Stethoscope On Rome: It Is What It Is

Party your way around Manhattan, coronavirus invited!

Stethoscope and French TV

Producers at France 2, France’s largest television network, ran into Stethoscope On Rome and decided they wanted my take on why the Italians have done so well in battling COVID-19. I barely made it into their transmission (bumped by the Minister of Health), dubbed into French and if you blink you’ll miss me. But if you feel like watching 5 minutes of my replies, in English, they’re posted on YouTube.

Treatment update

Convalescent serum (= convalescent plasma): The Mayo Clinic’s giant study has prepublished its first results of the impact of convalescent plasma on COVID-19 mortality, and I find them (and the very similar findings of another, smaller study) very promising. It’s one of the only observational studies I have found convincing despite not being randomized and placebo-controlled – and I really can’t understand why Anthony Fauci disagrees. My reason is their two types of analyses. First: patients who received their plasma infusion within 3 days of being diagnosed were 20% more likely to survive than patients who were treated later. Second: patients who received plasma that had a heftier load of anti-coronavirus antibodies were 23% more likely to survive than those whose plasma had fewer antibodies; you may recall that one negative Dutch study of convalescent serum was fatally flawed by its use of serum relatively poor in antibodies. Even though we don’t know how well the Mayo patients would have done with no treatment at all, it seems likely that using only antibody-rich plasma and administering it as early as possible will save lives.

AeroNab: Having shown that a llama antibody or something like (see the May 13^th Stethoscope) can inhibit the novel coronavirus in a testtube, some UCSF scientists designed cute little inhalers and invented a cute little brand name and have managed to get them splashed all over the media as the Final Solution to the COVID-19 problem before a single person has inhaled a single puff. Need I remind you that hydroxychloroquine works great in the testtube too? I hope these guys are just dreamers, not con artists.

Favipiravir (FabiFlu, Avigan, Favilavir, Avifavir): A Russian pilot study of 60 patients, randomized but open-label, found that patients hospitalized with mild COVID-19 and given a high dose of this oral antiviral cleared the virus more quickly than controls. This is nice. But patients taking a lower dose did worse than controls. These puzzling results seem awfully preliminary to me, but not to the local authorities, who have already authorized the drug for use in COVID-19. The same authorities, I might point out, who are about to distribute a vaccine with no evidence it works.

Methylprednisolone: A Brazilian placebo-controlled trial of this corticosteroid found no improvement in mortality rates, in confusing contrast to a British trial of dexamethasone, another steroid. Their patients were younger than in the UK, and the drug increased the death rate in younger patients; there are also differences between the drugs, the hospital contexts, and the duration of therapy that could help explain the discrepancy. ICU physicians will probably continue to use dexamethasone as per the UK trial.

Oleandrin: Mr. Trump’s latest and by far worst suggestion to doctors is that they treat COVID-19 with oleandrin, an extract of oleander. Far from being an “experimental botanical extract,” this shrub has been known since ancient times to be a mortal poison, listed by the Encyclopedia Brittanica under “7 of the world’s deadliest plants.” Why is it his most dangerous advice yet? Because it’s so easy to follow. Hydroxychloroquine is a prescription drug so you need a doctor to obtain it, and not many people are dumb enough to actually take a swig of Clorox. But oleander grows in gardens all over the United States, and eating a single leaf, or drinking an infusion boiled from a half-dozen, can kill an adult.

My car parked under an oleander tree in Rome

Vaccines: A two-dose inactivated whole-virus vaccine that I think we haven’t heard about before, apparently from something called the China National Biotec Group Company Limited, has been shown to produce high levels of neutralizing antibodies in human volunteers with relatively few side effects – that’s Phases 1 and 2 – and has joined 5 other candidate vaccines undergoing Phase 3 trials to see whether they actually prevent disease. In this particular game show, the more contestants the better.

Challenge trials for vaccines: I’ve gone on and on about the truly dreadful idea of “challenge trials,” testing vaccines by deliberately infecting volunteers with the COVID-19 virus – a potentially fatal, untreatable virus that has already likely killed more than a million people. I’ve also mentioned that a vaccine against Dengue fever was developed through a challenge trial, using a weakened strain of the virus that caused only mild disease. Now the United States and UKgovernments are trying to develop weakened strains of COVID-19 for that purpose. But that will take months at least, so it’s not at all clear that challenge trials would bring a vaccine faster to pharmacies – their only justification.

