Tuesday, March 17, 2020

Hydroxychloroquine, COVID-19, and Lupus

Researchers are taking seriously the use of hydroxychloroquine for COVID-19 therapy:
Both chloroquine and hydroxychloroquine inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [75].
I think saw a post somewhere that claimed it interferes with viral replication inside infected lung tissue but I can't find it now.

That's obviously great if it works out.

If it does work out though, it might be worth looking again at old (and still current) ideas that rheumatic disorders that response to hydroxychloroquine (esp. SLE, RA) are infectious in origin. Maybe an RNA virus ...

Sunday, March 15, 2020

Exercise and sanity in the time of you-know-what

Fellow exercise addicts -- let's examine our options...
  1. Trail, road, gravel biking. Extreme aerosol diffusion. Antiviral ultraviolet radiation built in. Social distance built in. Definite good. Buy your gravel bike now before they're all gone, but any road bike will do. Start commuting by bike.
  2. Mountain biking. Same, but different bike.
  3. Running. Hard to be less social. Trail runs nicer. For St Paul MN -- Battle Creek!
  4. Garage Gym. Get that car out of there. Who cares about cars anyway? Bench, bar, weights, programming from your local CrossFit franchise. Get some friends together at a distance (byob).
  5. Your local CrossFit ... class sizes will be smallish. Open the big doors and spread outside where the air flow is amazing. Dress for the occasion. Learn to love open air deadlift and those $!$^@ runs and rows and such.
  6. Golf. Chase (Tim) wants this. Lots of social distance! Don't share clubs :-).
  7. Lake swimming. Cold in MN March, but eventually ...
  8. Inline Skating! Time for a comeback. Get those blades out of the attic. Airflow, etc. Join the Facebook Minnesota Inline Skate Club Group.
  9. Hiking. Slow trail running for the win.
  10. Rock climbing outdoors. Sweat and blood do not transmit. Maybe don't spit on the rope?
  11. Paddling! Canoe, Kayak -- air flow, social distancing, perfect.
  12. Fishing -- not much exercise, but good for sanity.
  13. Tennis -- don't spit on the ball.
Things governments should do to help morale:

  1. Free fishing licenses!
  2. Waive state park fees.

Friday, March 13, 2020

COVID-03 and COVID-19: influenza co-infection and multiple strains

I remember COVID-03 (Coronavirus disease 2003, known then as SARS) caused by Novel Coronavirus 1 (SARS-CoV-1). It was frightening and puzzling, especially in Toronto Canada (from 11/2003, emphases mine):
The entire SARS story puzzles the heck out of me. Why did so many nurses die, even in locations that should have had strong infection control? Why did the disease seem so contagious in some places, and not at all contagious in others? Did the virus attenuate? Was the epidemiologic behavior due to an unidentified cofactor infection that was common in some places and not in others? (eg. a second virus was needed to develop full fledged SARS).  
I can't believe that the infection control measures were so effective. The disease was loose in China for months. Why did it not spread in India at all?
A year later I wondered if there were multiple strains circulating, all mutually immunogenic, some more toxic than others. (There may be multiple strains of SARS-CoV-2 as well.) I wondered if that suggested a pandemic management strategy - a kind of "backburning"...
Create a contagious synthetic pathogen that's relatively benign, but induces immunity to the major pathogen -- and spread it actively. I say not entirely novel, because this is how Polio was suppressed. The oral vaccine was an active contagious pathogen that was excreted in stool. It immunized a vast number of persons -- but some became sick, disabled, or dead. When Polio was less of a threat we switched to a non-pathogenic inoculation. The difference is the successful Polio strategy was probably unintentional (I suspect some people understood even in the 1950s), but in the future we'd be deliberately exposing an entire population to an immunogenic pathogen that would almost certainly harm many people.
Now we are enjoying COVID-19, the bigger, uglier, brother. Again there's tremendous variability from place to place and time to time. Again India seems unbothered. Again young healthcare workers are vulnerable. Again I wonder if some of the sickest patients have multiple viral inflections or more aggressive strains. Perhaps as our seasonal flu finally fades so will the worst of COVID-19.

I hope this time we'll understand it better.

Sunday, March 01, 2020

India suggests COVID-19 will behave like a bad influenza pandemic

I've been watching India on the Hopkins CSSE map for weeks. Even as case reports appear to the east and the west, India remains quiet.

India, population about 1.4 billion. India, not known for Singapore class public health. India, with life expectancy of 69 years (China is 76y). India, connected to the world.

What are the chances that India has 3 cases of COVID-19?

One in a hundred? One in a thousand? Lower than that I think. It must be everywhere in India (including in Trump's mass party).

If COVID-19 had a 2% mortality rate even India would notice. If it has a non-Wuhan China rate of 0.7% (where denominator is limited by testing criteria which is in turn limited by test cost), India might not notice.

So somewhere between 0.2% to 0.7%. Bad enough to justify a smarter and better response than the Trump administration is capable of providing, but not 1918 flu pandemic levels. In an ideal world it would be a wake up call for the US to do what it should have done years ago. In an ideal world, of course, Donald Trump would never have gotten within a thousand miles of the presidency. The only way we'll get better is if he's defeated.