Hopeful: Summary of Wuhan #Coronavirus Therapies and Potential Cures

Guest post by Rud Istvan,

In the 3/19 Wuhan virus briefing with the FDA, team Trump made much of the possibilities for two therapeutic candidates, chloroquine and remdesivir. Having now done informed basic research on both, I found their stories intrinsically interesting, while enabling an early assessment of their chances of success. Hence this hopeful guest post.

Background

Wuhan coronavirus is an enveloped positive sense single strand RNA virus, meaning its core genetic RNA code is just one long chain coding directly for several proteins, surrounded first by a protective viral protein capsid coat, and then a lipid membrane ‘envelope’ from which project so called “E” (for envelope) and “S” (for spike) proteins. The S protein is what the virus uses to bind to and then invade the lung’s epithelial cells in order to hijack those cell’s reproductive machinery to make copies of itself using its RNA polymerase, itself encoded in about 2/3 of the core viral genetics. The newly assembled virions that then bud out to infect new cells also eventually kill the infected epithelial cell. Covid 19 disease is caused both by the death of those cells and the immune system’s eventual response to the infection.

The S spikes are also the reason this virus class is named corona, because the spikes make it look under SEM like the virus is wearing a crown.

Chloroquine

These are actually two closely related anti-malarials, hydroxychloroquine (the small French trial) and chloroquine phosphate (the larger Chinese trial). Both were developed in the 1950’s, and interestingly the main use now is to treat rheumatoid arthritis rather than malaria (which evolved resistance).

The discovery that certain classes of anti-malarials also affect rheumatoid arthritis (RA) was made quite by accident in 1951 by an asute doctor treating malaria in an RA patient. The problem then was the side effects of chronic RA use made them unacceptable for RA. The chloroquines were developed expressly as ‘milder’ side effect anti-malarials, and in the mid to late 1950’s there were a number of papers (I reviewed several for this post) reporting good RA safety and efficacy leading to global approvals for that indication.

The mechanism of chloroquine action on RA has long been well known. It increases a cell’s lysosomal pH. (Lysosomes are membrane bound cellular organelles [think tiny balloons inside the cell floating at a lower pH in the higher pH cytosol] containing about 50 enzymes, discovered and named in 1955.) This in turn changes their ‘leaked’ enzyme balance into the cytosol, which then inhibits the cell’s RA tissue antigen signaling, which in turn reduces the immune system’s attack on the RA tissue, slowing (but usually not stopping) progression of RA tissue damage.

The reason the Chinese and then the French thought to use chloroquine against Wuhan coronavirus is this same mechanism of action, albeit with different sequelae. The viral S protein binds to the epithelial cell wall’s angiotensin-converting enzyme 2 (ACE2) receptor. Raising lysosomal pH changes (via indirect enzymatic action) the ‘shape’ of ACE2 enough that the S protein cannot bind to it, thus preventing cell infection. Chloroquine changes the cell ‘lock’ so the viral ‘key’ doesn’t work. Does not undo damage from infected cells, nor prevent an infected person from shedding existing viable virus, but does stop the spread in an infected person’s body—a promising therapeutic for those testing positive.

Since safety is well known (the main side affect is retinopathy [vision problems] in 25% of patients over 50 that resolves [slowly] after discontinuation), the main FDA legal issue (FDCA Act of 1906 as amended) issue is to determine dosing and duration for this new indication. But for starters, the standard RA 250mg once a day generic cheap pill should suffice for emergency use authorization (EUA). As a ‘Big Pharma’ goodwill gesture, today (3/19) Bayer announced it donated 3 million 250mg chloroquine phosphate pills to the US to get started.

Remdesivir

This is a novel antiviral from Gilead that has a somewhat checkered past. It was originally developed for Ebola, where in African trials a few years ago it was shown reasonably safe but not very effective. It did, however, show efficacy against SARS and MERS in vitro. And, importantly, the NEJM reported a positive case outcome in Seattle patient zero under a compassionate use exception. The patient had visited Wuhan, returned to Seattle, began displaying symptoms, and was hospitalized on symptom day 3. By symptom day 8 X-ray showed clear lower respiratory tract viral pneumonia (diagnostic ‘ground glass’) and supplemental oxygen was started. Patient worsened, and intravenous antibiotics were started day 9. Patient worsened (proving viral pneumonia), so attending physicians consulted with FDA then had Gilead rush the experimental drug by air, with intravenous treatment starting day 10. Patient improved in 24 hours, was saved, and has since been discharged. For those interested, there is this NEJM case report providing a very hopeful proof of principle.

The reason Gilead tested it against SARS and MERS even though those two episodes died out naturally has to do with Remdesivir’s novel mechanism of action. The ‘drug’ is just an analog of the amino acid adenosine, one of the 20 amino acid (only, in all life on Earth, proving a common genetic ancestor) building blocks the viral polymerase uses to ‘assemble’ new copies of the viral RNA genetic code. The polymerase does not recognize the small difference between adenosine and the analog. Flood an infected cell with enough remdesivir molecules, and the polymerase will eventually grab one and add it to the ‘building’ RNA copy. Remdesivir is enough different that the polymerase is then blocked from adding any more amino acids to the RNA chain, so viral replication halts. Neat very basic molecular genetics provided at a basic science 101 level.

What Gilead scientists recognized was that the RNA code for Ebola RNA polymerase was very similar to SARS and MERS RNA polymerase, hence the in vitro testing. And when the Chinese first published the roughly 30,000 base RNA code for Wuhan coronavirus in January, it was evident immediately that it was another good RNA polymerase match, so they started immediate in vitro testing once viral samples were in hand.

Aside from price (Gilead is infamous for its Hep C cure that ‘only’ costs about $100,000 per treated patient), and scaled up availability (none yet, same issue that killed my 3 of 4 EUA for a persistent hand sanitizer in the 2009 swine flu pandemic), there are questions about dosing and treatment timing. There is some thought that remdesivir may not be useful past symptom day 10 or 11, typically when a patient worsens to need an ICU ventilator. The concern logic is simple. Remdesivir blocks virion replication in an infected cell, but not its spread to newly infected cells by virions from previously infected cells. So basically a quantity/quality argument saying eventually blocking further spread when you already need a ventilator for viral pneumonia is futile. Those clinical questions are why China is conducting a double blind (drug/placebo) trial on ~790 patients in Beijing and Gilead is conducting an unblinded smaller trial in the US, starting in Nebraska with Diamond Princess patients. The first results from both will be available sometime in April.

Further observations

Neither chloroquine nor remdesivir are just luck. The rapidity of their development against Wuhan virus reflects the enormously powerful insights that molecular genetics and molecular biology and their associated tools (sequencing, PCR, oligomer synthesis, protein structure) now bring to science and medicine. To echo the contrasts to climate science in my first post on Wuhan, this is as if we actually had now the computational power to avoid parameterization in climate models. Climatologists do not, but virologists do.

Chloroquine probably works, as AW previously posted. It would solve this pandemic’s key issue, progression to viral pneumonia requiring ICU ventilation. New York’s Governor Cuomo said yesterday that he has been told that without ‘bending the curve’ based on Italy, New York will require 27000 ventilators in a few weeks when the state only has 3000. Invoking the Defense Procurement Act cannot solve that mismatch in time without a ‘bent curve’ achieved via social distancing, frequent hand washing, and avoiding touching the mouth, nose, and eyes. All three are difficult but not impossible. Ambassador Dr. Birx is pretty clear about the dire consequences of Millennials ignoring these basic common sense recommendations during Spring Break this week in Florida. Here in ground zero Fort Lauderdale, our public beaches are closed, and the closure is policed.

