Rapid Covid Tests Saving the Day

Finally, the promise of rapid Covid tests is paying off because public officials put them to use.  An article at Epoch Times explains: Calls Grow for US to Rely on Rapid Tests to Fight Pandemic  Excerpts in italics with my bolds.

When a Halloween party sparked a COVID-19 outbreak at North Carolina Agricultural and Technical State University, school officials conducted rapid screening on more than 1,000 students in a week, including many who didn’t have symptoms.

Although such asymptomatic screening isn’t approved by regulators and the 15-minute tests aren’t as sensitive as the genetic one that can take days to yield results, the testing director at the historically black college credits the approach with quickly containing the infections and allowing the campus to remain open.

Within the span of a week, we had crushed the spread. If we had had to stick with the PCR test, we would have been dead in the water,” said Dr. Robert Doolittle, referring to the polymerase chain reaction test that is considered the gold standard by many doctors and Food and Drug Administration regulators.

Compounding the problem is that an estimated 40% of people infected don’t develop symptoms. It’s among these silent spreaders that Mina says rapid tests have the clear advantage over lab tests. With its medical precision, he argues that the PCR test continues to detect COVID-19 in many people who have already fought off the virus and are no longer contagious. The rapid test, while less sensitive, is better at quickly catching the virus during the critical early days of infection when it can spread explosively through communities.

“This isn’t a clinical test — it’s a public health screening test,” Mina said.

The case for widescale rapid testing is getting a boost from universities and school systems that have used the approach to stay open through the latest waves of the pandemic. And proponents point to apparent success stories like the small European nation of Slovakia, which saw infections drop after screening two-thirds of its roughly 5 million people with the tests.

And from the Jerusalem Post, a report Israel is following the Slovakian approach: Rapid COVID-19 tests reduce morbidity in Slovakia by 60% in one week.  Excerpts in italics with my bolds.

Quidel’s Sofia kits for rapid coronavirus testing. (photo credit: SOFIA ISRAEL)

The Slovakian model for combating the spread of the virus has proven itself time and time again • pandemic could be completely eradicated worldwide within six weeks

Perhaps the most widely used coronavirus rapid test kit is the Sofia kit developed by American company Quidel. In the past couple of months, Israel has been receiving shipments of the rapid test kits and deploying them throughout the country, while connecting them to systems used by the Health Ministry.

“Rapid and large-scale tests have proven to be efficient in dealing with the coronavirus pandemic around the globe, at least until the long-anticipated vaccine reaches the entire population, and probably after as well,” a statement by Sofia Israel said.

The 300 kits of Sofia which were purchased by Israel have been distributed to retirement homes, medical clinics, health funds and IDF bases, as well as to Israel Police and Prison Services facilities. Sofia Israel has noted that this means Israel would be able to adopt the Slovakian model of conducting large-scale rapid tests successfully.

“The importance of receiving immediate results is critical in managing the outbreak, and overpowers the benefits of slow and more accurate lab tests that require several days for providing results,” a Sofia Israel press release said.

Each Sofia kit can administer 40 tests per hour and provide results within 15 minutes. In a day, 960 Israelis can be tested using one kit only. The 300 kits already distributed, working 24/7, have the capacity to test 288,000 Israelis every day.

Background from previous post: Covid Rapid Tests Finally Out from Quebec Storage (200 Scientists Ask)

Our son is working mightily to keep his HVAC enterprise alive during the contagion.  Last week a key employee after visiting a pharmacy where a person tested positive was told to go home and get tested (took two days), and then stay home to wait for results (3 more days).  So a work week was lost and the business hobbled during that time.  So I wondered what happened to all those rapid covid tests that were purchased back in September.

The story came out in the Montreal Gazette January 14, 2021 Scientists publish open letter calling for Quebec to use rapid testing.  Excerpts in italics with my bolds.

“We have 1.2 million of those tests just sitting in a warehouse in Farnham,” Université de Montréal professor Roxane Borgès Da Silva says.

A group of 213 scientists, professors, health-care workers and patients published an open letter to the Legault government Thursday calling on Quebec to roll out rapid COVID-19 tests to curb outbreaks more quickly and to step up its communications strategy.

“We have 1.2 million of those tests just sitting in a warehouse in Farnham,” Roxane Borgès Da Silva, a professor with the Université de Montréal’s school of public health, said in an interview Wednesday night. “We have reached a point in the evolution of the pandemic where the health system is at the breaking point. It is time that we use every tool at our disposal.

In the letter, the signatories from institutions including the Université de Montréal, McGill, Laval, UQAM and the Institut national de santé publique du Québec (INSPQ), note the partial closure of businesses and restrictions on gatherings have failed to stem the increase in coronavirus cases, hospitalizations and deaths.

With a month-long curfew instituted Saturday, officials must take advantage of the expected decline in cases to counter the spread through better screening, which is “all the more important in a context where possible variants of the SARS-CoV-2 virus, which are more infectious, could spread in Quebec,” the letter reads.

Using rapid tests could help to identify positive cases more quickly, particularly those among asymptomatic patients and those who have been at so-called “super-spreader” events, the letter states

“In this regard, we believe that the simple and widely available access throughout the territory to rapid tests … allowing a result to be obtained in a few minutes could be a game-changer, especially in places of propagation.”

Quebec has been hesitant to use the tests widely because it fears their lack of sensitivity could clear people for COVID-19 when they actually have the virus. But Da Silva said the tests are close to 90-per-cent accurate when used on patients who are in an extremely contagious phase, which is crucial to stopping the most dangerous transmitters. The tests could be used at workplaces, high schools and CHSLDs, or be made available at pharmacies and doctors’ offices to allow the public to get tested quickly, Da Silva said.

As well, the signatories argue the government needs to do a better job of transmitting data and information to the public to improve citizens’ confidence in the science and improve compliance with regulations. They suggest using improved communication campaigns that appeal to the general public and using new strategies that incorporate humour and music.

More from CBC (here): 

The tests, which return a result in as little as 15 minutes, have variously been called a “game-changer” (Ontario Premier Doug Ford) and “less safe” as the gold-standard PCR lab test (Quebec Health Minister Christian Dubé, to Le Devoir).

The chair of McGill University’s bioengineering department, Dr. David Juncker, leans to the Ford end of the spectrum —provided the tests are used effectively. Right now they are not, he said, and it’s to the detriment of the broader testing effort.

“The current testing system isn’t very effective in terms of contact, trace and isolate … it’s too slow, it’s too cumbersome, it has too many delays. That’s one of the reasons we’re failing in containing the spread of the pandemic,” said Juncker, an expert on diagnostic testing.

The main area of concern for the provincial government — also voiced by federal officials — is the the rapid test’s lower accuracy, or sensitivity, and the risk of false negatives.

Those fears are overblown, in Juncker’s view, because the rapid tests can still help ferret out highly infectious people.

“If we just speak about diagnostic performance … the PCR test is the most effective one,” he said. “But if we think about what we want to use this for, as a public health tool that we want to use to contain and detect infectious individuals very quickly and isolate them very fast, that’s where rapid tests can be very helpful.”

My Comment:  The need is to quickly identify people with enough viral load to infect others, and to become sick themselves.  Rapid tests excel at this when applied to people with symptoms that might or might not be Covid19.  Officials have been obsessed with PCR tests which are hyper-sensitive and show people as positive with too little load or even from a trace of dead virus.  Those false positives generate lots of fear and clog the system with people unnecessarily.

Background from Previous Post On Non-Infectious Covid Positives

Daniel Payne writes at Just the News Growing research indicates many COVID-19 cases might not be infectious at all. Excerpts in italics with my bolds.

Elevated ‘cycle thresholds’ may be detecting virus long after it is past the point of infection.

A growing body of research suggests that a significant number of confirmed COVID-19 infections in the U.S. — perhaps as many as 9 out of every 10 — may not be infectious at all, with much of the country’s testing equipment possibly picking up mere fragments of the disease rather than full-blown infections.

Yet a burgeoning line of scientific inquiry suggests that many confirmed infections of COVID-19 may actually be just residual traces of the virus itself, a contention that — if true — may suggest both that current high levels of positive viruses are clinically insignificant and that the mitigation measures used to suppress them may be excessive.

Background from previous post: New Better and Faster Covid Test

Kevin Pham reports on a breakthrough in coronavirus testing. Excerpts in italics with my bolds.

Another new test for COVID-19 was recently authorized — and this one could be a game-changer.

The Abbot Diagnostics BinaxNOW antigen test is a new point-of-care test that reportedly costs only $5 to administer, delivers results in as little as 15 minutes, and requires no laboratory equipment to perform. That means it can be used in clinics far from commercial labs or without relying on a nearby hospital lab.

That last factor is key. There are other quick COVID-19 tests on the market, but they have all required lab equipment that can be expensive to maintain and operate, and costs can be prohibitive in places that need tests most.

This kind of test is reminiscent of rapid flu tests that are ubiquitous in clinics. They’ll give providers tremendous flexibility in testing for the disease in not just clinics, but with trained and licensed medical professionals, in schools, workplaces, camps, or any other number of places.

So what’s new about this test? Most of the current tests detect viral RNA, the genetic material of SARS-CoV-2. This is a very accurate way of detecting the virus, but it requires lab equipment to break apart the virus and amplify the amount of genetic material to high enough levels for detection.

The BinaxNOW test detects antigens — proteins unique to the virus that are usually detectable whenever there is an active infection.

Abbott says it intends to produce 50 million tests per month starting in October. That’s far more than the number tested in July, when we were breaking new testing records on a daily basis with approximately 23 million tests recorded.

There’s a more important reason to be encouraged by this test coming available.  The viral load is not amplified by the test, so a positive is actually a person needing isolation and treatment.  As explained in a previous post below,  the PCR tests used up to now clutter up the record by showing as positive people with viral loads too low to be sick or to infect others.

Background from Previous Post The Truth About CV Tests

The peoples’ instincts are right, though they have been kept in the dark about this “pandemic” that isn’t.  Responsible citizens are starting to act out their outrage from being victimized by a medical-industrial complex (to update Eisenhower’s warning decades ago).  The truth is, governments are not justified to take away inalienable rights to life, liberty and the pursuit of happiness.  There are several layers of disinformation involved in scaring the public.  This post digs into the CV tests, and why the results don’t mean what the media and officials claim.

For months now, I have been updating the progress in Canada of the CV outbreak.  A previous post later on goes into the details of extracting data on tests, persons testing positive (termed “cases” without regard for illness symptoms) and deaths after testing positive.  Currently, the contagion looks like this.

