Month: August 2020

On Saturday, I received the image on the left from a well-meaning individual. She wanted me to see that we have been fooled regarding the severity of the virus that causes COVID-19. By Sunday, this image (or one like it) was all over my Facebook feed. Please understand that the statement starts out as completely false and then uses true statements to imply something else that is completely false. Unfortunately, it tends to resonate with people who do not understand medical science and who have not been personally affected by the pandemic. As I watched this lie literally spread around the world, I couldn’t help but think of Jonathan Swift’s famous statement¹

Falsehood flies, and the Truth comes limping after it.

Here is my attempt to get the truth to come limping after this falsehood.

Let’s start with the first lie. The CDC has not “quietly updated” the numbers to “admit” something. The CDC has been regularly updating the numbers in the same place since the pandemic began. In addition, they have been saying that 94% of COVID-19 deaths were in patients with underlying conditions since at least April 3rd. That’s nothing new to anyone who has done even a little investigation into the matter.

More importantly, this image is meant to imply that COVID-19 is not dangerous because the vast majority of people who die from it have some other illness. Once again, that is simply 100% false. If you look at the underlying conditions that are included in the 94% (table 3 in the link above), you find things like high blood pressure (hypertensive diseases), diabetes, obesity, etc. The image tries to categorize them as “serious illnesses,” and depending on the person, they might be. However, they are present in a large percentage of the population. 45 percent of adults in the U.S. have a hypertensive disease, 10 percent of the U.S. population have diabetes, and 42 percent have obesity. Thus, a huge number of people in the U.S. have at least one of the “serious illnesses” that make you likely to die from COVID-19. In other words, there are many, many people at risk of death from COVID-19.

But how can we say that these people died of COVID-19 when they had some other condition? Because most of these conditions are completely treatable and will not generally kill a person. However, when that person gets an infection, the underlying condition makes it harder for his or her body to fight off the infection, leading to death. The more serious the infection, the more likely the person is to die. In fact, the majority of people who die of an infection like influenza, pneumonia, tuberculosis, etc. have an underlying condition that makes it more difficult for them to fight off the infection. Thus, it is not even remotely unusual that 94% of people who die from COVID-19 had one or more underlying conditions. It is common for many serious infectious diseases, especially in the developed world.

There is one more issue in the image above that I must address. It says that the overwhelming majority of people who died from COVID-19 were of advanced age. That’s true, but it’s true for all deaths in the developed world, not just COVID-19 deaths. Indeed, a recent study compared the ages of people who died from COVID-19 to those who died from all causes. Guess what? They were quite similar:

In fact, the age distribution of deaths attributed to COVID-19 is quite similar to that of all-cause mortality, which tends to increase by about 10% every year of age after age 30 y.

We don’t know a lot about COVID-19, and there is no way to scientifically state the best cause of action against the disease at this time. However, we do know that it is a very serious disease, and it is being downplayed by some using falsehoods like the image above. Please stop the misinformation! If you want to share something about COVID-19, at least make sure it doesn’t communicate something blatantly false, like the image above does.

ADDENDUM (added 9/4/2020): Someone on a friend’s Facebook feed wrote an incredibly insightful comment that I must share. She said that if you really think that the only COVID-19 deaths are the ones that had COVID-19 as the sole cause, then you must think that AIDS has a mortality rate of zero!

REFERENCES

1. The Examiner, Number 15 November 2 to November 9, 1710, (Article by Jonathan Swift), Page 2, Column 1, Printed for John Morphew, near Stationers-Hall, London.
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In a previous post, I compared COVID-19 cases and deaths in Sweden and Denmark. As I said then, it’s because they are very similar countries in the same basic region of the world, but they have remarkably different responses to the disease. Sweden has avoided lockdowns and tried to target their social restrictions, while Denmark has followed the practices of most other countries, strongly limiting what their citizens can do during the pandemic. While no comparison of two different countries is conclusive, I think the results are very interesting. The data come from the European Centre for Disease Prevention and Control, and while it may very well be a biased source of data, at least it is equally biased for both countries.

The graph on the left shows the cumulative COVID-19 cases per million. That means each day on the graph shows the total cases that were reported by that date, divided by the population in millions. Initially, Denmark had more cases (probably because initially they were testing more), but as you can see, Sweden quickly surpassed Denmark in cases per million, and the difference between the two countries has continued to grow. Since the death rate of COVID-19 is low (but higher than most infectious respiratory diseases), many people (including myself) think that death rate is a better indicator of the severity of the pandemic. Thus, the graph on the right shows the cumulative deaths per million. Notice that Sweden has more than 5 times the deaths per million as Denmark.

If the comparison between these two countries is legitimate, then, government restrictions did reduce the number of COVID-19 deaths per million in Denmark. However, there are those who suggest that this might be okay, since Sweden will reach herd immunity faster than Denmark. In the long term, then, Sweden will have fewer COVID-19 deaths because the spread of the disease will stop sooner.

Based on my evaluation of the data, I don’t think Sweden is significantly closer to herd immunity than Denmark. Take a look at the graph below, which records cases per day per million. Rather than adding all the cases reported by a given date (as is done in the graph on the left above), this shows the daily reports of COVID-19 cases per million.

If Sweden were closer to herd immunity than Denmark, the recent cases per million per day in Sweden should be lower than the cases per million per day in Denmark. However, they are not. For most of August, Sweden and Denmark have roughly equivalent cases per million per day. That tells me the disease is spreading roughly the same in the two countries right now, but Sweden has lost five times the people (per capita) as Denmark. As a result, my analysis indicates that Denmark’s restrictions kept a lot of people from dying of COVID-19, and that will continue to be the case in the long run.