HOWEVER. I have now probed more deeply into this “weakened strain” business, and the deeper you get the murkier it looks. I had assumed the famous mild strain of Dengue was somehow developed artificially, but no: it was a natural variant that had caused an innocuous Dengue epidemic in Tonga in 1974. So scientists actually have no precedent whatever for developing a weakened virus on purpose in order to test a new vaccine. How will they go about it? How will they know it causes milder disease than the regular SARS-CoV-2? They can try it first in monkeys, but mild in monkeys doesn’t necessarily mean mild in people, and to be sure they’d have to give it to elderly, unhealthy volunteers… I’ll stick with my firm nix to vaccine challenge trials.

The greatest of ease?

The New York Times called a new aerosol report from the University of Florida “A Smoking Gun.” Is it? Maybe yes, maybe no. Certainly it is the only study to make me consider that aerosols might possibly play a role in transmitting COVID-19 from one person to another. The report – thus far only available as a preprint – says infectious virus was isolated from air samples collected in the hospital room of two COVID-19 patients, with the specific strain carried by Patient 1 detected fully 16 feet from his head. This is the first time virus has been detected in air so far away from patients (a University of Nebraska group detected viable virus in air at the foot of hospital beds, but that was less than 6 feet from patients’ faces), and is probably therefore important. But I don’t know how to get from that result to an estimate of the role airborne transmission might play in COVID-19, or what if anything we should do about it. Two reasons in particular: 1) The amount of distant virus is very small indeed – fewer than 75 particles per liter of air – and comments on the manuscript from people with technical expertise bring into question both whether those doses can transmit disease and whether the lab machines can reliably measure so few virions. 2) Looking carefully at the Figure,

you can see that Patient 1 had to walk right by that distant air collector, within a couple of feet of it, every time he went to the bathroom. That might to be a simpler explanation for how the device picked up his virus. I’ve submitted a comment on the manuscript and will be interested to see what the authors respond.

Faking Presidential

Henry Fuseli, The Nightmare (mistakenly posted last time, the originally home of this story)

Donald Trump changed campaign manager in mid-July, replacing Brad Parscale with Bill Stepien, a guy whose main claim to fame had been taking the fall for Chris Christie in the Bridgegate scandal. The new broom swept the President straight into an unaccustomed role: Pseudo-Presidential. Suddenly the pandemic was going to get worse before it got better, face masks were patriotic, and even the “safe environment” of the Republican convention was, between one day and the next, not.

But the man can’t help himself. No sooner had Trump been bludgeoned into giving a public nod to science than he backslid, tweeting out a video about COVID-19 so misleading that even Facebook took it down – though not before it had been viewed 16 million times and retweeted by none less than Madonna (who’s also dabbled in vaccine conspiracy theories). The star of the show? A certain Dr. Stella Immanuel, born in Cameroon trained in Nigeria working in Texas, whose disavowal of face masks is actually one of her more sensible ideas. She also believes that endometriosis is caused by copulation with demons, that some medications are laced with alien DNA, and that government scientists are currently working on a vaccine against religion.

He’s also fleshing out his coronavirus advisory team by adding Dr. Scott Atlas, a radiologist whose chief qualification seems to be appearing on Fox News and whose chief mission is clearly to act as counterbalance to actual experts Drs. Anthony Fauci and Deborah Birx.

If that’s the level of science your Supreme Leader and your favorite pop diva are advocating, it’s no wonder we have a high school senior saying she’s immune to COVID-19 because “Only liberals can get rona and I’m not a liberal.” Guess she never heard about poor Hermann Cain…

Madonna and Stella Immanuel

Coliseum Dreaming

Many Americans are clamoring to know when they will be allowed back in Italy (and the European Union in general)? There is actually an answer to that question. The official criteria are:

• the number of new COVID-19 cases over the last 14 days and per 100 000 inhabitants close to or below the EU average (as it stood on 15 June 2020)
• stable or decreasing trend of new cases over this period in comparison to the previous 14 days
• overall response to COVID-19 taking into account available information, including on aspects such as testing, surveillance, contact tracing, containment, treatment and reporting, as well as the reliability of the information and, if needed, the total average score for International Health Regulations (IHR).

The United States is flunking miserably at the moment – an excellent article in the Atlantic helps understand why. The magic June 15^th number in the EU was a total of 15.3 new cases per 100,000 inhabitants over the previous 14 days. I calculate the USA is currently at 197, and several EU countries ain’t doing so great either. As of yesterday, Italy gets the only gold star:

As I see it, the only chance my ravaged country has at getting onto the approved list would be a six-week coordinated strict stay-at-home order. But when the person who’s hired to lead the United States can respond to a 180,000 deaths only with “It is what it is,” a national lockdown seems unlikely to say the least.

Incidentally, if Italy followed the second criterion, stable case numbers, Italy should be quarantining all the vacationers coming back from Spain, Greece, Croatia, and Malta, in addition to requiring them to do COVID-19 swabs, and should add countries including France and Germany to the list.

The only good news I’ve gotten from the US lately is what I heard on WNYC’s Brian Lehrer show the other day: New York City is not only running a rock-bottom 1% positive rate on COVID-19 swab tests and reporting fewer than 10 deaths a day, but it is managing to set up mass rapid testing sites as soon as a neighborhood surges, carry out contact tracing on the spot with a 75% compliance rate, and provide instant access to free food delivery and other aids for people who test positive – even hotel rooms, if needed for isolation. They can do this, as can Italy, only because there are so few new cases and so many contact tracers.

The cat with 99 lives

Whenever I think hydroxychloroquine has disappeared from the COVID-19 world, there it comes again. Newsweek has shown fit to publish a spirited defense of its use, and a pseudoscientific internet screed is also making the rounds, penned by a certain Meryl Nass, MD. She’s “an internist with special interests in vaccine-induced illnesses, chronic fatigue syndrome, Gulf War illness, fibromyalgia, and toxicology,” who asked regarding Dr. Stella Immanuel – she of demon sex and alien DNA fame, “Why do so few Americans speak their truth like she does?” Sigh. In case anyone needs it, here’s a quick summary of the parabolic rise and fall of hydroxychloroquine: Initial enthusiasm was based on misinterpretation of studies in China (it turned out to have worked no better than a placebo), a totally awful study by a French charlatan where patients on hydroxychloroquine actually did worse than controls, and Trumpian hype. Many properly done studies have been done since then, none of them finding any benefit. Lupus patients who take hydroxychloroquine every day get COVID-19 just as often as those who don’t, and they get just as sick; the drug doesn’t prevent COVID-19 in people with intense exposures; it doesn’t help people with mild disease and/or recent symptom onset; and hospitalized patients who receive hydroxychloroquine are just as likely to die or wind up on respirators as those who don’t.

The birth of bleach

Did you miss the Guardian article back in April that revealed where Trump got the idea of drinking disinfectants? So did I, but we can all catch up now that the bleach peddlers – a Florida father-and-son team – have been arrested in Colombia and are awaiting extradition. Local authorities say their Miracle Mineral Solution, which “cures” not only COVID-19 but cancer, AIDS, and autism, has killed at least 7 Americans.

Mark Grenon, "Archbishop of the Genesis II Church of Health and Healing," with his MMS

In related news, several people have died, and others have been blinded, from swallowing hand sanitizing gels made with methanol.

It kills me, it kills me not

The Brits have come up with a brilliant trick for reducing COVID-19 mortality: stop counting as COVID-19 deaths anybody who dies more than 28 days after their first positive test. In one fell swoop they’ve lopped 5000 deaths off their official death toll, from 46,706 down to 41,329. These shenanigans are medically absurd – COVID-19 is infamous for keeping people hanging on life support for weeks and months. And they’re easily proved false: the overall death toll from all causes in the UK between week 12 and week 20 of this year was 56,456 higher than predicted from previous years. By this gold standard, even more people have died from the pandemic than the pre-censorship official total.

In parallel news from the United States, the New York Times now reports on the basis of CDC all-cause mortality figures that 200,000 people died due to the COVID-19 pandemic as of July 25^th, 60,000 more than the official figure. I estimated a month ago that that milestone had already been passed – but I may have been right after all, since the Times says “many states are weeks or months behind in reporting.”

No one is useless

Like the saying goes, they can always be used as a bad example. Here’s part of what’s driving the American “second wave,” which is really just the first one expanding its reach.

The directors of a Georgia sleepaway camp have shown us how not to run a camp in the COVID-19 era. Campers slept in cabins containing up to 26 kids, wore no masks, and enjoyed daily group “singing and cheering.” Doors and windows were left shut, and physical distancing was likely not even suggested much less enforced. The result? Out of 344 kids and staff who’ve been tested for COVID-19, 260 were positive, most of whom were sick.

That same great state, of course, had already showed us how not to open schools. One Georgia school district actually (can you believe this?) sent around emails saying, “Staff who test positive are not to notify any other staff members, parents of their students or any other person/entity that they may have exposed them.”

Then there’s the Liberty Belle, a riverboat that tooled around Manhattan two weeks ago hosting an intimate gathering for 170 jammed-in guests. The owners didn’t even bother to get a liquor license, gratuitously inviting (and receiving) additional criminal charges.