The graph shows that deaths are less than 5 a day, compared to a daily death rate of 906 in Canada from all causes.  Also significant is the positivity ratio:  the % of persons testing positive out of all persons tested each day.  That % has been fairly steady for months now:  1% positive means 99% of people are not infected. And this is despite more than doubling the rate of testing.

But what does testing positive actually mean?  Herein lies more truth that has been hidden from the public for the sake of an agenda to control free movement and activity.  Background context comes from  Could Rapid Coronavirus Testing Help Life Return To Normal?, an interview at On Point with Dr. Michael Mina.  Excerpts in italics with my bolds. H/T Kip Hansen

A sign displays a new rapid coronavirus test on the new Abbott ID Now machine at a ProHEALTH center in Brooklyn on August 27, 2020 in New York City. (Spencer Platt/Getty Images)

Dr. Michael Mina:

COVID tests can actually be put onto a piece of paper, very much like a pregnancy test. In fact, it’s almost exactly like a pregnancy test. But instead of looking for the hormones that tell if somebody is pregnant, it looks for the virus proteins that are part of SA’s code to virus. And it would be very simple: You’d either swab the front of your nose or you’d take some saliva from under your tongue, for example, and put it onto one of these paper strips, essentially. And if you see a line, it means you’re positive. And if you see no line, it means you are negative, at least for having a high viral load that could be transmissible to other people.

An antigen is one of the proteins in the virus. And so unlike the PCR test, which is what most people who have received a test today have generally received a PCR test. And looking those types of tests look for the genome of the virus to RNA and you could think of RNA the same way that humans have DNA. This virus has RNA. But instead of looking for RNA like the PCR test, these antigen tests look for pieces of the protein. It would be like if I wanted a test to tell me, you know, that somebody was an individual, it would actually look for features like their eyes or their nose. And in this case, it is looking for different parts of the virus. In general, the spike protein or the nuclear capsid, these are two parts of the virus.

The reason that these antigen tests are going to be a little bit less sensitive to detect the virus molecules is because there’s no step that we call an amplification step. One of the things that makes the PCR test that looks for the virus RNA so powerful is that it can take just one molecule, which the sensor on the machine might not be able to detect readily, but then it amplifies that molecule millions and millions of times so that the sensor can see it. These antigen tests, because they’re so simple and so easy to use and just happen on a piece of paper, they don’t have that amplification step right now. And so they require a larger amount of virus in order to be able to detect it. And that’s why I like to think of these types of tests having their primary advantage to detect people with enough virus that they might be transmitting or transmissible to other people.”

The PCR test, provides a simple yes/no answer to the question of whether a patient is infected.
Source: Covid Confusion On PCR Testing: Maybe Most Of Those Positives Are Negatives.

Similar PCR tests for other viruses nearly always offer some measure of the amount of virus. But yes/no isn’t good enough, Mina added. “It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to [ignore this]” Dr. Mina said, of how contagious an infected patient may be.

We’ve been using one type of data for everything,” Mina said. “for [diagnosing patients], for public health, and for policy decision-making.”

The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although if it was, it could give them an idea of how infectious the patients are.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Any test with a cycle threshold above 35 is too sensitive, Juliet Morrison, a virologist at the University of California, Riverside told the New York Times. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less.

Another solution, researchers agree, is to use even more widespread use of Rapid Diagnostic Tests (RDTs) which are much less sensitive and more likely to identify only patients with high levels of virus who are a transmission risk.

Comment:  In other words, when they analyzed the tests that also reported cycle threshold (CT), they found that 85 to 90 percent were above 30. According to Dr. Mina a CT of 37 is 100 times too sensitive (7 cycles too much, 2^7 = 128) and a CT of 40 is 1,000 times too sensitive (10 cycles too much, 2^10 = 1024). Based on their sample of tests that also reported CT, as few as 10 percent of people with positive PCR tests actually have an active COVID-19 infection. Which is a lot less than reported.

Here is a graph showing how this applies to Canada.

It is evident that increased testing has resulted in more positives, while the positivity rate is unchanged. Doubling the tests has doubled the positives, up from 300 a day to nearly 600 a day presently.  Note these are PCR results. And the discussion above suggests that the number of persons with an active infectious viral load is likely 10% of those reported positive: IOW up from 30 a day to 60 a day.  And in the graph below, the total of actual cases in Canada is likely on the order of 13,000 total from the last 7 months, an average of 62 cases a day.

 

Is It Still a Pandemic If No One Notices?

Along the lines of Bishop Berkeley’s famous philosophical question, John Tamny writes at Real Clear Markets: What If the Coronavirus Had Spread Without Detection? Excerpts in italics with my bolds.

Among those who’ve watched the tragic and needless lockdowns unfold over the last 11 months, a frequent question has come up: what if the coronavirus had spread, but had never been diagnosed or detected? Would life have been any different absent the discovery of what has caused a massive global panic among politicians?

It’s not an unreasonable question. Really, ask yourself what politicians and nail-biting media members would have done 100 years ago if the virus had revealed itself. Since work was a destination for realistically everyone, there’s no way there could have been lockdowns. People would have revolted.

As for deaths, life expectancy was already relatively low in the 1920s. This is relevant when it’s remembered that the coronavirus in a death sense has largely been associated with nursing homes. These homes weren’t very common one hundred years ago, and they weren’t mainly because pneumonia, tuberculosis and other major killers had a tendency to get to us long before we reached old age. Translated, there likely weren’t enough old people in the 1920s for the virus to have had any kind of lethal impact.

Due to a lack of old people, the virus perhaps wouldn’t have been discovered in the first place. Think about it.

As this column has long stated, the coronavirus is a rich man’s virus. It’s not just that the rich and generally well-to-do had portable jobs that mostly survived the mindless lockdowns., it’s not just that the break from reality we were forced to endure could have only happened in a rich country, it’s also the case that only in a country and world in which the elderly are truly old would the virus have any notable association with death. People live longer today, and they do because major healthcare advances born of wealth creation made living longer possible. We wouldn’t have noticed this virus 100 years ago. We weren’t rich enough.

Which brings us to a recent article by Leah Rosenbaum at Forbes. She wrote about a NIH paper indicating that almost 17 million coronavirus cases went uncounted last summer. In Rosenbaum’s words, this discovery “suggests the pandemic was much more widespread in the U.S. than previously thought.” Well, of course.

Lest readers forget, the virus began spreading sometime in the fall of 2019, if not sooner. The epicenter is widely thought to have been China, and flights between the U.S. and China, along with flights from China to the rest of the world, were rather numerous right up until 2020.

Considering how connected China was and still is to the rest of the world, logic dictates that the virus was infecting people globally long before politicians panicked. In that case, it’s not surprising that estimates made about the number of infected Americans were always way too low. The virus is said to spread easily, even easier than the flu, and it once again started working its way around the world sometime in 2019.

Notable about its rapid spread is that life went on as it made its way around the world.

As the closing months of 2019 make plain, people lived with the virus. What is most lethal to older people isn’t much noticed by those who aren’t old. A rapidly spreading virus was seemingly not much of a factor until politicians needlessly made it one.

Indeed, a virus most lethal to the very old has meek qualities when met by younger people. If they’re are infected with it, all-too-many don’t find the symptoms worrisome enough that they actually get tested.

That’s what Rosenbaum’s report seems to indicate. The NIH study covered blood tests of 11,000 Americans who hadn’t been previously diagnosed with Covid-19. 4.6% of the participants had Covid-19 antibodies, but their actual infection phase was never apparent to them. This is what Holman Jenkins has been pointing out all along. The number of those infected has always well exceeded estimates precisely because the symptoms of infection haven’t been worth going to the doctor over for the vast majority of those infected.

Looking back 100 years once again, ask yourself how many would have consulted a doctor then if something resembling the coronavirus had been spreading. Or better yet, ask yourself how many would have been tested in a U.S. that was quite a bit poorer relative to today. The questions answer themselves.

The virus would have spread rapidly within a younger population in the 1920s, and infected people would have developed immunity.

From Rosenbaum’s report it’s not unreasonable to speculate that far more Americans are immune to the virus than is known, and that the best approach all along would have been freedom. Let people live their lives. More important, let them get infected. For centuries they’re pursued immunity by – gasp – infecting one another.

So, what would have happened if the coronavirus had gone undetected? We will never know, but it’s not unrealistic to conclude that we have an idea. The virus didn’t suddenly start spreading in March of 2020 just because politicians decided it had. 2019 is the likelier beginning. Early 2020 too. Life was pretty normal as a virus made its way around the world then.

Politicians made it abnormal. Let’s never forget the sickening carnage they can create when they find reasons to “do something.”

My Comment:  An additional point seen in the history of environmental scares is that mass media first frightens the public, and then politicians have to be seen “doing something.”  And as we are seeing now,  they have difficulty to stop those things even when shown to be ineffective and harmful on top.

See also: Progressively Scaring the World (Lewin book synopsis)

 

Militant Medicine Breeds Bad Pandemic Policies

Perhaps you noticed how public health officials direct the war on coronavirus.  The generals obsess over “cases” and “deaths” while hiding numbers of “recoveries” and “cures.” The military paradigm has led pandemic policies seriously astray, as explained by Norman Doidge in his Tablet article Mad Science, Sane Science.  Excerpts in italics with my bolds.

There are more reasonable approaches to science and COVID-19 than the ‘eradication’ mentality that we lean on.

One cannot underestimate the extent to which modern medicine took up Bacon’s military metaphor of conquest and applied it to itself. This involved rejecting the ancient Hippocratic idea of healing, which—being part of that Greek worldview that saw us as of nature, and not against it—saw the physician as trying to work in alliance with nature, the patient (mind and body and spirit) and the patient’s family. But by the mid-1600s Thomas Sydenham, who became known as the “English Hippocrates,” saw medicine in a new way: “I attack the enemy within by means of cathartics and refrigerants, and by means of a diet”; he wrote, “a murderous array of disease has to be fought against, and the battle is not a battle for the sluggard …” Little has changed since. We see ourselves as engaged in endless wars: “The war against the virus,” “the war against cancer,” or against AIDS, “the war on drugs,” the “battle against heart disease,” we “combat” Alzheimer’s, and so on. As modern physicians came to see themselves as warriors and disease as “the enemy,” treatments became “weapons,” and drugs went from being healing potions to “magic bullets” and vaccines became “shots.”

We combat the enemy with “doctor’s orders,” from the medical “armamentarium,” or “arsenal” as we physicians call our bag of therapeutic tricks.

