Home > Critical Thinking, Current Affairs, Dystopia, Musings, Philosophy sans Sophistry, Reason, Secular Religions, Skepticism > Assorted Observations about the COVID-19 aka SARS-2 Pandemic: 1

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

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?

  1. Yusef
    April 3, 2020 at 2:58 pm

    “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?

    A recently published article in Science pegged the number at 86%.

    I would not be surprised.

    • doldrom
      April 4, 2020 at 10:44 am

      Yes, and the number of infections ascribed to asymptomatic carriers was 79% !!!
      Even though they carried viral loads 55% lower.

      The number of asymptomatics is probably upward of 25% of those 86% with mild symptoms.

  2. Yusef
    April 3, 2020 at 3:10 pm

    “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.”

    We know a significant majority of the infected don’t even develop symptoms.

    “…..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?

    Maybe they aren’t resistant exactly, but simply put, the pathogenicity of the virus has been horribly exaggerated. Except for people crying “fire” in a crowded theater, I have not seen solid data showing it is severe. All I see is evidence of exaggeration.(I’m open to being shown, though. Just don’t cite the NYT or any opinions as evidence.) As John Ioannides, a Stanford University epidemiologist has said, this may be “the evidence fiasco of the century”.

    I thought crying “fire” in a crowded theater was against the law.

    If I was a guessing guy, there are at least 2-3 subclinical cases for every one sick enough to seek any medical attention.

  3. Rum
    April 3, 2020 at 4:52 pm

    I am in a relevant field. I read non-public reports from MDs on the front lines.
    When this hits hard, it is devastating. Of those who require ventilator care, eventually 70-90 % die. One problem is that vent care is not therapeutic, it just maintains breathing for a few weeks. But their lungs rarely improve in the time before they die of sepsis or critical hypotension. The average age of ICU patients in places like Italy keeps falling for a reason no one wants to talk about:Triage regarding the old and infirm. They only treat younger patients.

    Yes, I am aware of those issues. Most people above 70 who end up on ventilators die. Also triage based on age is going to occur in USA, whether they like it or not.

    Extreme fluid restriction is needed to keep the lungs dry-ish and then the kidneys fail. Forget dialysis. CV systems become catecholamine resistant, which is bad when you are fluid restricted and hypotensive.
    The pre-clinical numbers out in the world being tossed around are just wild guesswork. It is probably way more common than supposed because it shows up in out of the way places that are hard to explain by current models. But once you develop respiratory failure, definite patterns stand out and its not pretty.

    And that is why repurposed oral drugs which prevent the worse case scenario (Chloroquine, Hydroxychloroquine, Ciclesonide, Azithromycin and maybe Indomethacin) should be used as early as possible in course of disease. Perhaps even a 2 or 3 day course of Colchicine might help before severe respiratory failure sets in.

    What is your theory for the reduction in blood pressure seen in this disease. Excess NO release? Endothelial damage?

    • Yusef
      April 3, 2020 at 6:57 pm

      I don’t trust MDs on the front lines to understand the battle any more than I trust combat soldiers to have a battlefield overview or know the best strategy, from where they’re standing, to fight the enemy and win the battle.

      MDs and soldiers have their personal experiences and share the experiences of the relatively few others with which they are in communication, that’s all. It’s not that these experiences they have or know about are not important, or that their observations deserve to be discounted. It is simply that they don’t have enough experience to form a clear idea of the big picture.

      What’s happening or not happening can only be understood statistically, by collecting population data. That means examination of many, many cases in a wide variety of settings and conditions.

      I doubt you are reading false reports or exaggerations from MDs, you see. When you say, “When this hits hard, it is devastating. Of those who require ventilator care, eventually 70-90 % die” I am sure this is accurate.

      However, the questions remain: “How frequently does it hit hard? Are there specifiable conditions where it hits hard or does it hit hard under all conditions? Are all age groups hit hard? Are there vulnerabilities observed predisposing to getting hit hard? These questions, among others, would have to be asked and answered before knowing the epidemiological significance of it hitting hard once it hits. Also, having the answers would help maximize the benefits of various responses without maximizing their costs to society now and in the future.

      I’m only trying to understand this situation myself, not criticize anyone’s ideas unless they are hysterically fear mongering.

  4. Rum
    April 3, 2020 at 6:13 pm

    Probably all of the above, just not in the same mix for every patient. Severe endocarditis sometimes is primary.with some and absent in others.There can be a CNS issue, a gut issue, etc. but variably.
    China lies about everything by habit and the Italians were too overwhelmed to tell the world in much detail what they were seeing. Besides, if nothing you try actually works, the tendency is to wait before you talk about that.

    From what I have heard, a few (2-4) days after intubation, many older patients develop carcinogenic shock with ejection fraction around 10% and pressor-refractory hypotension. All of this occurs without signs of cardiac muscle damage or actual infection of cardiac muscle cells by the virus.

  5. P Ray
    April 3, 2020 at 8:04 pm

    The big elephant in the room … is why are more MEN with CoViD-19 dying than women?
    And the other tasteless questions to ask is … did censoring that reality allow the situation to get worse, and was it more acceptable to do so because only MEN were the majority of deaths?

    Both SARS and MERS also caused a slight excess of male mortality.

    • doldrom
      April 4, 2020 at 10:41 am

      I have read elsewhere that the demographics of death in Italy exactly matches the normal mortality statistics, in other words, more men are dying around 75 years old all the time. Men have shorter life expectancy and this really kicks in around 75-80 years old.

    • P Ray
      April 9, 2020 at 10:19 am

      You know the setup to this joke/bullshit, right?
      “Men die, women hardest hit”
      https://www.dailymail.co.uk/news/article-8202637/Coronavirus-crisis-plunge-half-billion-people-poverty-Oxfam.html – Coronavirus could push half a billion people into poverty, with women more likely to suffer than men
      An Oxfam report said Covid-19 is causing a ‘rapidly unfolding’ economic crisis
      It estimated that global poverty could increase for the first time since 1990
      The total number of people living in extreme poverty could climb to 1.2 billion

      I guess this also means that feminism will be set back quite a bit, which is good news

  6. Directm
    April 3, 2020 at 8:21 pm

    60% of Americans are overweight, 30% are obese and 10% are diabetic and obese. Fill in the blanks.

    • pops
      April 4, 2020 at 1:51 am

      i think more black people are dying is because not how it affects thier bodies, but because of socioeconomic reasons. maybe cause its so expensive to go to the doctor they are getting diagnosed in the late stages of maybe even post-mortem. also damage done to the body by enviromental factors may play a part in the death rates of people. obesity, living in cities with high pollution, etc, etc may contribute to these rates.

      Very likely, but what aspect of poverty or neglect causes the more severe presentations?

    • Jay Fink
      April 4, 2020 at 8:50 pm

      I take a blood pressure med called Lisinopril which is an ACE inhibitor and floods your body with ACE2. My doctor insisted I keep taking it and said I have a lot higher chance a bad cardiac event or death if I don’t take it then dying of Covid 19 if I do take it.

      I thought maybe my doctor wasn’t informed about how the virus enters your body through ACE2. So I did an internet search and pretty much the entire medical community, including those who fully understand ACE2 receptors, say keep taking these meds if you have been prescribed them. Some even say they have a protective affect if you become infected. I am skeptical and worried but still taking my Lisinopril. Not sure if you have any insight on this.

      ACE inhibitors for treating high BP block ACE1, not ACE 2. As far as we know there is no evidence that ACE inhibitors increase mortality. In fact, there is some evidence that Angiotensin II blockers reduce the risk of severe outcomes.

      As for your #2 point. Obesity is obviously more common among the poor. Also the poor and working class are far more likely to smoke than the middle class and rich. I read a Chinese study that found those with a history of smoking have nearly a 14X more of a chance to develop complications. Not too surprising considering the virus attacks the lungs.

      But why? What is the biochemical mechanism?

  7. doldrom
    April 4, 2020 at 10:40 am

    I have read elsewhere that the demographics of death in Italy exactly matches the normal mortality statistics, in other words, more men are dying around 75 years old all the time. Men have shorter life expectancy and this really kicks in around 75-80 years old.

  8. doldrom
    April 4, 2020 at 10:57 am

    1] Children have less catastrophic disease progression with many viral illnesses. The relative low number of children with symptoms could piggy back the relatively mild symptoms in the majority of those infected.
    2] Brown, black, and poor people. The skew is probably a proxy for something else, such as the incidence of obesity, metabolic syndrome, and co-morbidities. There seems to be some evidence for African extraction actually being somewhat protective against respiratory infections.

    Not brown, as much as black.

    4] Evidence coming to light about mortality in the Netherlands and Italy (as well as Chinese anectodes) is that undetected Covid-19 related morbidity may be 2,5-3× the detected rate. On the other hand, the weight of Covid-19 as cause of death is also very problematical, as holds true for flu and respiratory ailments normally. Did he die of old-age, COPD, heart problems, hypertension, diabetes, metabolic syndrome, cardiac decompensation, stroke? It is common for old people with pneumonia (secondary infection to flu?) to have strokes or cardiac decompensation…

    That is the problem.. we just don’t know yet.

    5] This bug seems to screw around with your immune system. Many people have it for 7 days, then suddenly collapse, not just due to lung function but also complete collapse of immunity, with fungii and germs everywhere. Don’t be surprised if vaccines have problems with antigen dependent enhancement leading to more catastrophic infections instead of less.

    Nope, it causes overreaction by part of immune system- a cytokine storm.

    • doldrom
      April 5, 2020 at 8:33 am

      In Italy, of the Covid-19 dead (not the excess untested morbidity of pneumonia), 12% died due to Covid-19 and and the rest with Covid-19. Only 1.72% had not preexisting condition.

      But the cytokine storm is a struggle with visible symptoms. The surprise for doctors is the number of people who go from still OK to dead within hours.

    • Yusef
      April 5, 2020 at 10:11 am

      “This bug seems to screw around with your immune system. Many people have it for 7 days, then suddenly collapse, not just due to lung function but also complete collapse of immunity, with fungii and germs everywhere.”

      Can you provide a citation for this? I have to admit it is scarier than hell. There aren’t any other coronaviruses like this are there?

  9. Yusef
    April 5, 2020 at 10:05 am

    “Very likely, but what aspect of poverty or neglect causes the more severe presentations?”

    Dr. Shiva, who was recently quoted here via posted video, had the right idea.

    He thought the American healthcare system had failed the public’s health by concentrating on drugs for treatment/cure and neglecting preventative measures to strengthen the immune system.

    Go through Dr. Shiva’s list of preventative practices and you immediately see these are mainly unavailable to poor people.

    Fresh fruits and vegetables are of paramount importance for maintaining general health and beefing up the immune system, but also very expensive. Poor people can’t afford them. Poor families tend to buy cheaper and less nutritious foods. They get fat and sickly this way.

    There’s a vicious cycle: fat, sickly people don’t feel like exercising and not exercising also weakens the immune system.

    Poor black people might be more vulnerable than others because they are incarcerated so much more frequently. Most prisons or jails nowadays do not serve fresh fruits or vegetables. (This is justified on the basis of blocking prisoners from fermenting these to make alcohol, but I think it is a way of ladling on the cruel effects of confinement. Our society is run by greedy sadists.) Go a few years without fresh fruits and vegetables, and see what happens. Your health is harmed. Lots of people know you go to jail and get sick.

    • P Ray
      April 8, 2020 at 6:32 am

      There’s a vicious cycle: fat, sickly people don’t feel like exercising and not exercising also weakens the immune system.
      https://en.radiofarda.com/a/eleven-athletes-in-iran-have-died-of-coronavirus-infection/30502659.html – IRAN NEWS
      Eleven Athletes In Iran Have Died Of Coronavirus Infection
      March 22, 2020
      Radio Farda
      Elham Sheikhi, Iranian female footballer, died after being infected with Coronavirus– 27 Feb 2020
      Elham Sheikhi, Iranian female footballer, died after being infected with Coronavirus– 27 Feb 2020
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      More than ten current and former Iranian athletes have fallen victim to novel coronavirus, according to data collected by Radio Farda.

      Those people must have been very lazy and unfit.

      But seriously, the reality is … being fit doesn’t mean you have a strong immune system

      • Yusef
        April 8, 2020 at 8:29 am

        Exercise doesn’t strengthen the immune system to the point where fit people never get sick, but it does improve the immune system enough so they are sick less often. Google “exercise and the immune system.”

      • P Ray
        April 8, 2020 at 8:36 am

        You sometimes get the feeling that certain qualitative and quantitative truths will be hidden forever behind the wall of “google and get results”.

        Telling people for example, that certain jobs, even if qualified, they will never get due to nepotism or corruption … you ever think anyone will go on the record to say that in an official publication?

        Same thing with immune systems, I get the feeling you are born with a good one or not,
        and the way companies make money is by selling you the dream that everyone can get to that level, just by believing and buying products from them.

      • April 8, 2020 at 4:08 pm

        “Telling people for example, that certain jobs, even if qualified, they will never get due to nepotism or corruption … you ever think anyone will go on the record to say that in an official publication?
        “Same thing with immune systems, I get the feeling you are born with a good one or not,
        and the way companies make money is by selling you the dream that everyone can get to that level, just by believing and buying products from them.”

        AGREED, “immune systems”.

        I’ve age 64, been a (non-steroids) bodybuilder for forty-eight years beginning at age sixteen in 1972; despite what supplement companies, equipment manufacturers, and exercise program “gurus” typically say to sell their products, GENETICS ultimately and primarily decides how much muscle size and what proportions a person can build. Proper, consistent training, nutrition, and recuperation will enable a person to develop to those genetic limits, of course…but (even with anabolic steroids and other drugs enhancement) genetics definitively set each person to a limit.
        Consequently, those people born with average genes for developing muscle can never achieve a “championship level” physique even after twenty years of dedicated bodybuilding…and, the small percentage born with less-than-average genes sometimes don’t even look as if they ever touched a barbell after ten years of dedicated bodybuilding. But, no marketeer clearly volunteers that information to new prospects; instead, the muscle industry profits by clouding the truth while cultivating the false hope, “buy this, and you can look like that too!”

        Likewise, certainly, it’s possible to optimize or compromise whatever immune system genetics one is born with, via lifestyle choices. But the more important variable seems to be the genetics — a person born with exceptionally strong genetics can often remain healthy despite poor lifestyle choices, while another who born with a weak immune system gets sick despite consistent exercise, nutrition, and rest.

      • doldrom
        April 8, 2020 at 5:23 pm

        @JoeSantus
        Agree, but it is more complex than a good/strong immune system or a poor one. Immune systems and physiology vary a lot, which means parts of the populations are more or less susceptible to certain pathogens and other problems. It is almost impossible to predict why one person gets really sick from a certain bug and someone else mildly so, but vice versa for a different bug. There are also a lot of issues with auto-immune problems which don’t necessarily relate to a strong or weak immune system, but overreactions. There are a lot of moving parts to immunity, so weakness and strength are not just overall conditions: a maserati can still get a flat tire too.

        But the general point is valid: That’s why the East Blok countries tried to select athletes for swimming or track or whatever on the basis of physique and aptitude. You are not born a concert pianist or football star, but no amount of training can compensate for lack of innate talent. Fact is that even applies to doctors or teachers, but we pretend that it’s all in the education instead.

      • April 9, 2020 at 10:15 am

        DOLDRUM…

        (1)”…but it is more complex…”

        Yep, agreed.
        I deliberately oversimplified rather than make my already-too-long post longer.

        During my nearly five decades of bodybuilding, I’ve observed the wide genetic variation among individuals (even among the elite-gened, genetics vary so much that a training protocol and nutritional menu, and even a drug regimen, which is effective for one isn’t effective for another), and, observed the variations even within each individual’s genetics (for example, a man may have genetics which enable elite development of his arms and shoulders but at best mediocre development of his calves). The parallels to individual variations in immunity seem clear to me.

        But, yep, the main point is, “Whether muscular potential or immunity, it primarily comes down to individual genetics.”

        (2)”….Fact is that even applies to doctors or teachers, but we pretend that it’s all in the education instead.”

        Exactly…reality is not, “You can successfully be anything you wish!” Rather it’s, “You can successfully be whatever you’re innately apt to be.” The former is a lie we as humans seem to need to sustain hope and avoid feeling inferior among ourselves; the latter is the truth a feminized society avoids in order to muzzle the importance of biology.

      • Yusef
        April 9, 2020 at 11:26 am

        There are a few people who can train all day long without benefit; a few who don’t train at all and reap all the benefits most believe are only bestowed on those who train all day long. There are people who hardly smoke and contract cancer; there are people who smoke three packs a day for half a century and yet die of old age.

        However, it is not true choosing to smoke or not is of no consequence to one’s health. It is not true choosing to exercise or not is of no consequence to one’s health.

        Looking at this and comment on the corona virus here and across the internet leads me to believe people do not understand statistics and probability. It is as if there is no such thing as probability and statistics. And that is most unfortunate, indeed. If you don’t know how to think using probability and statistics you can’t have any hold at all on what’s happening in this “pandemic”.

  10. P Ray
    April 8, 2020 at 6:27 am

    Some more fun stuff:

    1)In South Korea, “51 recovered coronavirus patients test positive again”

    2)This is a virus, it stays with you for life.

    3)When enough people get it, and employers don’t hire people who had it previously, those people will lobby governments so that finding out who has it is a crime.

    4)Air New Zealand has already started hiding results. “Coronavirus: Air NZ employee says airline’s not releasing Covid-19 results”

    5)When the infected outnumber regular people, they will legislate for their own advantage

    6)Gonna be even more fun when the coronababies are born.

    I wonder how governments will react when women say “I don’t want to have sex with someone who had CoViD-19 before”

  11. doldrom
    April 8, 2020 at 5:35 pm

    There seems to be some evidence that C19 is somehow affecting blood cells, separating (reactive) iron molecules from hemaglobine. This leads to the poor O2 saturation even when respiration is still intact. How the virus does this is unknown (well, apart from the proteins involved), since it cannot infect and replicate in those cells. But it does explain why the pneumonia is always (unusually) equal bilaterally (starting in the blood instead of the lungs), the low saturation, the organ failure, and circulatory collapse in the absence of cardiac damage. It also ties in with Chinese success with high dosages of intravenous VitC and the Azithromycin, both have good anti-oxidation properties.
    There is also a hypothesis about some interaction with excess adipose deposits (belly fat).

  1. April 9, 2020 at 6:08 pm

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