Archive for the ‘Medicine’ Category

Vaccine worship is almost as bad as anti-vax

October 18, 2020

Anti-vax may be utterly stupid but vaccine worship is not far behind.

Let us not forget the public health fiasco with swine influenza vaccine and narcolepsy. In October 2009, Sweden’s public health services carried out a mass vaccination program against swine influenza. Six million doses of GlaxoSmithKline’s H1N1 influenza vaccine Pandemrix were administered. The vaccine was approved for use by the European Commission in September 2009, upon the recommendations of the European Medicines Agency. By August 2010, both the Swedish Medical Products Agency (MPA) and the Finnish National Institute for Health and Welfare (THL) launched investigations regarding the development of narcolepsy as a side effect.

An increased risk of narcolepsy was found following vaccination with Pandemrix, a monovalent 2009 H1N1 influenza vaccine that was used in several European countries during the H1N1 influenza pandemic. This risk was initially found in Finland, and then other European countries also detected an association.

CDC

Today over 400 people of those vaccinated in Sweden suffer from narcolepsy.

Narcolepsy is a central nervous system disorder characterized by excessive daytime sleepiness (EDS) and abnormal manifestations of rapid eye movement (REM) sleep. This disorder is caused by the brain’s inability to regulate sleep-wake cycles normally. The condition is incurable and life long. Some treatments can help to alleviate symptoms. 

It is the same “experts” and institutions who decided on mass use of Pandemrix who are now inventing public health strategies for Covid-19. Meanwhile a vaccine for the coronavirus is still in its early stages of development and clinical trials. Some of these “expert” strategies are just fairy tales and fantasy.

Vaccinations generally work. Particular vaccinations sometimes don’t. Whether any particular vaccine against Covid-19 will work remains to be seen. The experience with other coronaviruses provides no track record which inspires great confidence.

I get worried when people say they believe in science. To be scientific is to be skeptical. If some science has to be believed in, then whatever it is that has to be believed, is not science.


Courage! Science (and bean-counters) cannot control the pandemic

October 7, 2020

Ten months on and I keep hearing the inane slogan “Follow the science”. But the best medical advice is floundering and is still no more than the basic common sense advice of “avoid being infected”. The simple reality is that the best our current science has to offer was unable to prevent the pandemic and is unable to curtail it or bring it under control. The Covid-19 virus cannot, at least for now, be eradicated.

While the medical fraternity is doing great things in treating those infected and is expending enormous money and energy in finding a vaccine, the epidemiological fraternity has failed spectacularly in both preventing the pandemic and in controlling or curtailing the pandemic. But more damaging is the illusion they promote that they are in control. Pretending you can when you cannot is bordering on gross negligence. Essentially they have nothing more to offer than the best advice available at the time of the Black Death almost 700 years ago.

I begin to suspect that epidemiology is more about bean-counting than about science. The political process which has relied on these bean-counters has vacillated between cowardice and courage.


100 years after the Spanish flu, virology still has far to go

October 4, 2020

Medical science does wonders. From amazing surgical procedures to an incredible variety of drugs and a fantastic array of tools and equipment, medicine, as it is practiced today, is light years ahead of where it was in 1918 at the time of the Spanish flu. Yet, medical science has not been capable of quickly defeating the current Wuhan virus pandemic. Health care has improved beyond recognition. Compared to 100 years ago, health services can deploy a bewildering variety of drugs and equipment and therapies to treat the infected.

The effects of the current pandemic are most often compared with the effects of the Spanish flu in 1918. The flu virus was identified in 1933 and the first flu vaccine came out in 1942. However, even today the flu vaccine is thought to be effective only in a little over 50% of cases. It is estimated that the Spanish flu, over a period of 3 years killed between 25 and 39 million people and that about 500 million were infected when the global population was only about 1,800 million. Today with a global population of 7, 200 million it is estimated that at least 35 million have been infected and, so far, over 1 million are thought to have died. The pandemic has lasted 6 months and is still ongoing. The virus was identified very quickly – perhaps one month – but only after the data repressed by the Chinese government and the WHO – leaked out.