This military metaphor in medicine gives rise to a mentality that esteems invasive high-tech treatments as somehow more serious than less invasive ones—any collateral damage be damned. Of course, there is a time for a martial attitude in medicine, as, say, in emergencies: If a blood vessel in the brain bursts, the patient needs invasive surgery and a neurosurgeon with nerves of steel, to operate. But there are times when it sets us back. Today, rather than work with the patient as a key ally, we physicians often barely have time to listen to him or her speak. In this metaphor, the patient’s body is less an ally than the battlefield, and the patient is rendered passive, a helpless bystander, as he watches the confrontation that will determine his fate between the two great antagonists, the doctor (plus the scientific research establishment) and the disease (or pathogen). And of course, in the “war against the virus,” it is total “eradication” of such an enemy that is the goal. That, it would seem to us, Bacon’s offspring, as the only sensible approach.

As it turns out, so much of what ails us today are products of modern science and technology gone wild: lethal antibiotic-resistant organisms that our “total eradication of disease mentality” produced because we vastly overused the antibiotics we had (which, by the way, were originally natural products of nature, not the lab); pollution (of every element), chemicals in our baby food, toys, floors, and mattresses causing skyrocketing childhood illnesses; bioterrorism; loss of biodiversity affecting the food chain; fabulous totalitarian surveillance tools called cellphones, global networks that allow our enemies thousands of miles away to reach into the controls of our electrical grids, water systems, food delivery systems, banks, nuclear systems, computers, and control them, turning them on and off with a keystroke; 3D printers to make assault weapons in the basement, nuclear weapons to empower lunatics, industrialized death camps with cyanide showers, and, not to mention man-made environmental disruptions causing ecological catastrophes.

On this list of course, is also a pandemic that spread so rapidly because of air travel, and the “efficient” design of our urban centers which maximize overcrowding—and a microbe that may have originated in a lab known to be unsafe, and experimenting with bat viruses. “Just last year,” an article in Newsweek reported, “the National Institute for Allergy and Infectious Diseases, the organization led by Dr. Fauci, funded scientists at the Wuhan Institute of Virology and other institutions for work on gain-of-function research on bat coronaviruses.”

“Gain-of-function research” in this case means augmenting the virus’s contagiousness, and even lethality for the purpose of getting a head start on developing therapeutics or vaccines should it mutate in that direction. Such research is also the meat and potatoes germ-warfare research.. . . Whether or not Wuhan’s gain-of-function work involved creating an artificially enhanced coronavirus has been made almost impossible for outsiders to ascertain, because that lab’s government conveniently insisted it destroy its virus samples and records before an outside investigation could be done.

We are so reliably surprised and caught off guard by the unforeseen consequences of our technologies, and there are now so many serious cases of “science going wrong,” that it might be argued that, in practice, modern science (and the tech it produces) seems to be a machine designed to generate and maximize unintended consequences. And is hence, along with being powerful, also, quite often, ridiculous.

All of this is relevant to the current pandemic. In a way, there are three grand “strategies” to deal with a pandemic. But only one of them indulges the more lunatic strains of military metaphor in medicine.

  • The first strategy is never let it in.
  • The second, the approach most widely used at present, is to go to rather blunt lockdowns, while we develop therapeutics and vaccines to eradicate the virus.
  • The third is to resist lockdowns whenever possible, and instead focus on more differentiated measures than total societal closures, again while we develop therapeutics and vaccines to eradicate the virus.

If the virus doesn’t get in, people are not dying, there isn’t talk of eradication and the military metaphor isn’t used. That strategy has worked so far in Nauru, an island speck, in the paradise of Oceania, a country that is isolated, and small enough to walk across and around in one day, and which, along with Oceania’s Tuvalu, is tied for the record as being the least visited country in the world.

Even the relatively isolated, double-island paradise of New Zealand, was still too connected with the rest of the world to keep the virus out. When it did arrive there, New Zealand tried the second strategy, to eradicate it with a blunt lockdown.

The military metaphors began. Prime Minister Jacinda Ardern set the goal of “complete elimination of the virus.” France’s President Emmanuel Macron said, “We are at war … The enemy is there—invisible, elusive—and it is advancing.” Donald Trump described himself as “a wartime president.” War requires emergency measures, which require emergency powers, which demand the immediate suspension of civil liberties—with executives not bothering to go to legislatures because the enemy is coming at us “in waves,” and “surges,” is “killing us in droves.” We “hunker in our bunkers”—in total lockdown. Home’s the only place that’s safe. We must “mobilize” all society in immobility. Punish those who disobey orders. We do it, too, for the health care workers, the heroes on “the frontline,” who risked their lives.

But these undeniable similarities do not mean that medicine is war, any more than war is healing.

Perhaps the biggest problem with the military metaphor, is how it causes us to narrow our focus almost exclusively on “eradicating the virus,” and “cases of the infected.” This causes us to miss other important ways of dealing with it, that might help us survive it. Public health officials in the “the eradication mode” almost never mention how we can boost our immune systems with vitamins D and C, and zinc, exercise and weight loss. Not their focus. And the narrow focus on eradicating the virus is now causing serious “collateral” harm and death.

But it was not maliciousness but rather the virus eradication mindset that has caused much of the harm. That mindset has led many politicians, and also public health officials, to become oblivious to the death, illness, and devastation that have resulted from the lockdowns. Tedros’ own language speaks this obliviousness, when he says he knows people are “understandably frustrated with being confined to their homes” as though “frustration” is the extent of the problem. What is actually happening is that people’s worlds are collapsing. Fauci early on called the lockdown measure “inconvenient.”

Tedros and other lockdown supporters are almost all themselves employed, and working comfortably, many from home.

They are part of a class that has government, bureaucratic, educational, media, and corporate salaries, or are in Big Tech, which thrives in lockdown. With an often staggering indifference, they gloss over that fact that the measures they recommend “for all of us” are devastating to those working-class people, the poor, and small-business owners who are losing or have already lost their life savings, health insurance, health, and who are at risk of, or who have already been evicted from their apartments. By September we knew that nearly 60% of (mostly small) businesses that had been forced to close in lockdown were destroyed so their workers would have no jobs to return to. Many more have gone under since. They were closed by often illegal edicts, that left their large corporate competitors like Costco and Walmart open. Thus, instead of going to small widely separated community stores, that admitted a few at a time, people crowded into a few stores without social distancing—the complete reverse of a sensible, scientifically based policy. How did public health officials get away with destroying small business? This is war! Ignore that a meta-analysis of 10 countries and their regions, shows that during last spring, stringent stay and home and business closures did no better in slowing the virus than those that rely on voluntary measures (such as hand washing, social distancing, discouraging travel and large gatherings, successful case tracking, and testing). Gov. Andrew Cuomo’s own latest scientific statistics confirm that 74% of all New York COVID-19 transmission comes from indoor gatherings in private homes, and only 1.4% from in-restaurant dining (all set up for COVID now). The commander in chief says no to indoor restaurant dining in December. Now, even the WHO, which supported lockdowns, is claiming that closed Western economies are devastating poorer countries that are trading partners, and its special envoy for COVID-19, Dr. David Nabarro, has said the WHO anticipates a doubling of world poverty and a doubling of childhood malnutrition because of lockdowns.

The officials, blinded by the eradication at all costs mentality, discarded the practical wisdom required to respond to such a crisis, and endorsed an intervention that defies the standard public health practice of taking a holistic approach and always taking into account a measure’s total effects, and not just its immediate effects on the pathogen labeled as “the invisible enemy.”

“COVID denial” is real. So is “COVID-management-induced-devastation denial.”

What does a scientific approach look like, one that takes the best of our modern instruments that Bacon helped to facilitate, but which does not get us tangled up in the military metaphor, or make delusional attempts to artificially cut us off from the rest of nature?

That would be the approach of Janelle Ayres, Ph.D., a brilliantly original and constructive molecular and systems physiologist, and expert in both immunology and evolution, who heads two labs affiliated with the Salk Institute. Ayres’ work opens up a radically different approach to infectious disease—radical in the original sense of the word, meaning having to do with the root, i.e., the broader biological foundations of infectious disease and health in the “biome,” the sphere of living organisms in which we dwell, and which dwell within us. Thus, to my mind, her work has echoes with some of the ancient insights and intuitions about biological interconnectedness, though I’ve not seen her make this claim.

Ayres’ work is helping us reconceive our relationship to microbial organisms, including pathogens, and showing how they can, for instance, influence our evolution, and we theirs, and it gives us a much more detailed picture of how we actually survive serious infections. She happens to have written one of the best articles ever on COVID-19, that shows a breadth and depth of biological comprehension that is extremely rare among modern scientists who are often specialists in very circumscribed areas, who analyze things into ever smaller parts, and know an incredible amount about incredibly little. Ayres is both a first-rank specialist, and a big-think generalist.

She says, “The way we have been thinking about treating infectious diseases is that we have to annihilate the pathogens through vaccines and antimicrobials.” She completely reframes the problem, and challenges our thinking:

“Instead of asking how do we fight infections, we should be asking ‘how do we survive infections?’”

Changing that single word—“fight” to “survive”—transforms everything. Consider, for example, that new organisms, and strains are evolving all the time. A new coronavirus strain identified in December is said to be 70% more transmissible. Some new strains may be resistant to our existing vaccines and antivirals. Developing different antibiotics or vaccines to eradicate each of them, is not always possible, and when it is, generally takes a long time, and costs a fortune. But if, as is often the case, death is caused by our bodies’ own reactions to the infection, reactions which are very similar, regardless of the pathogen that caused them, learning to block the body from going into overdrive should help people survive multiple infections. As well, there is no reason to believe this approach will cause antibiotic-resistant, antiviral-resistant, or vaccine-resistant strains, because it is not targeting the pathogen per se.

In cooperative co-evolution, there is an incentive for us (or any infested animal) to develop methods to both prevent collateral damage to ourselves, as well as fix it when it occurs. That is the essence of the tolerance system. What Ayres and her colleagues are doing is describing these mechanisms—in minute molecular detail—in the body, and learning to read how organisms that are co-evolving with their hosts are communicating with them—sending signals back and forth. Ideally, the lab would ultimately learn how to use this information to enhance co-evolution in some way, to treat disease.

Ayres’ approach to COVID is not to minimize other approaches but point out that “if we can step beyond our focus on the virus,” there is much more we can learn. For instance, it was assumed early in the pandemic, that severe cases were caused by high viral load, and now we know it is the secondary collateral damage caused by our bodies that is the real killer.

Fewer and fewer medical schools now require the graduating physician to take the ancient Hippocratic oath, the first recorded articulation of medical ethics, that sanctified medical confidentiality and the idea that the doctor worked for his or her patient, and not a third party. How sad, how telling.

