shashank Heda, Dallas, Texas).

We cannot solve our problems with the same thinking we used when we created them.

Albert Einstein

You may well ask, is this the toughest challenge in the evolution of mankind? Well, I can say with confidence that we as mankind, have evolved through millennia and one thing is clear, this too shall pass.

Every day, I struggle to find, what’s the positive message for today. And I circle back to our inbuilt resilience. How do we strengthen and enhance, visit my next blog on road to resilience during pandemic and stress?

Disseminating COVID Expertise

We started a cross border initiative to share experience, insight, and expertise amongst those who are at the leading edge of managing COVID and those who have recently started seeing a surge in COVID cases.

COVID Rx Exchange:

It is a nonprofit & non-commercial initiative focused on the medical management of COVID patients across the globe. While those on the ground are managing COVID patients, refining, and sharing their experience with practice (guidelines), it is becoming increasingly obvious that the management of COVID needs real-time expertise sharing across political boundaries.

I am a Surgeon, do I need to be part of COVID?

Surgeons too need an understanding of primary and secondary prevention, management, and other clinical scenarios though they are not managing COVID. More so, few surgeons have accepted the mantle of driving COVID Rx Exchange as part of SOCIAL RESPONSIBILITY.

How to be part of the CovidRxExchange?

Please share your email and contact details on the below address. You may join forced discussion groups from your specialty or stay in the general pool and participate in the exchange.

Free Benefits from joining CovidRxExChange.org Slack Group –

1. Free storage of documents (word, pdf, pictures, videos audio, etc) until a limit.
2. Host meetings, audio, or video meeting. Use Zoom or other communication apps for scheduling your own (remote) consultations and exchange records/documents/reports.
3. Create theme/interest-specific groups for a focused discussion
4. Calendarize events and share invites for the meeting
5. Integrate with your Gmail account

I am confident; this will facilitate professional interaction on all medical topics. For a complete description of mission, scope, activities, and values, please visit https://wp.me/p7XEWW-1hj.

Upcoming activities:
• Managing Cardiac Complications with COVID
• Understanding Laboratory Tests for COVID Diagnosis

 

Shashank Heda, MD

Organizer, CovidRxExchange.org
CovidRxExchange@gmail.com

COVID Rx Exchange

We created this group for doctors managing COVID patients. While those on the ground are managing clinical challenges, practice guidelines are being developed, enriched, and enhanced daily. This group is focused on sharing realtime expertise across boundaries during these crises. It is nonprofit & non-commercial.

We are very optimistic about a professional discussion. Please invite your colleagues managing Covid patients. For a complete description please visit https://wp.me/p7XEWW-1hj

Welcome to all those who joined recently using the group’s invite.

We started this collaborative initiative to cross-pollinate experiences and expertise with COVID-19 across the borders. As is obvious, the EU and the US have a maximum toll from COVID-19 and obviously, the body of experience is significant. We wish to transfer the insight gained from these experiences to those where COVID is now on the rise, especially in India, South East Asia, and the Middle East.

Website Picture

Scope of this initiative:

To provide realtime information on –

1) Share actionable information to make decision making
2) Share ancillary medical information
3) Dispel myths and untrue (rumors) wandering on WhatsUp University

Activities:

  • Open and transparent real-time interaction between the members
  • Live Webinars conducted under the aegis of this podium
  • In-person interaction between experts (As far as possible)
  • Sharing of credible Webinars and Information

Accessing the archival information:

A website is being developed for uploading all this information. You will be asked to access via Facebook, Google, or LinkedIn. A link will be updated.

A key need is to have a realtime dialog with those on the ground on either side of the COVID Wave, both the receding and the rising. The intent is to share actionable and supporting ancillary information. SARS CoV2 is a new virus to humanity, is constantly mutating while humanity is unraveling the multitudes of mechanisms involved in the pathophysiology of COVID. This pandemic has driven several intelligent folks across the globe to research and refine the management guidelines regularly.

This is a non-profit, pro-bono initiative where several professionals are investing their time for humanity. We insist on using this podium to use this as an academic and non-commercial, non-promotional intent. Further, with the intent of serving humanity, this initiative is open to all ethnicities, religion, faith, or political boundaries. We ALL are committed to ethics and the highest value of service towards humanity. Last, we request you to share information that is based on scientific evidence and EBM. Professional interaction is an underpinning framework between our interactions. I am confident, you all are equally committed as I in upholding these standards.

Disclaimer:

This portal and associated applications, tools are provided as a voluntary free of charge service for the doctor and medical professionals.  The COVIDRxExchange or COVID-19RxExchange  is not responsible for the opinions and information posted on this site. The COVIDRxExchange or COVID-19RxExchange disclaims all warranties with regard to information posted on this site, whether posted by the COVIDRxExchange or COVID-19RxExchange or any third party; this disclaimer includes all implied warranties of opinion/s, insight, experience, expertise or any other implicit or explicit content for a particular use.

In no event shall the COVIDRxExchange or COVID-19RxExchange be liable for any special, indirect, or consequential damages, or any damages whatsoever resulting from loss of use, data, or profits, arising out of or in connection with the use or performance of any information posted on this site.

No content, in any form should not be construed as advice or recommendation. Doctors or Medical professional should use their judgment and expertise to make their decision while treating their patients. Those treating the patients are solely responsible for the outcome or the results. The professional opinion or expertise shared on this portal, apps, interactions, and links should be considered as the personal opinion of the practitioners. Under no circumstances, will COVIDRxExchange or COVID-19RxExchange take any responsibility for their opinion or insight, and COVIDrxExChange or COVID-19RxExchange will not be responsible for any outcome.

You agree that you have read and agree to the Code of Ethics (as a precondition for the use of this portal, its applications, services and products), as mentioned on the About Page.

​This website has select preprints or links to preprints. Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information. Using any reports, documents, guidelines, standards and best practices is the sole responsibility of the doctor/medical professional using their judgment and expertise. The information available on this portal or the links thereof, should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information.

You agree to these conditions and other conditions that the group may update from time to time. If you do not agree, you may kindly drop out of the group. Your use and or continuation of this group is conditioned to the acceptance of the above conditions. You agree to the terms and conditions for the use of this portal and its associated applications from time to time. You also agree to visit the disclaimer and keep yourself updated. You agree that you will not receive any change made to this disclaimer and it is your sole responsibility to keep yourself updated with any changes. You read and agree to these disclaimer without any preconditions.

Invite to COVID Rx Exchange (below):

Covid19’s management is fast-changing and we need a realtime exchange of experience from experts to cross-pollinate those in high prevalence areas.

I am sharing the invite, please join if you are actively involved in the direct care of Covid19 patients or in a capacity to influence the care or policies. Please forward the invite to your network, especially beyond borders.

Please introduce yourself once you join.

‎Open this link to join the Cross Border Initiative to Manage Covid19 https://chat.whatsapp.com/Ghj5eKt1CoN6bsk4P2TncR

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:

  1. If the author has truly done a study of 50 cases, why has he/she not published this?
  2. Often submissions are accepted as advanced publications subject to review, he/she could have resorted to this option?
  3. The name of the author is Dr. Fikry, a Google search does not indicate any such doctor.
  4. 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.
  5. 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.
  6. Should we rely on WhatsUp University for these conclusions?

References: 

  1. 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/
  2. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922
  3. 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.

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.

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