But chloroquine still has the same Wuhan issue illustrated by its previous use for malaria–evolving resistance. RNA viruses like Wuhan coronavirus mutate rapidly (explained in my first post on this topic). The most conserved protein is necessarily the RNA polymerase. We know this from influenza, where it is the hemagglutinin and neuraminidase envelope proteins (equivalent to Wuhan S) that mutate so the annual vaccine is never ‘right’. Chloroquine may well be effective now, but if Wuhan coronavirus becomes endemic (now likely given its spread in Africa and Southeast Asia), then it is not a long-term solution like a vaccine. But it will probably buy the precious time to get a vaccine.

Remdesivir may be a longer-term therapeutic solution, because it tricks the conserved RNA polymerase. But its cost and efficacy remain to be determined.

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507 thoughts on “Hopeful: Summary of Wuhan #Coronavirus Therapies and Potential Cures

  1. *****CORONAVIRUS: STOP GOING OUT – IT IS GOING TO KILL PEOPLE – WARNS ICU DOCTOR
    video – 8 minutes 45 seconds

    • “Stop this virus” ROFLMAO… that to me sounds like stopping the wind. Dr. Chicken Little et al don’t seem to realize that there is no stopping influenza or cold viruses. These viruses were around long before humans travelled the world easily and increased transmission rates.

      The sad fact is that everyone that lives long enough in modern societies today will probably get Covid-19 eventually, if not this year then next, if not next year then some year after that. Shutting down the global economy has the potential to be magnitudes worse than the worst case scenario with this novel cold virus. Millions of people died from economic hardship related causes in the USA alone during the Great Depression, we’d better hope a new cold is the worst thing that comes out of all of this.

      • I don’t know where you get your history from, but you need better sources. There were no deaths from economic hardship in the US during the depression.

        Yes, people will probably get the virus someday. However they will be a lot better off if they get it at a time when hospital beds are available and the medical system isn’t in the process of breaking down from over use.
        That’s why we try to isolate, in order to slow down the number of people getting the disease at any given time.

        • Well: I think the idea is that there is significant evidence, regardless of specific reasons, that wealth affects length of life. So picking whether or not people starve to death may not present the full picture. MIT has done studies, and there are lots of other studies.

          In US there is less likelihood of people dying because they cannot afford to heat their homes, like in UK. But in general, wealth of a nation leads to decreased mortality, me thinks.

          • My dad (1926-2017) told me that people took care of each other during the depression and WWII, which made all the difference from today. Now folks try to “watch out for #1” and “make sure nobody gets mine”.
            That might have been a mitigating factor for the less fortunate of that previous era.

          • Penicillin discovered in 1928. If looking for a cause for life span increases during the depression, that was surely also a factor. Diet changes and reduction of smoking (did it?) May also have contributed.

        • There were no deaths from economic hardship in the US during the depression.

          and GOOGLE says:

          Of six causes of death that compose about two-thirds of total mortality in the 1930s (Fig. 4), only suicides increased during the Great Depression. Suicide mortality peaked with unemployment, in the most recessionary years, 1921, 1932, and 1938.Oct 13, 2009

          so, YOU ARE WRONG and GOOGLE is your friend

      • “Stop this virus” ROFLMAO…
        ===≠========
        That isn’t the issue. If everyone gets sick on the same day, we don’t have the 5 million ICU beds we would need 10 days later, and the death rate would skyrocket.

        But if we can spread this out over time, we can dramatically reduce the death rate. Same number of people get sick, but different numbers of sick get life saving medical treatment.

        • I liked “bog” better. They sure bogged me down, right clicking for a definition every other word!

      • “Taiwan Says It Warned WHO About Coronavirus In December, But Its Warnings Were Ignored”
        https://dailycaller.com/2020/03/20/who-taiwan-coronavirus-warning/?utm_source=&utm_medium=email&utm_campaign=12322

        More grumpy pre-coffee news:

        I was scheduled to travel to SE Asia via China on 4Feb2020 and I cancelled because of cascading quarantines due to the corona virus. Now we learn that a coronavirus carrier off a cruise ship was allowed back into Canada on 21Feb2020 without being quarantined – MORE THAN THREE WEEKS AFTER I CANCELLED MY TRIP on 28Jan2020.