It is the same Hippocrates, who boiled all medicine down to two principles in his Epidemics Book I, “Practice two things in your dealing with disease: either help or do not harm the patient.”

And, in this light—of doing no harm, or at least far less—we might remember that we are part of nature, depend on it, it lives in us, and we have links to parts we think remote from us, that we often cannot even see. We might consider setting aside the utopian dream that always becomes a nightmare, because all too often we can’t conquer nature without conquering ourselves.

See Also:

The Virus Wars

Rx for Covid-fighting Politicians

Twelve Forgotten Principles of Public Health

 

 

 

Covid Rapid Tests Finally Out from Quebec Storage (200 Scientists Ask)

Our son is working mightily to keep his HVAC enterprise alive during the contagion.  Last week a key employee after visiting a pharmacy where a person tested positive was told to go home and get tested (took two days), and then stay home to wait for results (3 more days).  So a work week was lost and the business hobbled during that time.  So I wondered what happened to all those rapid covid tests that were purchased back in September.

The story came out in the Montreal Gazette January 14, 2021 Scientists publish open letter calling for Quebec to use rapid testing.  Excerpts in italics with my bolds.

“We have 1.2 million of those tests just sitting in a warehouse in Farnham,” Université de Montréal professor Roxane Borgès Da Silva says.

A group of 213 scientists, professors, health-care workers and patients published an open letter to the Legault government Thursday calling on Quebec to roll out rapid COVID-19 tests to curb outbreaks more quickly and to step up its communications strategy.

“We have 1.2 million of those tests just sitting in a warehouse in Farnham,” Roxane Borgès Da Silva, a professor with the Université de Montréal’s school of public health, said in an interview Wednesday night. “We have reached a point in the evolution of the pandemic where the health system is at the breaking point. It is time that we use every tool at our disposal.

In the letter, the signatories from institutions including the Université de Montréal, McGill, Laval, UQAM and the Institut national de santé publique du Québec (INSPQ), note the partial closure of businesses and restrictions on gatherings have failed to stem the increase in coronavirus cases, hospitalizations and deaths.

With a month-long curfew instituted Saturday, officials must take advantage of the expected decline in cases to counter the spread through better screening, which is “all the more important in a context where possible variants of the SARS-CoV-2 virus, which are more infectious, could spread in Quebec,” the letter reads.

Using rapid tests could help to identify positive cases more quickly, particularly those among asymptomatic patients and those who have been at so-called “super-spreader” events, the letter states

“In this regard, we believe that the simple and widely available access throughout the territory to rapid tests … allowing a result to be obtained in a few minutes could be a game-changer, especially in places of propagation.”

Quebec has been hesitant to use the tests widely because it fears their lack of sensitivity could clear people for COVID-19 when they actually have the virus. But Da Silva said the tests are close to 90-per-cent accurate when used on patients who are in an extremely contagious phase, which is crucial to stopping the most dangerous transmitters. The tests could be used at workplaces, high schools and CHSLDs, or be made available at pharmacies and doctors’ offices to allow the public to get tested quickly, Da Silva said.

As well, the signatories argue the government needs to do a better job of transmitting data and information to the public to improve citizens’ confidence in the science and improve compliance with regulations. They suggest using improved communication campaigns that appeal to the general public and using new strategies that incorporate humour and music.

More from CBC (here): 

The tests, which return a result in as little as 15 minutes, have variously been called a “game-changer” (Ontario Premier Doug Ford) and “less safe” as the gold-standard PCR lab test (Quebec Health Minister Christian Dubé, to Le Devoir).

The chair of McGill University’s bioengineering department, Dr. David Juncker, leans to the Ford end of the spectrum —provided the tests are used effectively. Right now they are not, he said, and it’s to the detriment of the broader testing effort.

“The current testing system isn’t very effective in terms of contact, trace and isolate … it’s too slow, it’s too cumbersome, it has too many delays. That’s one of the reasons we’re failing in containing the spread of the pandemic,” said Juncker, an expert on diagnostic testing.

The main area of concern for the provincial government — also voiced by federal officials — is the the rapid test’s lower accuracy, or sensitivity, and the risk of false negatives.

Those fears are overblown, in Juncker’s view, because the rapid tests can still help ferret out highly infectious people.

“If we just speak about diagnostic performance … the PCR test is the most effective one,” he said. “But if we think about what we want to use this for, as a public health tool that we want to use to contain and detect infectious individuals very quickly and isolate them very fast, that’s where rapid tests can be very helpful.”

Comment:  The need is to quickly identify people with enough viral load to infect others, and to become sick themselves.  Rapid tests excel at this when applied to people with symptoms that might or might not be Covid19.  Officials have been obsessed with PCR tests which are hyper-sensitive and show people as positive with too little load or even from a trace of dead virus.  Those false positives generate lots of fear and clog the system with people unnecessarily.

Background from Previous Post On Non-Infectious Covid Positives

Daniel Payne writes at Just the News Growing research indicates many COVID-19 cases might not be infectious at all. Excerpts in italics with my bolds.

Elevated ‘cycle thresholds’ may be detecting virus long after it is past the point of infection.

A growing body of research suggests that a significant number of confirmed COVID-19 infections in the U.S. — perhaps as many as 9 out of every 10 — may not be infectious at all, with much of the country’s testing equipment possibly picking up mere fragments of the disease rather than full-blown infections.

Yet a burgeoning line of scientific inquiry suggests that many confirmed infections of COVID-19 may actually be just residual traces of the virus itself, a contention that — if true — may suggest both that current high levels of positive viruses are clinically insignificant and that the mitigation measures used to suppress them may be excessive.

Background from previous post: New Better and Faster Covid Test

Kevin Pham reports on a breakthrough in coronavirus testing. Excerpts in italics with my bolds.

Another new test for COVID-19 was recently authorized — and this one could be a game-changer.

The Abbot Diagnostics BinaxNOW antigen test is a new point-of-care test that reportedly costs only $5 to administer, delivers results in as little as 15 minutes, and requires no laboratory equipment to perform. That means it can be used in clinics far from commercial labs or without relying on a nearby hospital lab.

That last factor is key. There are other quick COVID-19 tests on the market, but they have all required lab equipment that can be expensive to maintain and operate, and costs can be prohibitive in places that need tests most.

This kind of test is reminiscent of rapid flu tests that are ubiquitous in clinics. They’ll give providers tremendous flexibility in testing for the disease in not just clinics, but with trained and licensed medical professionals, in schools, workplaces, camps, or any other number of places.

So what’s new about this test? Most of the current tests detect viral RNA, the genetic material of SARS-CoV-2. This is a very accurate way of detecting the virus, but it requires lab equipment to break apart the virus and amplify the amount of genetic material to high enough levels for detection.

The BinaxNOW test detects antigens — proteins unique to the virus that are usually detectable whenever there is an active infection.

Abbott says it intends to produce 50 million tests per month starting in October. That’s far more than the number tested in July, when we were breaking new testing records on a daily basis with approximately 23 million tests recorded.

There’s a more important reason to be encouraged by this test coming available.  The viral load is not amplified by the test, so a positive is actually a person needing isolation and treatment.  As explained in a previous post below,  the PCR tests used up to now clutter up the record by showing as positive people with viral loads too low to be sick or to infect others.

Background from Previous Post The Truth About CV Tests

The peoples’ instincts are right, though they have been kept in the dark about this “pandemic” that isn’t.  Responsible citizens are starting to act out their outrage from being victimized by a medical-industrial complex (to update Eisenhower’s warning decades ago).  The truth is, governments are not justified to take away inalienable rights to life, liberty and the pursuit of happiness.  There are several layers of disinformation involved in scaring the public.  This post digs into the CV tests, and why the results don’t mean what the media and officials claim.

For months now, I have been updating the progress in Canada of the CV outbreak.  A previous post later on goes into the details of extracting data on tests, persons testing positive (termed “cases” without regard for illness symptoms) and deaths after testing positive.  Currently, the contagion looks like this.

The graph shows that deaths are less than 5 a day, compared to a daily death rate of 906 in Canada from all causes.  Also significant is the positivity ratio:  the % of persons testing positive out of all persons tested each day.  That % has been fairly steady for months now:  1% positive means 99% of people are not infected. And this is despite more than doubling the rate of testing.

But what does testing positive actually mean?  Herein lies more truth that has been hidden from the public for the sake of an agenda to control free movement and activity.  Background context comes from  Could Rapid Coronavirus Testing Help Life Return To Normal?, an interview at On Point with Dr. Michael Mina.  Excerpts in italics with my bolds. H/T Kip Hansen

A sign displays a new rapid coronavirus test on the new Abbott ID Now machine at a ProHEALTH center in Brooklyn on August 27, 2020 in New York City. (Spencer Platt/Getty Images)

Dr. Michael Mina:

COVID tests can actually be put onto a piece of paper, very much like a pregnancy test. In fact, it’s almost exactly like a pregnancy test. But instead of looking for the hormones that tell if somebody is pregnant, it looks for the virus proteins that are part of SA’s code to virus. And it would be very simple: You’d either swab the front of your nose or you’d take some saliva from under your tongue, for example, and put it onto one of these paper strips, essentially. And if you see a line, it means you’re positive. And if you see no line, it means you are negative, at least for having a high viral load that could be transmissible to other people.

An antigen is one of the proteins in the virus. And so unlike the PCR test, which is what most people who have received a test today have generally received a PCR test. And looking those types of tests look for the genome of the virus to RNA and you could think of RNA the same way that humans have DNA. This virus has RNA. But instead of looking for RNA like the PCR test, these antigen tests look for pieces of the protein. It would be like if I wanted a test to tell me, you know, that somebody was an individual, it would actually look for features like their eyes or their nose. And in this case, it is looking for different parts of the virus. In general, the spike protein or the nuclear capsid, these are two parts of the virus.

The reason that these antigen tests are going to be a little bit less sensitive to detect the virus molecules is because there’s no step that we call an amplification step. One of the things that makes the PCR test that looks for the virus RNA so powerful is that it can take just one molecule, which the sensor on the machine might not be able to detect readily, but then it amplifies that molecule millions and millions of times so that the sensor can see it. These antigen tests, because they’re so simple and so easy to use and just happen on a piece of paper, they don’t have that amplification step right now. And so they require a larger amount of virus in order to be able to detect it. And that’s why I like to think of these types of tests having their primary advantage to detect people with enough virus that they might be transmitting or transmissible to other people.”

The PCR test, provides a simple yes/no answer to the question of whether a patient is infected.
Source: Covid Confusion On PCR Testing: Maybe Most Of Those Positives Are Negatives.

