Archive for the ‘Medicine’ Category

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.


 


 

Common influenza has killed 20 times more people than coronavirus in the last 2 months

March 8, 2020

The global mortality due to all strains of conventional influenza is greater than 1000 deaths per day (between 400,000 and 600,000 deaths per year). The flu season in northern climes runs from about September to March and most fatalities occur at this time.

The current Covid-19 coronavirus outbreak has resulted in 3,600 deaths, globally, in the last 50 days with over 2,000 just in China.

During the same period influenza has killed at least 50,000 (and more likely around 80,000) around the world.

The number of influenza deaths occur in spite of there being vaccines for some strains of the virus. There is no vaccine yet for Covid-19. There is no “cure” for influenza and neither is there a “cure” for Covid-19. However treatment of influenza is much better established than for the new virus.

Common influenza – even with vaccines available and with better established treatment –  has killed at least 20 times more people than Covid-19 in the last 2 months. So why the unnecessary and ridiculous panic?

I suspect it is because we have now been conditioned by Alarmism and are governed by fear. I note that cowardice is when actions are subordinated to fear (and bravery is when fears are subordinated to actions). The alarmist world has become a more cowardly place.


#coronavirus

Covid-19 and the culling of humans

March 3, 2020

It’s early days yet to have a clear picture of the effects of the Covid-19 coronovirus outbreak.

In all but being formally declared it is pretty close to being a pandemic.

But what is already pretty clear is that it targets and culls humans by age.

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

data from worldometers.info


 

Euthanasia takes off in Canada

April 28, 2019

I don’t believe there are ethical problems here.

Maybe it’s just because I’m getting older, but when there is great suffering or no quality of life left, there is much to recommend an assisted peaceful end.

Reblogged from BioEdge.

At least 1.12% of deaths in Canada are due to euthanasia

According to the latest figures, about 3,000 Canadians were euthanised in 2018. According to the Fourth Interim Report on Medical Assistance in Dying there were at least 2,614 medically assisted deaths in Canada between January 1 and October 31.

Although euthanasia was only legalised in Canada in June 2016, it has quickly become widespread. In the 10 months covered by the report, euthanasia accounted for 1.12% of all deaths in Canada. Cancer was the most frequently cited underlying medical condition, accounting for approximately 64% of all deaths. 

According to the report, “The percentage of deaths due to MAID in Canada also continues to remain within the percentage of medically assisted deaths provided in other countries where 0.4% (Oregon, USA, 2017) to 4% (Netherlands, 2017) of total deaths has been attributed to a medically assisted death.”

There have been at least 6,749 medically assisted deaths since June 2016. However, this does not include data from the Yukon, Northwest Territories and Nunavut. Some figures are also missing from Quebec. Most people who were euthanised were between 56 and 90, with an average age of 72. Most deaths occurred in a hospital (44%) or in a patient’s home (42%). Doctors were the main agents (93%), with nurse practitioners providing the rest.

This is the last interim report now thatregulations standardising euthanasia statistics across Canada have come into force.

It is interesting to note that only 6 of all reported MAID deaths were attributable to assisted suicide. Nearly all patients wanted their doctors to administer a lethal injection.

The release of the figures did not create a big splash in the media. But Wesley J. Smith commented in the National Review: “This means well over 3,000 people are killed by their doctors each year in Canada, which — if my math is correct — is more than 250 a month, more than 58 a week, and more than eight per day. Heck, that’s about one every three hours.”


 

Chillies are to food as the zero is to mathematics

March 10, 2017

Every so often  a new article pops up about the inherent goodness of the capsaicin in chillies. For me this is just stating the obvious, like stating the earth is round and not flat or that man-made carbon dioxide is irrelevant for global warming. To like chillies is to like sunlight and brightness.