        I don’t claim to be that well-informed on global health issues, rarely bother to take my vitamins, and am not interested with the popular obsessions of personal health that fascinate younger generations. I don’t watch TV news or subscribe to a newspaper. So how the heck did I know more than three weeks ahead of our slothful Canadian government that something was seriously amiss?

        All our government imbeciles had to do was read the news – on January 31, 2020 the USA banned foreign nationals who had travelled to China from entering the USA, and any US citizen who has traveled in China had to undergo health screening upon entry into the country and was asked to self-quarantine for 14 days.
        https://www.theverge.com/2020/1/31/21117403/trump-coronavirus-ban-travel-non-us-citizens-china

        This is what I’ve come to expect from Canadian governments at all levels – at best, they are asleep at the switch. More likely the Libranos were busy plotting a way to scam billions of taxpayers’ money for personal use – the Justin Trudeau Liberals make the Jean Chretien crooks look like choir boys.

        • Well in Holland a majority of parliamentarians were refusing a debate on coronavirus als late as jan. 28 and jan.29. Now we’re shy of being a police state like most countries. Time for coffee I guess.

        • You answered your own question. You told what you don’t use as news sources, all the others are better.

        • Two of my relatives returned from Vietnam to Canada March 7rh. They had 2 observations. Eveything in Vietnam was closed and noone at YVR mentioned anything about 14 day self-isolation.

          We returned to Canada from the US March 2nd by car, same thing. No health questions.

          From my experience, it was only after Sophie Trudeau tested positive that the Canadian government began to get off its lazy ass.

          Much too busy jet setting around the world giving out taxpayer money and snapping selfies. Karma is a bitch.

        • PRIME MINISTER JUSTIN TRUDEAU CONVENES THE INCIDENT RESPONSE GROUP FOR AN UPDATE ON THE CORONAVIRUS SITUATION
          February 2, 2020
          Ottawa, Ontario
          https://pm.gc.ca/en/news/readouts/2020/02/02/prime-minister-justin-trudeau-convenes-incident-response-group-update

          Today, Prime Minister Justin Trudeau convened the Incident Response Group to discuss the Government of Canada’s response to the novel coronavirus,

          Minister of Foreign Affairs François-Philippe Champagne, lawyer

          Minister of Health Patty Hajdu, Bachelor of Arts, Master of Public Administration

          Minister of National Defence Harjit Sajjan, former detective with the Vancouver Police Department, a former Lieutenant Colonel with the British Columbia Regiment

          and Minister of Public Safety and Emergency Preparedness Bill Blair, 39 years with the Toronto Police Service, the last decade as its Chief of Police.

          JUSTIN TRUDEAU’S CORONAVIRUS TEAM: A LAWYER, TWO EX-COPS, AND A BACHELOR OF ARTS. ZERO QUALIFICATIONS FOR THIS TASK.
          PLUS ÇA CHANGE, PLUS C’EST LA MÊME CHOSE.

    • There’s a horrible tale on https://going-postal.com/2020/03/fred-and-doris/ telling the story of an old couple subjected to Boris’s ‘self exclusion’. It basically tells the tale of a ‘don’t-care’ government attitude. Now, as an ex-Pommie, I’d like to think that it was merely carelessness on the part of the UK rule makers, but then, as a South African, I remember the stories of the Anglo-Boer war ‘concentration camps’ and the ‘don’t-care’ attitudes that led to so many deaths by disease. Having grown up in the post WW2 years, I have to say: Not My Country!

      • Yet, for whatever reasons, the UK has suffered far fewer deaths per million population than EU countries. As noted, Germany isn’t comparable because of different statistical and medical practices, eg not testing those who’ve died of pneumonia and other causes for Wuhan virus.

        Italy has suffered 80 deaths per million, Spain 30, the Netherlands 8.0, but Britain only 3.5 so far. Being an island might help.