Similar PCR tests for other viruses nearly always offer some measure of the amount of virus. But yes/no isn’t good enough, Mina added. “It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to [ignore this]” Dr. Mina said, of how contagious an infected patient may be.

We’ve been using one type of data for everything,” Mina said. “for [diagnosing patients], for public health, and for policy decision-making.”

The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although if it was, it could give them an idea of how infectious the patients are.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Any test with a cycle threshold above 35 is too sensitive, Juliet Morrison, a virologist at the University of California, Riverside told the New York Times. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less.

Another solution, researchers agree, is to use even more widespread use of Rapid Diagnostic Tests (RDTs) which are much less sensitive and more likely to identify only patients with high levels of virus who are a transmission risk.

Comment:  In other words, when they analyzed the tests that also reported cycle threshold (CT), they found that 85 to 90 percent were above 30. According to Dr. Mina a CT of 37 is 100 times too sensitive (7 cycles too much, 2^7 = 128) and a CT of 40 is 1,000 times too sensitive (10 cycles too much, 2^10 = 1024). Based on their sample of tests that also reported CT, as few as 10 percent of people with positive PCR tests actually have an active COVID-19 infection. Which is a lot less than reported.

Here is a graph showing how this applies to Canada.

It is evident that increased testing has resulted in more positives, while the positivity rate is unchanged. Doubling the tests has doubled the positives, up from 300 a day to nearly 600 a day presently.  Note these are PCR results. And the discussion above suggests that the number of persons with an active infectious viral load is likely 10% of those reported positive: IOW up from 30 a day to 60 a day.  And in the graph below, the total of actual cases in Canada is likely on the order of 13,000 total from the last 7 months, an average of 62 cases a day.

 

End Covid19 Vaccine Obsession Now

Fig. 1. The four pillars of pandemic response to COVID-19. The four pillars of pandemic response to COVID-19 are:
1) contagion control or efforts to reduce spread of SARS-CoV-2,
2) early ambulatory or home treatment of COVID-19 syndrome to reduce hospitalization and death,
3) hospitalization as a safety net to prevent death in cases that require respiratory support or other invasive therapies,
4) natural and vaccination mediated immunity that converge to provide herd immunity and ultimate cessation of the viral pandemic.

Robert Clancy explains in his Quadrant article  COVID-19: A realistic approach to community management The author is Emeritus Professor of Pathology at the University of Newcastle Medical School. He is a member of the Australian Academy of Science’s COVID-19 Expert Database.   Excerpts in italics with my bolds.

Historically pandemics generate suspicion, speculation and emotion, before logic and empiric decisions determine optimal management. The current Covid19 pandemic is no exception. Twelve months on, there is an emerging consensus supporting an integration of a four-pillar plan: public health strategies; vaccination; early pre-hospital treatment; and hospital treatment. This position replaces an early confusion, with supporting data appearing on a near daily basis.

Public Health strategies are well understood and highly effective, forming the bedrock for disease control, while hospital management is a work in progress, but with progressive improvement in outcomes. Typical data for high risk subjects (>50 years with 1 or more co-morbidities) in the USA is currently 18-20% hospitalisation, with mortality around 1%. Less attention has been given to ongoing symptoms, with about 80% of hospitalised patients having profound fatigue and/or breathlessness 3-4 months after discharge. Many are unable to return to full time work 6 months after infection control.

The area of intense disagreement is community management combining prevention by vaccine and reduction of hospital admission, using pre-hospital treatment.

There is a global expectation that vaccines will dramatically change the current face of Covid19 while there is broad based denial that any of the available (unpatented) drugs beneficially alter the natural history of infection. Expectation of a vaccine nirvana alongside therapeutic nihilism are both incorrect, although each is promoted with a vigour rooted in socio-political conviction (& supported by the Pharma industry).

The conclusion based on logic and data, is that vaccines and early treatment strategies are both necessary for optimal disease control. As a result, a community plan has been formulated, aimed at keeping patients out of hospital. Experienced physicians have developed protocols based on evidence, with sequenced multi-drug regimens that support >80% reductions in admissions to hospital and death.

Implementation of this approach would effectively end the US, UK, Canada, and EU hospitalisation crises.

The objective of this brief review is to provide argument in support of these conclusions, based on an untangling of the pathobiology of Covid19 over the last 12 months; review of the available data on the three vaccines used in the western world; and current data supporting significant benefit of pre-hospital drug treatment.

The Vaccine

The idea that a vaccine would induce sterilising immunity and therefore prevent community spread by creating herd immunity, has become the dominant political and medical story. Political, economic and social planning has been based on a sense of certainty that this will happen. This was never a likely outcome, as such success was asking more of the immune apparatus responsible for containment of a respiratory virus, than had been observed. The first principal of vaccinology has always been that a vaccine is unlikely to give better protection than does the disease itself. First cousin Corona viruses cause recurrent airways infections over many years, manifest clinically as “common colds”. Recurrent Covid19 infections have been documented during the first year of the pandemic. Mucosal immunological memory for corona viruses is predictably poor.

The objective of any Covid19 vaccine is to limit virus replication within the mucosal compartment of the airways. This requires specific activation of the mucosal immune system, which differs from systemic immunity, geared to protect the internal spaces of the body. Blood antibody levels characterise the systemic immune response. These antibodies are very effective at neutralising virus that passes through the blood stream in its normal course of infection, such as the measles or mumps virus. These vaccines readily induce sterilising immunity.

The relevance of this immune machinery to Covid19 vaccines can be summarised:

  •  the systemic and mucosal immune compartments communicate poorly, with minimal mixing. Some mixing occurs in regions such as the nasal cavity and the alveolar space as demonstrated by injected pneumococcal vaccines where IgG antibody from blood can inhibit pneumocooci in the nose and the gas exchange apparatus of the lungs and thus protect from ear infections and pneumonia. This may explain the high level of “PCR-ve Covid19 infections” (that is, apparent clinical infection by Covid19 virus, but with a negative laboratory test in the mRNA trials, as discussed below. 
  • mucosal immune responses to the virus are transient.
  • immune senescence at a mucosal level is marked.

Three vaccines have been released in the US and UK after limited observation and review due to the dramatic circumstances of the pandemic. . . The outcome of these reviews suggest that little difference exists between the three vaccines.  To summarise current position with vaccines;

  • Little protection against infection occurs, although protection against symptomatic disease is significant, but is likely to be far less than 90%. It remains to be demonstrated whether this translates into protection against admission to hospital, & mortality since this was not the case in 2 months of follow-up with the mRNA vaccines. The duration of protection and level of protection in high risk individuals over time, need to be monitored. The likely outcome is that vaccines push the disease profile towards asymptomatic infection, rather than induce any discrete sterilising immune state. It is unhelpful and risky to attempt to choose between available vaccines until far more data becomes available.
  • Re-infection in vaccinated subjects appears to occur at a similar rate as it does for community non-vaccinated controls.
  • There is no realistic chance of herd immunity, given the high rate of asymptomatic infections in vaccinated individuals. This becomes more probable should the current intention of about 30% of the population (US figures) to not be vaccinated irrespective of advice given, be accurate. In Australia, every encouragement should support over 90% vaccination, with whatever of the available vaccines are available: dissention and argument over “false news” undermines this endeavour. In other words, though immunity with Covid19 vaccination appears to be neither complete nor durable, any chance of approaching “herd immunity” depends on a near 100% vaccination rate. Time will give answers to the critical questions, and vaccines still in trials, may be a better choice in the longer run. None of the “clever” delivery systems have yet proved to be an advantage over traditional (or 21st century variations) adjuvenated split vaccines (other than for those who own the patent).
  • It can be predicted that endemic spread of the virus throughout the population will occur. The observations in the UK trial of high levels of asymptomatic infection, and “Diagnostic Test Negative” infections in the Pfizer study, focus attention on confirming the dynamics of asymptomatic infection post vaccination, and the degree of transmission in the community, from that source. Data on these critical issues is limited.
  • There is a potential danger that as vaccination levels increase, but remain short of comprehensive cover, virus could spread with “hotspots” difficult to identify. Such spread could promote the emergence of resistant strains.The worst scenario would be an increase in mortality due to spread from unrecognised vaccinated subjects with asymptomatic infection, to those without vaccination protection. On this, current data is scanty, indicating about 20% of Covid19 infections are asymptomatic, but that the infectivity of these, is reduced, perhaps 3-4 fold. Similar data in the post-vaccine world will be of central importance.
Early Drug Treatment

It could be summarised that in a “Post Truth World’, those with Covid19 disease are denied safe, effective treatment which if given early can reduce admission to hospital and death. The main purpose of the comments to follow, is to show that the data have moved on, and that science-based decisions can and must be made if lives are to be saved. Two drugs are effective: hydroxychloroquine (HCQ), and ivermectin (IVM) with most effective trials including nutraceutical, zinc and intracellular antibiotics. These antivirals have been available as antimicrobial drugs for many years. Their antiviral activity is due to intracellular processes that inhibit virus assemblage – HCQ reduces acidity within cytoplasmic vesicles, and IVM blocks communication between the cytoplasm and the nucleus, while both have many sites of action that impair the inflammatory response.

The basic principal in treating viral infections is to treat early. This is well established for all virus therapy including acyclovir treatment for shingles, herpes simplex infections, and neuraminidase inhibitors in influenza. The same principal applies to treatment of Covid19. Treatment during the first “virus dominant” phase is directed at reducing the viral load within the mucosal compartment, while in the second phase treatment aims at inhibition of the damaging inflammatory response. Patients with significant second phase disease are usually in hospital, and treated with organ support, anticoagulation and anti-inflammatory drugs.

The data base supporting the value of early treatment of Covid19 disease is so strong, that it is hard to understand the current philosophy of “wait until you are sick enough, then go to hospital” (The question I put to naysayers is “would you give or not give HCQ or IVM to your grandparent with early Covid19 disease in an Australian aged care facility?”). Suggested reasons for unscientific denial include: ideological unmovable mind sets; a rapidly evolving pandemic where new data appears on a daily basis making it hard to keep up with the data flow; failure to understand the value of non RCT data sets which from a scientific and ethical viewpoint are appropriate to the circumstances of a pandemic; and a total focus on an anticipated Covid-free world following the release of vaccines.

The RCT mantra selectively used against HCQ and IVM is cynical, given the experience with Remdesivir. This antiviral agent has been tried in the treatment of Covid19 and was shown in a RCT to reduce time in hospital by 4 days, with no reduction in mortality. On this scanty evidence it was rushed through the regulatory process. Although three additional RCTs failed to confirm this slight benefit, it continues to be used at around A$4,000 a course, with many significant side effects.

