Days, weeks are passing, and COVID-19 is not passing away. Even in countries which thought they had tamed the beast, it keeps reappearing.  Meanwhile besides conspiracy theories, partisans of the herd immunity and those of lockdown enforcement, debate and some of their extreme opinions are disseminated in minor TV stations and then recirculated through social media. We mentioned previously the irrational utterings of Nobel prize winner Pr. Montagnier, whose statements have been removed from the internet. This weekend, I received on What’s App a video showing part of an interview of another Nobel winner, this time of the  2013 chemistry winner, Michael Lewitt, who at least appeared sound of mind if not of opinion, as he endorsed the Swedish  herd immunity approach, and decried the UK one, , compared the epidemic to a strong flue season, with total disregard to the fate of the old. However, he appeared short of statistics to back his case. As there has not been sufficient testing, one can cast doubt as to how much penetration of the virus has occurred in the countries he is mentioning. Moreover, he lacked total empathy about the atrocious, lonely deaths.   When I tried to find the whole speech on the internet, it had been taken down. More interestingly even, UnHerd, the reputable UK site that had done the interview, had removed the video. Reassuringly, polls showed that 73% of British think protecting lives should take precedence over the economy, compared to just 49% of Germans and 44% of Swedes.

The problem is that, until the epidemic phase1 is squashed, we will not have relevant statistics, as the deaths trail the infections by many weeks and are a function of many other parameters, such as not only the underlying conditions in some patients, but also certain gene-related weaknesses in others. Moreover, as the cases multiply, the diverse ways as to how the virus progresses and affects patients in different areas of their bodies, become more apparent.

If the number of infections is difficult to gauge accurately, as both active and even more asymptomatic patients roaming across individual states are untested, the number of deaths forms an on-going curve that extends well after the epidemic is terminated. The number of deaths is certainly a function of the demographics of the region affected, the underlying condition of the infected, the load on its hospital facilities, possibly the strain of the virus, the viral load the patient has been exposed to, and  not yet proven the therapeutic approach and capacity of different hospitals.

Ever since the virus appeared in China, the leading cause of death in patients with COVID-19 is respiratory failure belonging to the acute respiratory distress syndrome classification. The images from Chinese videos of that appeared in social media, in the second half of January, showed collapsed persons, with acute breathing difficulty, surrounded by incredulous crowds. These people were driven to hospitals and put into respirator machines to only die in too many cases shortly after. Although it is probably too early to draw conclusions, it is believed that there is over 50% chance of fatality, when somebody is intubed and put into an artificial coma.  People reached hospital when it was too late. After all, the medical name of the disease, coined as SARS-CoV-2 for Severe Acute Respiratory Syndrome Coronavirus 2, pointed to a lung related illness.

That was the way the disease was perceived at the earlier stages of the epidemic when at least in Europe, and then in the US, there were too few serious patients to be able to realize that other than the lungs, the complications such as cardiac problems, strokes ,kidneys or liver were only a portion of  the  different parts of the body the virus attacked after first the symptoms developed and the disease progressed for the most affected. As the experience of the doctors treating patients grew with increased cases, the inefficacy of the limited medications available leading to the Golgotha route of intubation steered the minds towards different therapeutic methods.

Chloroquine, a drug used against malaria for decades, had been demonstrated in vitro to have some antiviral effect. It had also some anti-inflammatory properties. Professor Raoult, a French Doctor, that ran a large university hospital cum research center, had the idea to use it in combination with azithromycin, an antibiotic drug that had also proved some antiviral effect on the Zika virus. This combination was used on a group of 26 infected patients in a non blind test i.e. without an equivalent infected group receiving placebo. When 75% of the patients, even though 3 had to be taken off the treatment and one had died, were cured after 10 days, a premature cry of victory was barked. This was enough for our Dr. Strangelove, envisioning a triumphant re-election, to promote Chloroquine as the savior of the US. Following an uproar within the French medical echelons, a larger study was carried out but as any criteria left doubts, the drug was only authorized by the French Health ministry for extreme cases. Meanwhile, Doug Bright, the head of BARDA, the Federal Biomedical Research and Development Agency had been demoted for recommending that Chloroquine should not be available over the counter and should only be administered under the controls of a physician.

Whereas one can criticize the hurriedness of Prof. Raoult to impose his semi proved therapeutics, it must be said that he probably opened the mind of many doctors on the front line, searching for better ways to save lives.

Doctors around the globe observed  that it was not a SARS like disease, where respiration becomes impossible, but a progressive general inefficiency of the blood vessels in effecting their function of bringing oxygen from the lungs to the various organs and in reverse getting rid of the carbonic dioxide through the lungs, through the air sacs (alveoli), which are intermingled with myriads of capillary vessels.

Thus, in fragile infected individuals the virus triggers strong inflammation characterised by cytokine storm, which results in a tsunami of water in the lungs. This progressively hampers breathing and reducing the arrival of oxygen in the air sacs and depriving the body of one of its lifelines. If left alone the patient undergoes a lethal asphyxia, unless he is put into artificial respirator where the issue is often fatal. To avoid as much as possible this dreaded ultimate step, cocktails of medicines with antiviral, antibiotic and anti-inflammatory effects and additional anticoagulants have emerged, and are given under the discretion of individual treating physicians.

As we are entering a period of respite, it is essential that all these separate methodologies and their relative successes are gathered in a central research program, so as to validate a safe coronavirus therapeutics until a vaccine is found. A doctor, head of the Emergency and Intensive Care department of the University Hospital in Bern (Switzerland), describes it as an attack of the virus to the endothelial cells of the blood vessels therefore affecting all parts of the body. This is not only credible when one observes the varieties of the complications but also the diversities of the initial symptoms. The degree of progression of the virus may be linked to the strength of the immune system of the individual, but also of all other underlying conditions, including obesity and cancer. As older people are more likely to have underlying conditions and weaker immune systems, they are more likely to die. However, it may very well also be that the people that survive severe attacks will have long term after underlying weaknesses, that may reduce their life expectancies. Herd immunity proponents be ware!

By Digenis19th May

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