        • If you look at Willis’ latest coronavirus post, you will see that UK is only just below Italy for death rate against time since first case. If you subdivide the UK deaths into London and ‘the rest’, London has had about 10 deaths per million, and the rest about 2.5.

          • So far in the US, cases and deaths are also concentrated in big cities, and Italian cases in the North, with so many Chinese workers.

            The U.K. is unlikely to track Italy in cases and deaths.

          • Willis’ graph starting all curves from time of first death shows the UK far below Italy.

  2. “as been told that without ‘bending the curve’ based on Italy, New York will require 27000 ventilators in a few weeks when the state only has 3000”

    Spare us.

    Those stats are not based on infection increases but testing increases. For all we know real infection rates could be decreasing in reality.

    So what about Italy? May be all there drugs are Mafia counterfeits or otherwise faulty and that’s killing Italians. Meanwhile the Koreans are using quinine and the Israeli govt. is sending millions of pills to the US.

    Trump’s fear spreading newsconferences have made the country crazy, and certainly susceptible for misleading statistics. Sound familiar?

  3. Quinine derivatives are also Zinc ionophores, they increase the concentration of intracellular zinc. The viral replicase enzyme of n-COV-19 is gummed up by Zinc slowing replication.

    • I have B-blood type (I naturally lack the antigen that is most effective against viruses)
      I catch every virus that goes around taking weeks to months to get better. I’ve tried every product, by far the most effective is “zinc”
      I’ve tried zinc throat sprays and nose sprays which are not effective as the zinc rapid melts. If you have a sore throat, break up a tablet and place small pieces between your cheek and gum and let it slowly melt. Most effective before bed absorbing all night, when you wake up the sore throat is gone. Do you feel a cough coming on? Crush a small amount between your fingers and breathe the dust, sucking air sharply. Same with the runny nose, crush a small amount into dust with your fingers (smaller than half a pea) and breathe it in. The powder will stick to the membranes delivering the medicine where it’s needed. The results are amazingly quick and will stop a cold before it starts.

      • Max:
        I am B+ and grew up catching every dang cold, flu and sinus infection that went around. I was not aware of blood type vs virus until recently where I read O type is most resistant and A type least resistant. Is B type in the middle?

        I have asthma when around cats and some other allergens, and get bronchitis every time I catch a cold. Running and cardio allowed me to gain control over it –which when I was 12 years old was against my doctors orders to be active. So I decided to not follow his advice.

        At 55, and since my mid 40’s, I don’t catch so many, and when I do, they are extremely short lived.
        It’s the Zn (CA/Mag/Zn) Vitamin D3, C, quercetin, juiced powders, that made the difference in my life. The thing is, I was most afraid of growing old and dying of suffocation. Now I am more robust than when I was in my youth.

        One funny thing… when I get sick the point where I crave steak I know I’m just about over it. It’s a fluffy science barometer for me. Good health!

        • I’m A1, rh- and I nearly never suffer from any virus, only rhinovirrus. Rarely a influenzal infection, with low fiever, often without, so not knowing if it was a viral infection.
          Born 52, smoking.

          • Please expand on the ‘juiced powders’, please…

            I vary the use of brands. Costco used to have a green green powder called Amazing Greens. They also still have a powder with lots of reds and greens, called Juce, Trader Joes used to have “Reds” and “Greens”

            I like to make sure I get all the colors and a huge variety of well known organic juiced veggies so that all of the phyto’s are available to feed me.

            Today I continue to use Juce and my wife is a naturopath and orders greens called Nourish Greens by Apex Energetics.

            She can tell what I am in lack of through muscle testing, but I also eat way more of these juices than is called for.

            I do this mostly because we will probably never stop finding specific vitamins and nutrients to supplement, but food has a nearly infinite ability to provide what we need, especially plants.

            I swear by them, and have gotten rid of cancers that doctors promised would not go away.

            People say it’s anti oxidants, or give a myriad other reasons. All I know if that my health has turned around over the past 15 years as I expected age would force it in the other direction!

        • Mario: like you, as a child I developed bronchitis after every cold. These attackes were sheer hell – I’d be fighting for every breath I took during the night, and vomiting as well. Our local doctors were wonderful, a home visit and antibiotics to follow brought relief. I had pneumonia twice as a child as well.
          My doctor advised exercise – perhaps swimming, but the idea of being exposed to chlorinated water at the local pool didn’t appeal to me or my parents. Then I took it into my head to learn to ride a bicycle , at around age ten. I rapidly became a cycling fanatic, I rode hard, even trying a bit of racing in my teens. My bronchitis attacks feel dramatically within a year – the effect of exercise was unbelievable.
          My eternal gratitude to my GP, my parents, and my older brother who built up my first bicycle for me. He found an old Raleigh frame which had been poorly brush painted. I stripped it to bare metal, my brother got it sprayed a nice cherry red at a local motor cycle dealership and then assembled it for me. All of those who helped me are gone – they gave me the precuous gift of health, and I remember them with fondness for their kindness.

      • I’m B- . Not heard of this virus problem before and I’m not going to test it. I have MGUS and diabetes both from unknown sources although I recently read a paper that suggested pylori ? bacteria, those associated with stomach ulcers can trigger both illnesses. The surgeon I had when treated for ulcers said that anglo Saxons lack a certain enzyme which can allow Pylori to thrive. It’s all conjector though

      • When I was child, when a sore throat was knocking at the door, I got a desinfecting tablet of Chinosol to gargle with after dissolving it in water. As I remberer it well because of effectiveness, I used it later too, it’s rare I have a sore throat.
        Chinosol is a quinine product, chinolinsulphate-potassiumsulfhate for external use

      • I am B+ and almost never catch a cold and have never had the flu. The few colds I do catch is consistently caused from not getting sufficient sleep.

        I may be an anomaly to your theory so I am not denying it.

      • The whole blood type thing may be a total red herring, no-one has yet determined what the actual proportions of blood groups were in the are of Wuhan affected. They data is blood groups of those who died against WORLD AVERAGES and you get considerable deviation from that in many countries.

        • In the study was also a table with total proportions of the blood groups in Wuhan then compared with the infected. Though could of course have other reasons. Let’s say one type of blood live at one side of the city where the infection rate was higher. Will take another study to be sure.

      • I use the snuffing up of salt water into my nose and spitting it out my mouth at the first signs of a cold or flu. You can get a spray at the drugstore. About 1/3 to 1/2 tsp in a cup of warm water – it should not be enough to ‘burn’ your nasal passages. Pour in the palm and suff strongly up your nose. You will swallow a little bit. Add this to washing your hands. For Corona, I don’t know, but it wouldn’t hurt at worst.

        It was noticed years ago that North Atlantic fisherman didn’t seem to get these diseases commonly while landlubber friends and family did. Presumably fisherman everywhere get some benefit but rougher seas obviously would be a factor.

        • There is a device called a neti pot, looks like a miniature tea kettle.
          It is meant to be used with little packets of a salt crystals that is buffered and measured into an amount which will make an isotonic saline solution.
          This is poured into one nostril while standing in the shower, and it pours all the way through the sinuses while you keep your head tilted to the side.
          After pouring one pot through one nostril, you mix up another batch and pour it through the other side.
          Washes out the sinuses but good.
          Back when I was on chemo one time I had something going on where my sinuses smelled really awful.
          The cure was every day a nasal decongestant, and a antihistamine, and neti pot as many times a day as I could get around to.
          I kept it up afterwards.
          I think it washes stuff out of the sinuses that accumulates over an entire lifetime.
          If you look at a diagram of the sinuses in the face, it is obvious that stuff that gets in there has no easy way to get out…hence neti pot with hot saline.
          http://medivisuals1.com/images/products/detail/R15359_01XG.jpg

          • I do the same thing using neilmed sinus rinse. It comes with buffered salt mix.
            I use spring water heated to about 98F. The right temperature, lack of chlorine and proper salt sooth and work like a charm. I lay back holding my sinuses full of the water for a minute to let it dissolve the dry stuff.