Review of clinical studies in early (pre-hospital) disease as at end of November 2020 illustrate the data:

  • All 27 trials of HCQ showed protection (OR 0.37 (0.29-0.47)). 10 of these were RCT (OR 0.71 (0.54-0.95)) (the Odds Ratio , or OR of , say, 0.37, means “63% protection”, and 0.71 would be “29% protection”). The figures in ( ) are the 95% confidence levels: if <1.0, this is equivalent to {at least } a P value <0.05) (P value refers to probability of result being by chance. A value of 0.05 means a 1 in 20 chance that it is “by chance”, with that level taken as reflecting a significant observation).
  • 26 of 32 prophylaxis studies using HCQ showed protection (OR for 5 post exposure studies: 0.61 (0.4-0.74))
  • IVM in 8 studies, half of which were RCT, showed protection in early treatment studies (OR 0.28(0.13-0.59) P=0.004)

As this clinical data continues to accumulate, regions around the world are adopting therapy with HCQ or IVM with dramatic results, when compared to adjoining areas that have not adopted this therapy. This has been marked in regions in Brazil.

The incidence and mortality of Covid19 in the US and Europe is of crushing proportions with no end in sight. . . Planning on the basis that all this will change following introduction of vaccines, needs reassessment, as early review of trial data, while showing short term protection from significant symptomatic disease, must be tempered by evidence that infection is little reduced when asymptomatic and “PCR-ve Covid19” (a negative test for virus on a nasal swab) cases are counted. . . Uncertainties regarding the capacity of current vaccines to attain herd immunity due to continued asymptomatic infection, dictate that additional measures to reduce the impact of the pandemic must be put in place.

Two drugs used early in disease reduce admission into hospital and death, including in those considered high-risk subjects, and they go a significant way to filling this need: HCQ and IVM. Both can be used as prophylactic or therapeutic medications. From uncertain beginnings, an impressive data base has more recently accumulated, that strongly supports the use of HCQ and/or IVM. Their use in concert with vaccines can no longer be denied; indeed this is the only science-based option.

Background from previous post Why Pandemic Responses Fail

As reported in the journal Reviews in Cardiovascular Medicine, Top US medics recommend ‘sequenced multidrug therapy’ including HCQ & Ivermectin, for early high-risk COVID-19 infections (source Palmer Foundation).  Bureaucratic public health officials obsessed with top-down, high-tech solutions have failed to provide citizens with the most important pillar: advice and the means to treat themselves and take charge of their own health care.  Excerpts in italics with my bolds.

The pandemic of SARS-CoV-2 (COVID-19) is advancing unabated across the world with each country and region developing distinct epidemiologic patterns in terms of frequency, hospitalization, and death. There are four pillars to an effective pandemic response:
1) contagion control,
2) early treatment,
3) hospitalization, and
4) vaccination to assist with herd immunity (Fig. 1).

Additionally, when feasible, prophylaxis could be viewed as an additional pillar since it works to reduce the spread as well as the incidence of acute illness.

Many countries have operationalized all four pillars including the second pillar of early home-based treatment with distributed medication kits of generic medications and supplements as shown in Table 1.

In the US, Canada, United Kingdom, Western European Union, Australia, and some South American Countries there have been three major areas of focus for pandemic response:
1) containment of the spread of infection (masking, social distancing, etc.,
2) late hospitalization and delayed treatments (remdesivir, convalescent plasma, antiviral antibodies), and
3) vaccine development (Bhimraj et al., 2020; COVID-19 Treatment Guidelines, 2020).

Thus the missing pillar of pandemic response is early home-based treatment (as seen in Fig. 1).

The current three-pronged approach has missed the predominant opportunity to reduce hospitalization and death given the practice of directing patients to self-isolation at home. Early sequential multidrug therapy (SMDT) is the only currently available method by which hospitalizations and possibly death could be reduced in the short term (McCullough et al., 2020a).

Innovative SMDT regimens forCOVID-19 utilize principles learned from hospitalized patients as well as data from treated ambulatory patients.

For the ambulatory patient with recognized signs and symptoms of COVID-19 on the first day (Fig. 2), often with nasal real-time reverse transcription or oral antigen testing not yet performed, the following three therapeutic principles apply (Centers for Disease Control and Prevention, 2020) :

1) combination anti-infective therapy to attenuate viral replication,
2) corticosteroids to modulate cytokine storm, and
4) antiplatelet agent/antithrombotic therapy to prevent and manage micro- or overt vascular thrombosis.

For patients with cardinal features of the syndrome (fever, viral malaise, nasal congestion, loss of taste and smell, dry cough, etc) with pending or suspected false negative testing, therapy is the same as those with confirmed COVID-19.

Fig. 3. Sequential multidrug treatment algorithm for ambulatory acute COVID-19 like and confirmed COVID-19 illness in patients in self-quarantine. Yr = year, BMI = body mass index, Dz = disease, DM = diabetes mellitus, CVD = cardiovascular disease, chronic kidney disease, HCQ = hydroxychloroquine, IVM = ivermectin, Mgt = management, Ox = oximetry, reproduced with permission from reference.

Summary

The SARS-CoV-2 outbreak is a once in a hundred-year pandemic that has not been addressed by rapid establishment of infrastructure amenable to support the conduct of large, randomized trials in outpatients in the community setting.

The early flu-like stage of viral replication provides a therapeutic window of tremendous opportunity to potentially reduce the risk of more severe sequelae in high risk patients. Precious time is squandered with a “wait and see” approach in which there is no anti-viral treatment as the condition worsens, possibly resulting in unnecessary hospitalisation, morbidity, and death.

Once infected, the only means of preventing a hospitalization in a high-risk patient is to apply treatment before arrival of symptoms that prompt paramedic calls or emergency room visits. Given the current failure of government support for randomized clinical trials evaluating widely available, generic, inexpensive therapeutics, and the lack of instructive out-patient treatment guidelines (U.S., Canada, U.K., Western EU, Australia, some South American Countries), clinicians must act according to clinical judgement and in shared decision making with fully informed patients.

Early SMDT developed empirically based upon pathophysiology and evidence from randomized data and the treated natural history of COVID-19 has demonstrated safety and efficacy.

In newly diagnosed, high-risk, symptomatic patients with COVID-19, SMDT has a reasonable chance of therapeutic gain with an acceptable benefit-to-risk profile.

Until the pandemic closes with population-level herd immunity potentially augmented with vaccination, early ambulatory SMDT should be a standard practice in high risk and severely symptomatic acute COVID-19 patients beginning at the onset of illness.

Authors:

Peter A. McCullough, Paul E. Alexander, Robin Armstrong, Cristian Arvinte, Alan F. Bain, Richard P. Bartlett, Robert L. Berkowitz, Andrew C. Berry, Thomas J. Borody, Joseph H. Brewer, Adam M. Brufsky, Teryn Clarke, Roland Derwand, Alieta Eck, John Eck, Richard A. Eisner, George C. Fareed, Angelina Farella, Silvia N. S. Fonseca, Charles E. Geyer Jr., Russell S. Gonnering, Karladine E. Graves, Kenneth B. V. Gross, Sabine Hazan, Kristin S. Held, H. Thomas Hight, Stella Immanuel, Michael M. Jacobs, Joseph A. Ladapo, Lionel H. Lee, John Littell, Ivette Lozano, Harpal S. Mangat, Ben Marble, John E. McKinnon, Lee D. Merritt, Jane M. Orient, Ramin Oskoui, Donald C. Pompan, Brian C. Procter, Chad Prodromos, Juliana Cepelowicz Rajter, Jean-Jacques Rajter, C. Venkata S. Ram, Salete S. Rios , Harvey A. Risch, Michael J. A. Robb, Molly Rutherford, Martin Scholz, Marilyn M. Singleton, James A. Tumlin, Brian M. Tyson, Richard G. Urso, Kelly Victory, Elizabeth Lee Vliet, Craig M. Wax, Alexandre G. Wolkoff, Vicki Wooll, Vladimir Zelenko. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19). Reviews in Cardiovascular Medicine, 2020, 21(4): 517-530.

Guess Who’s Kicking the Pandemic? (it’s not EU, US or Canada)

TrialSiteNews gives the answer in article An Unlikely Nation Is Kicking This Pandemic. Guess Which. Then Why. Excerpts in italics with my bolds.

She is a gynecologist. He is a surgeon. They are married and both 77 years old.

In mid-November, they were diagnosed with COVID-19, first her, then him. Their paths diverge at this point, but not to worry.

She took the drug hydroxychloroquine. He took ivermectin. They are both well now – walking, golfing, doing yoga — seven weeks later.

The couple’s brush with COVID might have ended very differently. In the United States, patients 75 to 84 years old die at 220 times the rate of adults under 30. But these two elderly, otherwise healthy physicians live in India. They were able to get early home treatment that is virtually, and unconscionably, unheard of in many western countries.

“Without any treatment, we know that the virus enters the cells and replicates there,” Dr. Makarand Paranjpe told me by phone from his home in Pune, where he had quarantined through a fever and other symptoms. “They can create disease that gets much more severe.” Which, of course, is the point of treating early. Stop the progression. ASAP.

From the outset, India, a nation of both economic vigor and poverty, knew it had to act decisively. It did. India locked down early and long; it promoted masks, tested millions, and, as with the Pune couple, treated the infected early.

Ten months into its battle with the SARS-CoV-2 virus, India is on track to become an unexpected warrior in the fight against this global pandemic. Although the densely populated nation has four times the population of the U.S., India has less than half the U.S. COVID deaths. And India isn’t just beating the poorly performing U.S. In all, 98 nations have higher death rates than India.

It may be tempting to attribute this startling news to imperfect data from a developing country. But doctors in India, Indian press reports, and even the Wall Street Journal have taken note of a sea change in COVID there. “In September, India was reporting almost 100,000 COVID-19 cases a day, with many predicting it would soon pass the U.S. in overall cases,” the WSJ wrote on Dec. 30. “Instead, its infections dropped and are now at one-fourth that level.”

Dr. Anil K. Chaurasia, a physician in Lucknow, in the state of Uttar Pradesh, watched this trend unfold. Starting about mid-September, “a clear decline in COVID cases and fatalities in India was noticeable,” he told me in a text message. The “steep decline in cases and fatalities is still continuing.”

Like a lot of western reporting, the WSJ article held fast to an accepted COVID theme. The Indian miracle was due to masks, it asserted, since they are worn by 88 to 95 percent of a population “bombarded” with public-service reminders. The article cited German research that showed masks work.