The hunt for a vaccine is only 6 months old. There are at least 300 groups actively searching for one. Around 30 proposed vaccines have entered some kind of clinical trials. Estimates of when a vaccine could be readily available range from 6 months to 2 years to never. Money is being thrown at vaccine development at unprecedented levels. Certainly some of the groups chasing a vaccine have zero chance of success but cannot resist the temptation of huge amounts of easy money.

But virology is far from a settled science. In fact, there is still debate on whether a virus is living or not. That there are 300 different groups seeking a vaccine is, itself, evidence of 300 different opinions. During the past 6 months a bewildering variety of suggestions have been made for prophylactics, remedies and cures. Every single one has come from a “medical specialist”. The best advice is still “avoid infection” (by social distancing and masks which may or may not work), and hope. There are no preventive drugs and there are no cures (beyond treating symptoms). If and when vaccines are found, they will vary in how effective they are. Estimates of how expensive a vaccine may be range from 30$ to 300$ per dose for either a one-dose or a two-dose vaccine, with immunity available for periods ranging from 3 months to 1 year after vaccination.

Everyday new “experts” are trotted out on TV. But the science is not settled and there are no experts. The simple reality is that compared to 100 years ago, this pandemic has medical science just as stymied as the Spanish flu did – but at a very much higher level of knowledge.


At least 44 vaccines under Phase 1 -3 trials

September 1, 2020

There may never be a vaccine.

A vaccine may apparently be developed but long term effects will be unknown.

The most plausible scenario is that there may be promising vaccine available for mass usage, and with a reasonable level of safety, in the summer of 2021.

RAPS has an illuminating post detailing the various vaccines under trial and their status:

Researchers worldwide are working around the clock to find a vaccine against SARS-CoV-2, the virus causing the COVID-19 pandemic. Experts estimate that a fast-tracked vaccine development process could speed a successful candidate to market in approximately 12-18 months – if the process goes smoothly from conception to market availability.

To date, just one coronavirus vaccine has been approved. Sputnik V – formerly known as Gam-COVID-Vac and developed by the Gamaleya Research Institute in Moscow – was approved by the Ministry of Health of the Russian Federation on 11 August. ………. 

The pandemic has created unprecedented public/private partnerships. Operation Warp Speed (OWS) is a collaboration of several US federal government departments including Health and Human Services and its subagencies, Agriculture, Energy and Veterans Affairs and the private sector. Within OWS, the US National Institutes of Health (NIH) has partnered with more than 18 biopharmaceutical companies to accelerate development of drug and vaccine candidates for COVID-19 (ACTIV). The COVID-19 Prevention Trials Network (COVPN) has also been established, which combines clinical trial networks funded by the National Institute of Allergy and Infectious Diseases (NIAID): the HIV Vaccine Trials Network (HVTN), HIV Prevention Trials Network (HPTN), Infectious Diseases Clinical Research Consortium (IDCRC), and the AIDS Clinical Trials Group.

The COVAX initiative, part of the World Health Organization’s (WHO) Access to COVID-19 Tools (ACT) Accelerator, is being spearheaded by the Coalition for Epidemic Preparedness Innovations (CEPI); Gavi, the Vaccine Alliance; and WHO. The goal is to work with vaccine manufacturers to offer low-cost COVID-19 vaccines to countries. Currently, CEPI’s candidates from companies Inovio, Moderna, CureVac, Institut Pasteur/Merck/Themis, AstraZeneca/University of Oxford, Novavax, University of Hong Kong, Clover Biopharmaceuticals, and University of Queensland/CSL are part of the COVAX initiative. There are further candidates being evaluated in the COVAX Facility from the United States and internationally.