Now please understand that this analysis considers only deaths from COVID-19. We know that government restrictions have also caused deaths. There are those who say that the government restrictions will cause more deaths than the ones that were saved from COVID-19. Others say that overall, the restrictions have saved lives. I think the data are insufficient to make that determination, but I do agree that most countries are ignoring the devastating death toll caused by the restrictions themselves. Nevertheless, I think the data are now clear that Sweden’s strategy has not accomplished what the country had hoped it would.

So far, there are no widely-accepted treatments for COVID-19. Hydroxychloroquine, often mixed with other things like azithromycin, was initially thought to be promising, but the data so far are inconclusive. While there are some indications that it is effective (and some physicians are convinced it works very well), the controlled studies that have been done so far see no significant benefit to its use. The antiviral drug remdesivir shows some promise, as does the corticosteroid drug dexamethasone. However, there are not enough data yet to make a firm decision on either of them.

Yesterday, President Trump held a press conference to announce a new possible treatment: convalescent plasma. Based on an analysis of several different studies, it seems to be the best candidate yet (in my non-medical-doctor opinion). I say this because of the kinds of studies that have been done. First, there have been three randomized clinical trials. This means patients were assigned to either get the treatment or not get the treatment based on random chance. The group that got the treatment was compared to the group that didn’t (called the control group). In the three studies, the death rate in the treatment group was half that of the control group. There were also five matched-control studies, where the treated patients were compared to a control group specifically selected to closely match them. The results of those studies were similar to those of the randomized clinical trials. There were also four case-series studies, where patients were given the treatment and their progress was tracked. While that kind of study has practical uses for physicians, its ability to determine the effectiveness of a treatment is extremely limited. However, the case-series studies seem to support the other two kinds of studies. All of the studies were done on patients with severe or life-threatening cases of COVID-19.

Taken all together, then, the treatment looks very promising. However, I do have to say that each study was very small, so even when all the patients were analyzed, the total number was only 804. Phase three clinical trials that determine whether or not a drug should be widely used typically involve a few thousand patients. Thus, this is still a limited data set. Also, many of the studies (as well as the analysis linked above) are not peer-reviewed. As a result, there could be major flaws that have not been noticed. A recent analysis (once again not peer reviewed) of more than 35,000 patients seems to support the small studies, but since it has no control group, it cannot be used to draw any real conclusions. Nevertheless, the FDA has approved emergency use of the treatment, and it is asking those who have recovered from the disease to help in determining whether or not it is truly effective.

How can someone who has recovered from COVID-19 help determine the effectiveness of the treatment? To understand that, you need to learn a bit about the wonderful mixture that is running through your circulatory system.

Continue reading “Another Possible COVID-19 Treatment”

Scientists are pursuing several different strategies to protect people from the virus that causes COVID-19, and a recent paper that hasn’t been peer reviewed reports on a strategy I haven’t seen before. It makes use of the fact that the virus starts the infection process by employing specific chemicals called spike proteins to bind to an enzyme (ACE2) in human cells. The idea is simple: Block the virus’s ability to bind to that enzyme, and it will be unable to start the infection process. But how can that be accomplished? In the paper, the researchers report on making a small molecule, called a nanobody, that binds to the spike proteins on the virus. Once the nanobody binds to them, the spike proteins can no longer bind to the ACE2 enzyme.

First found in alpacas, nanobodies are like antibodies, but they are smaller, simpler molecules. Because of that, they are easy to make and manipulate. Essentially, scientists can build a small gene that produces the nanobody, insert it into certain microorganisms, and let the microorganisms churn out the nanobodies. As a result, there have been many, many different kinds of nanobodies produced over the years. The researchers searched a database that contained more than two billion nanobody genes, and they found 21 that should be able to bind to the virus’s spike proteins in some way. They put those genes into yeast, extracted the nanobodies that were produced, and studied them.

Based on their analysis, they found the three most promising candidates and tested them against the virus itself. One of the nanobodies was particularly effective, so they focused on it. They mutated the gene multiple times to make slight changes to the nanobody and tested the result against the virus. They then produced a gene that could take the three most effective nanobodies and chain them together. The result was a chemical that basically shut down the virus’s ability to infect human cells.

Continue reading “Another Exciting Development in COVID-19 Prevention”

Children make up less than 2% of all identified COVID-19 cases. This is unusual, since they make up 20-30% of influenza cases. Why is COVID-19 so much rarer in children? A study from the Icahn School of Medicine at Mount Sinai Hospital in New York might have found the answer. Cells found in the nose, lungs, veins, and other parts of the body sometimes have an enzyme called ACE2 in their membranes. The enzyme is important, because it can participate in a process that lowers blood pressure when necessary. Studies show that the virus which causes COVID-19 (SARS-CoV-2) attacks cells by attaching to that enzyme.

The researchers examined nasal tissue from people between the ages of 4 and 60. The tissue collection had already been done between 2015 and 2018 for a research study on asthma. The researchers specifically looked at how much the gene that makes ACE2 was expressed. The more the gene is expressed, the more ACE2 is made. They found that the youngest children expressed the gene the least, older children expressed it more, young adults even more, and older adults even more. Thus, the younger you are, the fewer ACE2 proteins in the cells that line your nasal cavity, so the fewer places the virus has from which to attack. As a result, the less likely you are to be infected.

Because of the nature of the original study for which the tissue was collected, nearly half of the people from whom the tissue came had asthma. Also, they didn’t have tissue from anyone over 60 years of age. Thus, the sample is not truly representative of the nation as a whole. Nevertheless, the results are very intriguing, and they seem to explain why this respiratory virus affects children differently from most common respiratory viruses.