Fair enough. However, many factors are likely at play in India, including its painful yet supported national shutdown and individual state efforts at contact tracing and testing. But a pivotal role in any illness is surely the availability of treatments to resolve illness before crisis.

Late last March, as the U.S. argued over the merits of Trump-endorsed hydroxychloroquine and studies failed in late-stage patients, India decided to recommend the drug in its national guidelines. HCQ “should be used as early in the disease course as possible…and should be avoided in patients with severe disease,” the directives wisely state. As a precaution, authorities suggested an EKG to monitor for a rare heart arrhythmia that several COVID studies have since shown to be minimal.

But a crucial turn for India may have come in August when the Indian state of Uttar Pradesh recommended use of another drug: Ivermectin, which is coming on fast as a leading COVID treatment — without the baggage of at-turns effective but vilified hydroxychloroquine.

This was no small move. Were it a country, U.P.’s more than 230 million citizens would rank it fifth worldwide. As India’s largest state, its embrace of ivermectin may have changed the treatment landscape across India.

“This authentication of ivermectin revived the faith of people,” Dr. Chaurasia told me, “and net result was a massive inclination to take these drugs” — both ivermectin and hydroxychloroquine.

By the end of 2020, Uttar Pradesh — which distributed free ivermectin for home care — had the second-lowest fatality rate in India at 0.26 per 100,000 residents in December. Only the state of Bihar, with 128 million residents, was lower, and it, too, recommends ivermectin.

See Also:  Why Pandemic Responses Fail

 

 

Why Pandemic Responses Fail

Fig. 1. The four pillars of pandemic response to COVID-19. The four pillars of pandemic response to COVID-19 are:
1) contagion control or efforts to reduce spread of SARS-CoV-2,
2) early ambulatory or home treatment of COVID-19 syndrome to reduce hospitalization and death,
3) hospitalization as a safety net to prevent death in cases that require respiratory support or other invasive therapies,
4) natural and vaccination mediated immunity that converge to provide herd immunity and ultimate cessation of the viral pandemic.

As reported in the journal Reviews in Cardiovascular Medicine, Top US medics recommend ‘sequenced multidrug therapy’ including HCQ & Ivermectin, for early high-risk COVID-19 infections (source Palmer Foundation).  Bureaucratic public health officials obsessed with top-down, high-tech solutions have failed to provide citizens with the most important pillar: advice and the means to treat themselves and take charge of their own health care.  Excerpts in italics with my bolds.

The pandemic of SARS-CoV-2 (COVID-19) is advancing unabated across the world with each country and region developing distinct epidemiologic patterns in terms of frequency, hospitalization, and death. There are four pillars to an effective pandemic response:
1) contagion control,
2) early treatment,
3) hospitalization, and
4) vaccination to assist with herd immunity (Fig. 1).

Additionally, when feasible, prophylaxis could be viewed as an additional pillar since it works to reduce the spread as well as the incidence of acute illness.

Many countries have operationalized all four pillars including the second pillar of early home-based treatment with distributed medication kits of generic medications and supplements as shown in Table 1.

In the US, Canada, United Kingdom, Western European Union, Australia, and some South American Countries there have been three major areas of focus for pandemic response:
1) containment of the spread of infection (masking, social distancing, etc.,
2) late hospitalization and delayed treatments (remdesivir, convalescent plasma, antiviral antibodies), and
3) vaccine development (Bhimraj et al., 2020; COVID-19 Treatment Guidelines, 2020).

Thus the missing pillar of pandemic response is early home-based treatment (as seen in Fig. 1).

The current three-pronged approach has missed the predominant opportunity to reduce hospitalization and death given the practice of directing patients to self-isolation at home. Early sequential multidrug therapy (SMDT) is the only currently available method by which hospitalizations and possibly death could be reduced in the short term (McCullough et al., 2020a).

Innovative SMDT regimens forCOVID-19 utilize principles learned from hospitalized patients as well as data from treated ambulatory patients.

For the ambulatory patient with recognized signs and symptoms of COVID-19 on the first day (Fig. 2), often with nasal real-time reverse transcription or oral antigen testing not yet performed, the following three therapeutic principles apply (Centers for Disease Control and Prevention, 2020) :

1) combination anti-infective therapy to attenuate viral replication,
2) corticosteroids to modulate cytokine storm, and
4) antiplatelet agent/antithrombotic therapy to prevent and manage micro- or overt vascular thrombosis.

For patients with cardinal features of the syndrome (fever, viral malaise, nasal congestion, loss of taste and smell, dry cough, etc) with pending or suspected false negative testing, therapy is the same as those with confirmed COVID-19.

Fig. 3. Sequential multidrug treatment algorithm for ambulatory acute COVID-19 like and confirmed COVID-19 illness in patients in self-quarantine. Yr = year, BMI = body mass index, Dz = disease, DM = diabetes mellitus, CVD = cardiovascular disease, chronic kidney disease, HCQ = hydroxychloroquine, IVM = ivermectin, Mgt = management, Ox = oximetry, reproduced with permission from reference.

Summary

The SARS-CoV-2 outbreak is a once in a hundred-year pandemic that has not been addressed by rapid establishment of infrastructure amenable to support the conduct of large, randomized trials in outpatients in the community setting.

The early flu-like stage of viral replication provides a therapeutic window of tremendous opportunity to potentially reduce the risk of more severe sequelae in high risk patients. Precious time is squandered with a “wait and see” approach in which there is no anti-viral treatment as the condition worsens, possibly resulting in unnecessary hospitalisation, morbidity, and death.

Once infected, the only means of preventing a hospitalization in a high-risk patient is to apply treatment before arrival of symptoms that prompt paramedic calls or emergency room visits. Given the current failure of government support for randomized clinical trials evaluating widely available, generic, inexpensive therapeutics, and the lack of instructive out-patient treatment guidelines (U.S., Canada, U.K., Western EU, Australia, some South American Countries), clinicians must act according to clinical judgement and in shared decision making with fully informed patients.

Early SMDT developed empirically based upon pathophysiology and evidence from randomized data and the treated natural history of COVID-19 has demonstrated safety and efficacy.

In newly diagnosed, high-risk, symptomatic patients with COVID-19, SMDT has a reasonable chance of therapeutic gain with an acceptable benefit-to-risk profile.

Until the pandemic closes with population-level herd immunity potentially augmented with vaccination, early ambulatory SMDT should be a standard practice in high risk and severely symptomatic acute COVID-19 patients beginning at the onset of illness.

Authors:

Peter A. McCullough, Paul E. Alexander, Robin Armstrong, Cristian Arvinte, Alan F. Bain, Richard P. Bartlett, Robert L. Berkowitz, Andrew C. Berry, Thomas J. Borody, Joseph H. Brewer, Adam M. Brufsky, Teryn Clarke, Roland Derwand, Alieta Eck, John Eck, Richard A. Eisner, George C. Fareed, Angelina Farella, Silvia N. S. Fonseca, Charles E. Geyer Jr., Russell S. Gonnering, Karladine E. Graves, Kenneth B. V. Gross, Sabine Hazan, Kristin S. Held, H. Thomas Hight, Stella Immanuel, Michael M. Jacobs, Joseph A. Ladapo, Lionel H. Lee, John Littell, Ivette Lozano, Harpal S. Mangat, Ben Marble, John E. McKinnon, Lee D. Merritt, Jane M. Orient, Ramin Oskoui, Donald C. Pompan, Brian C. Procter, Chad Prodromos, Juliana Cepelowicz Rajter, Jean-Jacques Rajter, C. Venkata S. Ram, Salete S. Rios , Harvey A. Risch, Michael J. A. Robb, Molly Rutherford, Martin Scholz, Marilyn M. Singleton, James A. Tumlin, Brian M. Tyson, Richard G. Urso, Kelly Victory, Elizabeth Lee Vliet, Craig M. Wax, Alexandre G. Wolkoff, Vicki Wooll, Vladimir Zelenko. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19). Reviews in Cardiovascular Medicine, 2020, 21(4): 517-530.

 

Primary Viral Defensive Care in the New Year

The medical story and advice comes from Swiss Policy Research article On the Treatment of Covid-19.  This is what primary care physicians are recommending in many parts of the world, and what should be the generally accepted practice everywhere.  Excerpts in italics with my bolds.

Based on the available scientific evidence and current clinical experience, the SPR Collaboration recommends that physicians and authorities consider the following covid-19 treatment protocol for the prophylactic and early treatment of people at high risk or high exposure.

Numerous international studies have shown that prophylactic and early treatment can significantly reduce the risk of severe or fatal covid-19 (see scientific references in linked article).

Note: Patients are asked to consult a doctor.

Treatment protocol

Prophylaxis

  • Zinc (25mg to 50mg per day)
  • Quercetin (250mg to 500mg per day)
  • Bromhexine (24mg to 36mg per day)*
  • Vitamin D (2000 IU per day)
  • Vitamin C (1000mg per day)

Early treatment

  • Zinc (75mg to 150mg per day)
  • Quercetin (500mg to 1000mg per day)
  • Vitamins D (5000 u/d) and C (1000mg/d)
  • Bromhexine (50mg to 100mg per day)*
  • Aspirin (162mg to 325mg per day)*

Prescription only

  • Ivermectin (12mg per day for 2 days)*
  • High-dose vitamin D (up to 100,000 IU)
  • Azithromycin (up to 500mg per day)
  • Prednisone (60mg to 80mg per day)*
  • Hydroxychloroquine (400mg per day)*

(*) Notes:

Contraindications for aspirin and bromhexine must be observed. Ivermectin may also be used prophylactically on a weekly basis. Prednisone is to be used if pulmonary symptoms develop. Correctly dosed HCQ has been shown to be effective and safe for the early treatment of covid-19.

Modes of action
  • Zinc inhibits RNA polymerase activity of coronaviruses and thus blocks virus replication, as first discovered by world-leading SARS virologist Ralph Baric in 2010.
  • Ivermectin (an antiparasitic drug) has strong anti-viral and anti-inflammatory properties.
  • Quercetin (a plant polyphenol) supports the cellular absorption of zinc and has additional anti-viral properties, as first discovered during the SARS-1 epidemic in 2003.
  • Bromhexine (a mucolytic cough medication) inhibits the expression of cellular TMPRSS2 protease and thus the entry of the virus into the cell, as first described in 2017.
  • Vitamins C and D support and improve the immune system response to infections.
  • Aspirin may help prevent infection-related thrombosis and embolisms in patients at risk.
  • Azithromycin (an antibiotic) prevents bacterial superinfections of the lung.
  • Prednisone (a corticosteroid) reduces covid-related systemic inflammation.
  • HCQ has known anti-viral, anti-thrombotic and anti-inflammatory properties.
Summary

The early treatment of patients as soon as the first typical symptoms appear and even without a PCR test is essential to prevent progression of the disease. In contrast, isolating infected high-risk patients at home and without early treatment until they develop serious respiratory problems, as often happened during lockdowns, may be counterproductive.