The US government has chosen three vaccine candidates to fund for Phase 3 trials under Operation Warp Speed: Moderna’s mRNA-1273, The University of Oxford and AstraZeneca’s AZD1222, and Pfizer and BioNTech’s BNT162. Members of ACTIV have suggested  developing safe controlled human infection models (CHIMs) for human trials could take 1-2 years. A sponsor would need to provide data from placebo-controlled trials indicating their vaccine is at least 50% effective against COVID-19 in order to be authorized for use, according to FDA guidance issued and effective 30 June. 

The 44 candidates ( as of 31st August 2020) are:

AAVCOVID, Ad26.COV2-S, Ad5-nCoV, AdCOVID, Adenovirus-based vaccine, AdimrSC-2f, Adjuvant recombinant vaccine candidate, AZD1222/Covishield, Bacillus Calmette-Guerin (BCG) live-attenuated vaccine, bacTRL-Spike, BBIBP-CorV, BNT162, ChAd-SARS-CoV-2-S, CoronaVac, COVAX-19, Covaxin, gp96-based vaccine, GRAd-COV2, GRAd-COV2, HaloVax, HDT-301, Ii-Key peptide COVID-19 vaccine, Inactivated vaccine, INO-4800, LineaDNA, LUNAR-COV19, Molecular clamp vaccine, mRNA lipid nanoparticle (mRNA-LNP) vaccine, mRNA-1273, mRNA-based vaccine, mRNA-based vaccine, NVX-CoV2373, PittCoVacc, Plant-based adjutant COVID-19 vaccine candidate, Protein subunit vaccine, Recombinant vaccine 1, Recombinant vaccine 2, SCB-2019, Self-amplifying RNA vaccine, Sputnik V, T-COVIDTM, V590, V591, ZyCoV-D

Covid candidate vaccines (pdf)


 

Sweden’s voluntary lock-down may be able to flatten the curve

March 26, 2020

Sweden has been following a voluntary lock-down for some time now. Those who feel ill (with a cold or influenza-like symptoms) have been asked to stay at home. Those over 70 have been asked to self-isolate, stay home and only go out if absolutely necessary. Formally, only public gatherings of over 500 are not permitted. People have been asked to be socially distant but there are no compulsive measures. The strategy is absolutely reliant upon people being responsible. Of course, there are cases of irresponsible young people. However, bearing in mind that the areas of critical judgement in the human brain are not fully developed till the age of 25, this is not too surprising. Mass testing for the virus is not being carried out. Only those who clearly show symptoms and require hospital treatment are tested. Large scale testing of hospital staff and health care workers is being done. So there is no clear number of how many are actually infected. The only reliable statistics are the number of those hospitalized, those in intensive care and those who have died. Of course, the markets have crashed and small businesses are dying. Travel services, restaurants and all the service industries are in deep trouble. Big companies are sending workers home and declaring redundancies at an alarming rate.  Economic support packages are being announced every few days.

Anders Tegnell is the chief epidemiologist at the Public Health Agency and is on the news every day. To me he has been the face of common sense, even if many “influencers”, some in the media and prominent celebrities have been crying out for draconian measures to be applied (always it seems, to others). Saint Greta has been starved of attention and has just dramatically announced that she has probably been infected with Covid-19 but is recovering. (!!!??). It is not yet clear if the relatively low-key Swedish approach has worked and it will be some time before this real crisis is over. It is quite interesting that Sweden takes the common sense approach when dealing with a real crisis but becomes hysterical when dealing with imaginary crises. Virus smart but climate dumb. However, every day that goes by without the number infected increasing sharply (“day zero” when exponential growth takes off) means that the time baseline has been extended and the potential peak has been reduced. It is thought that it needs 80 days after “day zero” for the virus to have run its course.

Anders Tegnell: “Contrary to many other countries, like Great-Britain or Germany, the number of infections in Sweden has not yet started to incline dramatically, despite the fact that 36 Swedes have already died of covid-19. No region, not even Stockholm where the virus has spread considerably, has already experienced their ‘day zero’. Everything lies still ahead of us. Moreover, day zero will most likely not arrive simultaneously in the different Swedish regions.”