(Getty Images)

There are few dishes or sauces which cannot be improved by the judicious addition of fresh green chillies, fresh red chillies, dried red chillies  or even – for the hard-pressed urbanite – chillie powder. From a pinch of chopped green chillies in salads or chillie flakes on pizzas (which ought to be mandatory) or a few drops of “hot oil” on all pasta dishes or chillie infused olive oil for dressings and sauces, virtually every cuisine can be improved. No barbecue ought to be allowed without a hot sauce (though the overuse of vinegar with red chillies should be outlawed). Brazilian churascarias usually do have sharp, fresh ginger and often have wasabi but could well do with having more chillies available. Traditional European cuisine (especially Eastern Europe) was long ignorant of the virtues of chillies. It was like the mathematics Europe had without a symbol for zero. They are learning now. English “cuisine” has changed immeasurably – for the better – only since the proliferation of curry houses. French cuisine is only just beginning to learn how to use chillies. It seems ridiculous to have a Michelin starred chef who does not know how to use chillies.

BBC: Why hot chillies might be good for us

As anyone who has ever eaten a really hot chilli will testify, they can cause a lot of pain.

Chillies come in many shapes, colours, sizes and strengths, but one thing they have in common is the burning sensation they cause in your mouth, eyes and any other part of your body into which their juices come into contact.

Although most people think that the hottest part of a chilli is its seeds, in fact it is the white spongy layer you find inside, called the placenta. Bite into this and you will really feel the burn. That burning sensation is mainly caused by a chemical called capsaicin, which is found in tiny glands in the chilli’s placenta. When you eat a chilli, the capsaicin is released into your saliva and then binds on to TRPV1 receptors in your mouth and tongue. The receptors are actually there to detect the sensation of scalding heat. Capsaicin makes your mouth feel as if it is on fire because the capsaicin molecule happens to fit the receptors perfectly. When this happens it triggers these receptors, which send a signal to your brain, fooling it into thinking that your mouth is literally burning.

The reason why wild chilli plants first started to produce capsaicin was to try and protect themselves from being eaten by mammals like you. From an evolutionary perspective the plant would much rather have its seeds dispersed far and wide by birds. Oddly enough birds, unlike mammals, don’t have TRPV1 receptors, so they do not experience any burn.

So producing capsaicin turned out to be the ideal way to deter mammals from eating the plant while encouraging birds to do so. But then along came an ape with a giant frontal cortex who somehow learnt to love the burn.

Humans are not only not deterred by capsaicin, most of us positively love it. So what’s going on? The ferocity of a chilli pepper is measured in something called Scoville heat units (SHU). A relatively mild chilli, like the Dutch Long chilli, is only 500, but by the time you move on to the Naga chilli, which is one of the hottest in the world, you are biting into something with a Scoville score of more than 1.3m units. The current world record holder for hotness, however, is the Carolina Reaper, first bred in Rock Hill, South Carolina. According to tests carried out by the University of Winthrop in South Carolina it scores an impressive 1.57m SHUs

So, what happens when you bite into a really hot chill? …….. Within minutes of eating my first chilli, my eyes began to water and my pulse shot up. My body had responded to an initial burst of severe pain by releasing adrenaline. This not only made my heart beat faster, but it also made my pupils dilate. Every round the chillies got hotter and both of us soon dropped out. Had we been able to tolerate biting into some really hot chillies, it’s possible we would have experienced a “chilli endorphin high”. Endorphins are natural opiates, painkillers which are sometimes released in response to the chilli’s sting. Like opiates they are said to induce a pervasive sense of happiness. It is a form of thrill-seeking – feeding our brains’ desire for stimulation. ……

…… In a recent study done by researchers from the University of Vermont they looked at data from more than 16,000 Americans who had filled in food questionnaires over an average of 18.9 years. During that time nearly 5,000 of them had died. What they found was that was that those who ate a lot of red hot chillies were 13% less likely to die during that period than those who did not. This supports the finding of another recent study, carried out in China, that came to similar conclusions.

So why might eating chillies be good for you?

The researchers speculate that it could be that capsaicin is helping increase blood flow, or even altering the mix of your gut bacteria in a helpful direction.


 


%d bloggers like this: