4/7/2020 ©Moira Dolan MD
There seems to be only one thing that specialists from around the world can agree upon, and that is that we don’t yet have a good idea of the true risk of illness, much less death from this new virus.
It is appreciated that many are entirely asymptomatic, and those estimates are currently ranging from 50% up to 80%, but changing all the time.
The missing information is key to making definite statements about rates of illness and death.
Although we can count dead bodies, if we do not have an accurate denominator, or even a denominator that is in the right ballpark, then the statistics are bound to be wildly overstated.
As explained by Jason Brinkley, PhD in his article the CoVID Denominator:
“Total deaths is a fixed value, but should we compare that to the total number of individuals hospitalized? The total number tested? The total number exposed? The total population? Each of these answers gives a different denominator and a different perspective on risk.”
In Germany, Hong Kong, and the UK, anyone who dies from any cause (such as a brain aneurysm, cancer, or bacterial pneumonia) who also has tested positive for CoVID19, is being counted as a “CoVID19 death”.
This is also happening in the US: no matter what the attending physician thinks is the cause of death, any death of a person who tests positive for CoVID-19 is counted for public reporting as a “CoVID-19 death”.
This is unprecedented in the field of medicine.
For example, if all deaths in HIV positive persons were counted as AIDS deaths, we would see crazy high global numbers of so called “AIDS deaths”, high enough to declare a global pandemic.
In a more absurd example, what if everyone in a nursing home who died from cancer or pneumonia or chronic lung disease, while they had a bladder infection, were counted as a “bladder infection death”? It would be a global pandemic.
The public should understand that it is a political decision to count this way rather than a medical one.
Carriers of CoVID19?
There is speculation about asymptomatic persons possibly being carriers, and yet this is at odds with the information that this is a respiratory pathogen spread by secretions from coughing.
The best current estimate is that there might be limited time frame in which some asymptomatic persons may transmit infection if they are in very close contact with others.
From a casual look at at typical the grocery store, people are doing very well with social distancing, and less than 1 in 10 shoppers are feeling the need to wear a mask.
There is no evidence that the CDC’s guidance for the general public to wear masks will be more effective than simple social distancing.
Testing for CoVID19
Over 100 different tests have been developed in the US alone to test for pieces of genetic material from SARS-CoV-2, the virus that causes the disease. Over 20 of them are on the US market.
Many academic centers are making their own test kits, for example Seattle area hospitals are using a test developed at the University of Washington, while in Ann Arbor they are using the University of Michigan’s own version of a test.
Microbiology specialist Dr David Pride admits that at UC San Diego they are using up to 5 different testing kits, switching as they run out of one test kit to another that is available.
Under normal circumstances such tests would undergo rigorous validation before being released for use, but the emergency situation has allowed an explosion of tests with completely unknown reliability.
There has been little published on the sensitivity and specificity of COVID-19 tests, and the false positive rate may be higher than expected – meaning people testing positive who do not have infection.
There are also false negatives, where an infected person gets a negative result.
The magnitudes of false positives and false negatives are unknown.
CoVID19 treatment updates
Antiviral medication is only being considered for those ill enough to be hospitalized, as the vast majority recover with no treatment at home.
According to a live interview on April 6, 2020 with Dr. Preeti Malani, Professor of Medicine and Chief Health Officer at the University of Michigan, they have stopped using chloroquine to treat CoVID19 infections there, because of seeing too much toxicity to the liver and gastrointestinal tract.
Other antivirals are being tried, such as the combination of two HIV drugs, lopinavir/ritonavir, and the antivirals emdesivir and favipiravir.
The FDA has approved a test for antibodies the virus, but it is not yet available to the public. There are limited trials underway to give the serum from recovered persons to patients very ill with CoVID19.
This is a type of treatment that has been used in various diseases over the last century, and holds promise as a stopgap measure while more specific therapies are sought.
Meanwhile in India, with 2,547 cases and 6 CoVID deaths by April 4, the Ministry of Human Resource Development has officially directed school and universities to advise students to boost their immunity with protocols developed by the Ayush Ministry.
The Ayush is the ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy, which is purposed with developing education, research and propagation of indigenous alternative medicine systems in India.
Among other things, the Ayush protocol includes drinking warm water throughout the day, practicing pranayama yoga for at least 30 minutes, and using turmeric, cumin, coriander and garlic in cooking.
The Chinese have reported that 90% of persons in Wuhan took some traditional herbal remedies during the outbreak.
Chinese government official Yu Yanhong, secretary of the State Administration of Traditional Chinese Medicine, recently stated that traditional remedies helped to alleviate symptoms, reduced the severity of the virus, improved recovery rates and reduced mortality rate.
However like everything else having to do with coronavirus, there were no controlled studies
Hang on; it’s a wild ride!
Photo: In the recording studio for the upcoming audio version of Boneheads & Brainiacs: Heroes and Scoundrels of the Nobel Prize in Medicine.