As of writing there have been 44 deaths in Sweden attributed to the virus and nearly all had some other underlying conditions.

The voluntary approach can only work if the sense of civic responsibility is strong. Civic responsibility runs high here. I note that it had to be enforced in China where they seem to be coming out of the crisis. It also runs voluntarily very high in S Korea and Japan where the curve does seem to have been flattened.

At the personal level, we have been “social distancing” for more than a week. Our lives are somewhat discommoded. It isn’t quite warm enough to be out on the deck. Much needed and necessary surgery is inevitably being delayed since intensive care places are limited. We don’t have the usual network of relatives or friends to run our errands or do our shopping for us but I remain quite hopeful that common sense will prevail.


 

Where Malaria is, Covid-19 is not (so far)

March 20, 2020

Just coincidence that countries with most malaria have least Covid-19?

Just coincidence that antimalarial drugs (such as hydroxychloroquine) seem to have very good effects in eliminating the Covid-19 virus?

Perhaps. But it sounds to me like good news.

An Effective Treatment for Coronavirus (COVID-19)

Summary

Recent guidelines from South Korea and China report that chloroquine is an effective antiviral therapeutic treatment against Coronavirus Disease 2019.  Use of chloroquine (tablets) is showing favorable outcomes in humans infected with Coronavirus including faster time to recovery and shorter hospital stay.  US CDC research shows that chloroquine also has strong potential as a prophylactic (preventative) measure against coronavirus in the lab, while we wait for a vaccine to be developed.  Chloroquine is an inexpensive, globally available drug that has been in widespread human use since 1945 against malaria, autoimmune and various other conditions.  

Chloroquine: C18H26ClN3


 

Every ignoramus has become an expert on Covid-19 and epidemics

March 16, 2020

Every radio commentator has, overnight, become an expert. I can no longer listen for very long to radio news (and during the day I usually listen in the background to Swedish, UK and some US news broadcasts). Not only has every journalist become an expert, but every doctor, every politician and every member of the general public has also become an expert. When a journalist interviews a physician it is always about resources being insufficient. When a journalist interviews a politician it is always about why the politician got it wrong. Every posturing politician either attacks or supports the government actions depending upon whether his party is in power or not. Less than 10% of any broadcast is about reporting the latest news. The rest is inevitably taken up with opposing somebody. Even the “human interest” reports are focused on the human interest being a complaint or criticism of some kind.

So my background radio listening is now self-confined to the music channels (BBC Radio 3 or Swedish P2).

Fortunately, I don’t watch too much TV. TV commentators are a few orders of magnitude worse than their Radio counterparts. I tried last night. It took me less than 30 seconds to switch away from CNN and Fox, but BBC World News lasted over a minute. Rapport and Aktuellt were a little better but not by much.

The opinion columns in the “big” newspapers are not a lot better. The New York Times carried an article of some 2,000 words on Saturday entitled: How to Protect Older People From the Coronavirus.

I am an older person but this article is 2,000 words of drivel, signifying nothing. According to this nonsense verbiage, the way to protect older people consists of the following pearls of wisdom:

  • Familiarize yourself with guidelines and follow them.
  • Cancel nonessential doctor’s appointments if you can.
  • Beware of social isolation.
  • Have a talk with home health aides.
  • Bar visits to nursing homes.
  • Stay active, even in a pandemic.

There is not just one strategy, applicable to every population group or to every country, to limit infection and minimize fatalities. I take it on faith that all governments in power do have that as their objective. I am also taking on faith that government decisions to handle this crisis are themselves made in good faith with the best information to hand. However viruses are not so well understood that even all experts are of one mind. Even our most expert experts, whether on viruses or epidemics, are far from knowing everything.

We don’t even know whether viruses are living things or just a bunch of chemicals accumulated by chance. What we do know from the expert community (represented by the WHO) is

On 31 December 2019, WHO was informed of cases of pneumonia of unknown cause in Wuhan City, China. A novel coronavirus was identified as the cause by Chinese authorities on 7 January 2020 and was temporarily named “2019-nCoV”.

On 30 December 2019, three bronchoalveolar lavage samples were collected from a patient
with pneumonia of unknown etiology – a surveillance definition established following the
SARS outbreak of 2002-2003 – in Wuhan Jinyintan Hospital. Real-time PCR (RT-PCR) assays
on these samples were positive for pan-Betacoronavirus. Using Illumina and nanopore
sequencing, the whole genome sequences of the virus were acquired. Bioinformatic
analyses indicated that the virus had features typical of the coronavirus family and belonged
to the Betacoronavirus 2B lineage. Alignment of the full-length genome sequence of the
COVID-19 virus and other available genomes of Betacoronavirus showed the closest
relationship was with the bat SARS-like coronavirus strain BatCov RaTG13, identity 96%.

The best I can do, I think, for myself and the community is to rely on common sense.

  • Minimize my chances of being infected.
  • Minimize chances of my unknowingly infecting someone else.
  • Avoid hoarding.

 

The coronavirus dilemma lies between developing mass immunity and coping with the severe cases

March 15, 2020

As a layman I am still trying to understand the thinking which is leading to the political decisions surrounding the different country responses. This is just thinking aloud to get my own thoughts in order.

It seems to me that whereas it is desirable, in the long term, for as many as possible to be mildly infected (as with mass vaccinations) and develop immunity, right now countries are shutting down their borders because:

  • the infection wave would be uncontrolled, and
  • the number of resulting severe cases would also be uncontrolled, and
  • the health services may not be able to cope

I read that the virus cannot be killed off. It may die out as the human population develops immunity and the virus itself mutates. Most people who are infected, recover and develop immunity. However, for those who are severely affected (maybe 10-15% of those infected) there are no specific treatment therapies yet established. It also seems that most of those severely affected are the elderly or those who are in close contact with sick patients (doctors and nurses). A vaccine, when developed, would effectively spread immunity without the risk of severe effects, especially among those at risk. From the almost panicked reactions of so many countries I suspect that they have access to some worrying data. This is probably that

  • There is no great success in treating the risk groups who are severely infected, and
  • the fatality rate among these high-risk groups is much higher than with conventional influenza.

I discern a 3-Phase strategy being implemented.

  1. The drastic country lock-downs is Phase One. It is not so much an effort to prevent infection but an effort to prevent infection at such a rate that the severe cases are too high for the health services to cope. Probably the lock-downs will last about a month (or two).
  2. This buys time to develop some effective treatment therapies for the severely affected which then leads to Phase Two where infection is allowed to proceed “naturally” but where there is a preparedness for the severely affected.
  3. Phase Three comes when a vaccine is available and mild “natural” infection together with vaccination for those at risk, leads to the virus becoming just another “flu virus”.

The long term goal is then for populations to develop immunity (natural and by vaccination) and to have treatments for the severely infected. There is no goal to eliminate the virus (which is probably impossible).

In my lifetime, I have not seen anything like the response to the Covid-19 response. I was travelling extensively during the SARS and H1N1 and HIV scares, but the responses then were nowhere near as drastic as now. We have aged into the risk group. We travel much less now. Self-isolation causes minor difficulties but is not so very traumatic. Certainly I would prefer to get any immunity from a vaccine rather than an untreatable “natural” infection. A new risk for us, though, is that the serious but “routine” hospital care we rely on will be delayed or postponed.


 

Corona virus fatality rate: Playing with numbers

March 14, 2020
  1. Over the last 50 days (starting January 23rd), 5436 deaths around the world have been attributed to complications after being infected with the Covid-19 coronavirus. While the number of deaths yesterday was 448, the peak may not yet have been reached. Hopefully all the restrictions in place will lead to the peak being reached soon. The global number of deaths over this period has averaged about 110/day. A vast majority of the deaths are of people over 65.
  2. Around 152,000 people die every day (7.7/1000 of population). Around 65% of these die due to age related causes.
  3. Symptoms of influenza rarely lead to testing for the influenza virus. Every year an estimated 290,000 to 650,000 people die in the world due to complications from seasonal influenza (flu) viruses. This figure corresponds to 795 to 1,781 deaths per day due to the seasonal flu.

But:

  • In retrospect it seems that this coronavirus first appeared around November 2019. So some of the deaths attributed to influenza since then may have been due to Covid-19.
  • At least 145,000 people have tested positive for the virus. However people are not generally tested unless symptoms are severe. Many are infected and show no symptoms at all. Many are infected and recover without ever having been diagnosed.
  • The number of people infected is – as an estimate – around 10-20 times the number who have tested positive (1.4 – 3 million).

Even if the number of deaths due to coronavirus is certain, which it is not, the fatality rate depends entirely upon what number is used to divide by:

  • Around 0.07% of all daily deaths
  • Around 0.15 – 0.35% of those infected
  • Around 3.7% of those who have tested positive
  • Around 6 – 15% of daily influenza deaths

Numbers don’t lie but the same numbers can be used in many different ways. They can be used rationally or, more likely, to promote an alarmist agenda or a political agenda.

And they can be used maliciously.

I find the most significant statistic for my own behaviour (and since I am in the risk-age group) is that risk of death increases by a factor of about 50 if I get infected. However, even if I do get infected the chances of survival are around 10 times higher than the chance of dying. It makes sense to exert myself to avoid infection but I don’t need to kill myself to avoid being infected.


 

Covid-19 global lock-down is a mishmash of fear and precaution

March 12, 2020

Being over 70, I am apparently in the high-risk group if I get infected.

I am sure that all those who are currently battling with containing the outbreak are well-qualified and and are doing their best. But being well-qualified and knowledgeable are not always an indicator of wisdom.  Even given the same level of knowledge, there is a difference between a measured response and an alarmist response. The current panic response to the outbreak seems to me to be more alarmist than measured.

The Twitter and Facebook worlds are ideally suited to spreading alarm. Fact and fiction are blended with the ridiculous and the malicious to give a “tale told by an idiot, signifying nothing”.

  • Don’t touch your own face unless you have washed your hands.
  • Stock-up on toilet paper.
  • Stock-up with food for 14 days. Replenish every day.
  • Wash your hands every 20 minutes.
  • Don’t go to sports events. Complain if the match is cancelled.
  • Stay 1 m away from fellow passengers on public transport.
  • Viruses are necessary for biodiversity.
  • Ban the virus (except in cases of asylum).
  • Ban foreigners who may carry the virus from entering your country.
  • Your own citizens who carry the virus may enter freely.
  • Banning a foreigner carrying the virus is racist.
  • Children are the lowest risk group. Close the schools.
  • The old are at greatest risk. Don’t visit them / lock them up.
  • If you think you have a cold, self-isolate.
  • If you are tested positive, wait it out, don’t self-immolate.
  • If you think a household member is infected, self-isolate.
  • The old who are infected take up the most health resources. Let nature cull those over 65.
  • It is divine punishment for ……
  • Coronavirus transmission is ‘highly sensitive’ to high temperatures. Covid-19 pathogen appears to spread fastest at 8.72° Celsius.
  • Close the world until summer.

The fear-driven response is going to continue for a few months yet. There will be fatalities. But the deaths resulting from the Covid-19 outbreak are still well below the “normal” 1000+ deaths per day due to influenza. At the time of the peak in China in February, deaths reached about 150 in a day (mainly in Wuhan). Yesterday, March 11th, the peaks in Iran and Italy have given a world total of 331 deaths. Some say it is going to get worse.


 


 


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