People at high risk living in an epidemically active area should consider prophylactic treatment together with their doctor. The reason for this is the long incubation period of covid-19 (up to 14 days): when patients first notice that they contracted the disease, the viral load is already at a maximum and there are often only a few days left to react with an early treatment intervention.

Early treatment based on the above protocol is intended to avoid hospitalization. If hospitalization nevertheless becomes necessary, experienced ICU doctors recommend avoiding invasive ventilation (intubation) whenever possible and using oxygen therapy (HFNC) instead.

It is conceivable that the above treatment protocol, which is simple, safe and inexpensive, could render more complex medications, vaccinations, and other measures largely obsolete.

Footnote: New Ivermectin Results

WHO-commissioned review of ivermectin trials finds 83% reduction in covid mortality.

Dr Andrew Hill of the Department of Pharmacology at the University of Liverpool (UK) is currently performing a WHO-commissioned review and meta-analysis of randomized controlled trials of ivermectin against covid. In the following 12-minute video, Dr Hill is presenting his preliminary results, which confirm a highly significant 83% reduction in covid mortality (95% CI 65%-92%).

This result is based on in-hospital trials, so it doesn’t even take into account early ambulatory and prophylactic treatment. The WHO now wants to wait for three more trials, due to be published sometime in January, before issuing an official recommendation. At the end of his presentation, Dr Hill speaks of ivermectin as a potentially “transformational treatment”.

Note: Use video setting to select english subtitles.

My Comment

I wouldn’t presume to judge winners and losers among societies coping with this strange virus: so infectious and not dangerous to most people while deadly to some. I do note that the response was different in more remote and poorer places. Treatment decisions were taken by doctors close to their sick patients, without the burden of bureaucracies obsessed with high tech Big Pharma silver bullet vaccines. Physicians in many parts of the world scrambled to provide anti-viral medicines and immune-enhancing nutritional supplements, whatever they could get their hands on. An example is Dominican Republic, small island nation depending on tourism, so not isolated. Dr. Redondo:

“After eight months of active clinical observation and attending about 7 thousand patients of Covid-19 in three medical centers located in Puerto Plata, La Romana, and Punta Cana, Dr. José Natalio Redondo revealed that 99.3% of the symptomatic patients who received care in his emergency services, including the use of Ivermectin, managed to recover in the first five days of recorded symptoms.”

“The renowned cardiologist and health manager affirmed that Ivermectin’s use against the symptoms of Covid-19 is practically generalized in the country and attributed to this factor, among others, the fact that the risk of dying from this disease in the Dominican Republic is significantly lower than in the United States.”

He added that “in a therapeutic format duly tested over the years, infections have always been cured faster and leave fewer sequelae if antimicrobial treatment is applied as early as possible since this allows the use of lower doses of the selected drugs. This has been one of the dogmas that remain in our daily medical practice.”

“From the beginning, our team of medical specialists, who were at the forefront of the battle, led by our emergency physicians, intensivists and internists, raised the need to see this disease in a different way than that proposed by international health organizations,” says Dr. Redondo in his report.

And he adds that the Group’s experts proposed the urgency of reorienting the management protocols towards earlier and more timely stages. “We realized that the war was being lost because of the obsession of large groups, agencies, and companies linked to research and production of drugs, to focus their interest almost exclusively on the management of critical patients.

“Our results were immediate; the use of Ivermectin, together with Azithromycin and Zinc (plus the usual vitamins that tend to increase the immune response of individuals) produced an impressive variation in the course of the disease; it was demonstrated that 99.3% of the patients recovered quickly when the treatment was started in the first five days of proven symptoms, with an average of 3.5 days, and a fall of more than 50% in the rate and duration of hospitalizations, and reducing from 9 to 1 the mortality rate, when the treatment was started on time.”

This is not about HCL or Ivermectin. In any society family physicians and local clinics are the key to preventative medicine. For Covid, so-called “advanced” societies ruled out safe, effective, inexpensive and available treatments that made the contagion manageable.

But the successes of such unsung heroes in many far away places are also ruled out of social media and 24/7 cable news.

See also: The Case for Ivermectin Covid Regimen

 

 

Xmas 2020: Twelve Forgotten Principles of Public Health

Dr. Martin Kulldorff, PhD, is a Professor of Medicine at Harvard Medical School. His research centers on developing new epidemiological and statistical methods for the early detection and monitoring of infectious disease outbreaks and for post-market drug and vaccine safety surveillance. This holiday gift remembrance is collected from Dr. Kulldorff’s twitter thread courtesy of AIER, which also includes links to articles adding depth to the 12 points. Tweets in italics with my bolds.

  1. Public health is about all health outcomes, not just a single disease like Covid-19. It is important to also consider harms from public health measures. More.

  2. Public health is about the long term rather than the short term. Spring Covid lockdowns simply delayed and postponed the pandemic to the fall. More.

  3. Public health is about everyone. It should not be used to shift the burden of disease from the affluent to the less affluent, as the lockdowns have done. More.

  4. Public health is global. Public health scientists need to consider the global impact of their recommendations. More.

  5. Risks and harms cannot be completely eliminated, but they can be reduced. Elimination and zero-Covid strategies backfire, making things worse. More.

  6. Public health should focus on high-risk populations. For Covid-19, many standard public health measures were never used to protect high-risk older people, leading to unnecessary deaths. More.

  7. While contact tracing and isolation are critically important for some infectious diseases, it is futile and counterproductive for common infections such as influenza and Covid-19. More.

  8. A case is only a case if a person is sick. Mass testing asymptomatic individuals is harmful to public health. More.

  9. Public health is about trust. To gain the trust of the public, public health officials and the media must be honest and trust the public. Shaming and fear should never be used in a pandemic. More.

  10. Public health scientists and officials must be honest with what is not known. For example, epidemic models should be run with the whole range of plausible input parameters. More.

  11. In public health, open civilized debate is profoundly critical. Censoring, silencing and smearing leads to fear of speaking, herd thinking and distrust. More.

  12. It is important for public health scientists and officials to listen to the public, who are living the public health consequences. This pandemic has proved that many non-epidemiologists understand public health better than some epidemiologists. More.

Dr. Martin Kulldorff

Pandemic of Misinformation

Update: Quote of the Day Dec. 23, 2020

“It’s a vaccine so safe we must be forced to take it, to fight a disease so severe we don’t know we have it without being tested.”

Scott Atlas explains at Wall Street Journal A Pandemic of Misinformation.  Excerpts in italics with my bolds.

The media’s politicization of Covid has proved deadly and puts Americans’ freedoms at risk.

America has been paralyzed by death and fear for nearly a year, and the politicization of the pandemic has made things worse by adding misinformation and vitriol to the mix. With vaccines finally being administered, we should be entering a joyous phase. Instead we endure still more inflammatory rhetoric and media distortion.

Americans need to understand three realities. First, all 50 states independently directed and implemented their own pandemic policies. In every case, governors and local officials were responsible for on-the-ground choices—every business limit, school closing, shelter-in-place order and mask requirement. No policy on any of these issues was set by the federal government, except those involving federal property and employees.

Second, nearly all states used the same draconian policies that people now insist on hardening, even though the number of positive cases increased while people’s movements were constrained, business activities were strictly limited, and schools were closed. Governors in all but a few states—Florida and South Dakota are notable exceptions—imposed curfews, quarantines, directives on group gatherings, and mask mandates.

Mobility tracking verifies that people restricted their movement. Gallup and YouGov data show that 80% to 90% of Americans have been wearing masks since early August. Lockdown policies had baleful effects on local economies, families and children, and the virus spread anyway. If one advocates more lockdowns because of bad outcomes so far, why don’t the results of those lockdowns matter?

Third, the federal government’s role in the pandemic has been grossly mischaracterized by the media and their Democratic allies. That distortion has obscured several significant successes, while undermining the confidence of ordinary Americans. Federal financial support and directives enabled the development of a massive, state-of-the-art testing capacity and produced billions of dollars of personal protective equipment. Federal agencies met all requests for supplemental medical personnel and hospital-bed capacity. Officials in the Health and Human Services Department have told me there are no unmet requests for extra resources.

The federal government also increased the protection of the elderly during late summer and fall. This effort included an intensive testing strategy for nursing-home staff and residents based on community activity, new proactive warnings to the highest-risk elderly living independently, millions of point-of-care tests and extra personal protective equipment for senior living facilities, and new alliances and financial incentives to improve nursing home infection control.

The federal government also expedited development and delivery of lifesaving drugs, such as novel antibody treatments that reduce hospitalizations of high-risk elderly by more than 70%. According to HHS, more than 200,000 doses of these monoclonal-antibody drugs have been delivered to hospitals in all 50 states. Under Operation Warp Speed, the federal government took nearly all the risk away from private pharmaceutical companies and delivered highly effective vaccines, hitting all promised timelines.

In this season when respiratory virus illnesses become more common and people move indoors to keep warm, many states are turning to more severe restrictions on businesses and outdoor activities. Yet empirical data from the U.S., Europe and Japan show that lockdowns don’t eliminate the virus and don’t stop the virus from spreading. They do, however, create extremely harmful health and social problems beyond a dramatic drop in learning, including a tripling of reported depression, skyrocketing suicidal ideation, unreported child abuse, skipped visits for cancer and other medical care.

It adds up to a future health disaster. “For younger people, the lockdowns are so harmful, so deadly, there’s really no good justification,” says Stanford’s Jay Bhattacharya, especially when considering their extremely low risk from Covid-19.

States and cities that keep their economies locked down after highly vulnerable populations have been vaccinated will be doubling down on failed policies that are destroying families and sacrificing children, particularly among the working class and poor.

The media has done its best to misinform the public with political attacks about who is to blame for this pain and misery even as it diminishes the great achievement of the new vaccines. The decline of objectivity in journalism has been evident for years. Now we see that even respected scientific journals, which are supposed to vet and publish the best objective research, have been contaminated by politics. Social media has become the arbiter of allowable discussion, while universities intimidate and suppress the free exchange of ideas necessary to uncover scientific truths.

It is not at all clear that American society with its cherished freedoms will survive, regardless of our success in defeating the pandemic threat.

Dr. Atlas served from August through November as a special adviser to the president.

See Also Science Says: Media Covid Coverage Driving US Crazy

Covid Masquerade