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Assorted Observations about the COVID-19 aka SARS-2 Pandemic: 1

April 3, 2020 27 comments

Since I have been following this viral pandemic pretty closely, and actually possess professional expertise in the topic, I thought it might be an good idea to create yet another series for posting about assorted bits of news and my musings on them. With that in mind, let us start now..

1] We still do not understand why children under 10 years of age or even teens and youth under 20 seldom get seriously ill, given that cells in their bodies also express the ACE2 protein which is used by this virus to enter cells. Sure.. man in his 80s with serious cardiovascular issues might express more of that protein on their cells, but not that much more and in any case the difference is not enough to explain the very different course of infection in the below-20 vs the above-80. Variations in amount of ACE2 expression is totally inadequate to explain why many in the younger age-groups don’t even have symptoms versus why many above 80 quickly go into respiratory failure and then cardiogenic shock so quickly.

2] Many of you might also have noticed that rich and middle-class people between 20 and 80 are noticeably less likely to develop the more serious forms of the disease than the poor or working class people. Why? Why does the course of this disease vary so much with socio-economic status? What part of being from a higher social-economic status translates into the more benign form of this illness and which aspects of being poor or working-class result in a substantially higher percentage becoming seriously ill? This is especially relevant since we do not, yet, have good and specific treatments for this infection. Also, why is mortality among blacks in USA noticeably higher than whites or latinos. Yes, this observation is based on fairly preliminary data from certain states such as Michigan and New York– but it is just too obvious to ignore.

3] We also still do not know what percentage of those infected experienced an asymptomatic or mildly-symptomatic version of the disease. This is important since the vast majority of testing in western countries is still limited to those showing some symptoms, usually serious enough to seek medical attention. But we already know that a significant minority of the infected don’t even develop symptoms and then go on to develop immunity to it without experiencing the disease. What is the percentage of those who never develop even a fever or cough serious enough to seek medical attention and why is the course of the disease so mild or nonexistent in them? What makes some people resistant to the disease even if they have no prior immunity to it?

4] How many older people who died of Acute Respiratory Distress Syndrome (ARDS) due to an unidentified reason (not bacterial pneumonia, influenza etc) in the past two months in USA, and countries such as Italy or Spain, actually died from COVID-19. I suspect that the number of such deaths might be far higher than most “serious people” are willing to accept right now. There is evidence that doctors in Italy were seeing isolated cases of serious viral pneumonia that could not be attributed to influenza or other common virus, as early as November and December 2019. In USA, this is especially obvious in certain urban areas such as Cook County and New Orleans. We require far more extensive testing of the population- both for the virus and resultant antibodies.

5] If you look at the “official” symptoms of COVID-19 or SARS-2, you will see stuff such as fever, dry cough and difficult breathing. However even a cursory glance at published data and accounts of medical professionals attending them paint a different picture. For example, symptoms such as sudden loss of smell (anosmia), some GI symptoms in elderly patients, anomalously low blood pressure, puffy allergy-like eyes carry far more diagnostic significance to this disease than typical symptoms supposedly associated with it. For example, patients who display hypotension are far more likely to progress to more serious forms of the disease than those who don’t. What is the mechanism behind these unusual symptoms and their correlation with disease severity?

In the next part, I will write about potential drug therapies to treat this infection as well as possible routes for rapid vaccine development.

What do you think? Comments?