            Importantly, DO NOT hold both nostrils when blowing your nose after this, as it will push the water with infection through Eustachian tubes. NOT good!

          • I do the same thing using neilmed sinus rinse. It comes with buffered salt mix.
            I use spring water heated to about 98F. The right temperature, lack of chlorine and proper salt sooth and work like a charm. I lay back holding my sinuses full of the water for a minute to let it dissolve the dry stuff.

            Importantly, DO NOT hold both nostrils when blowing your nose after this, as it will push the water with infection through Eustachian tubes. NOT good!

            PS fantastic sinus descriptions! No wonder I used to get so many infections.

          • re: “I think it washes stuff out of the sinuses that accumulates over an entire lifetime.”

            Hmmmm … Horseradish, hot yellow mustard? Seems to activate the sinus ‘flush’ mechanism too?

          • Nicholas,

            So glad that the chemo worked! (and your sinus treatment, too)

            And, very glad that you are still commenting at WUWT… 🙂

            Take, over there (well, most people are sound asleep at 1:55 AM 🙂 ),

            Your ally for science truth (that’s TRUTH, phone — heh, it tried to insert “fiction” there),

            Janice

    • Something for those considering Chloroquine to consider if they take ACE inhibitors. Those drugs deplete zinc, so you might need extra zinc to take advantage of chloroquine’s zinc ionophore property.

    • I’ve ordered some quinine supplement tablets as linked in the original WUWT post. Any idea what an appropriate dose might be?

    • Medcram on YouTube have an interesting video (Coronavirus update 34) explaining the way zinc works to protect the infected cell and why certain factors inhibit its usefulness.

    • UV light and high intensity. Instead of walking around cleaning desks with rags and alcohol sterilize them with UV. I’m not sure what intensity and duration would be needed but some water filters use them to kill off virus contamination. You don’t want to look at it without protective goggles.

    • It was the combination used to clear one cohort of the French patients in 6 days. IIRC, chloroquine alone cleared 60 percent while the combination cleared ‘all’ in 6 days. Why azithromycin antibiotic helps dunno unless some of the pneumonia was in fact secondary bacterial pneumonia, which quite common especially in elderly patients—the reason there are pneumonia vaccines for the two most common causative bacteria.
      Maybe an artifact. The study was small (40 patients) and the endpoint a bit murky (no detectable virus in the nose and throat is NOT the lower respiratory tract). There is a youtube of a US doctor analyzing the study rather critically.

      • Rud: Great article and very well written!

        That is my experience wrt to the use of azithromycin. Secondary infection is treated with antibiotics. In my case, I was reasonably sure I had no bacterial infection and waved the antibiotics. In no way did I want to kill off my hopefully healthy gut flora with antibiotics.

        At 55, my immune system is evidently still working well enough to enjoy (/sarc) short duration viral infections… feed the body with loads of mixed nutrients… carefully. Be in touch with how you feel… which is tough since we are relatively good at feeling change, but not good at feeling stasis.

        One needs to invest in keeping the old body ahead of the curve, where medical does not really chime in much in that respect. So it’s a lot of anecdotal research and accumulation of knowledge –that requires conscious change in what works and does not. Fluffy science sometimes.

      • no detectable virus in the nose and throat is NOT the lower respiratory tract)
        Don’t forget, the corona tests are based on curtailment exactly there, thoroat and nose, so what.

          • Nose and throat are good places to swab for the virus. It will be there.

            However, the virus attacks the lungs… not really easy place to collect a sample. But the mucus from the lungs will make its way to sinus and throat through cilia action.

      • The French treatment results with combined HCQ and Azithromycin are encouraging, and can be seen in this video presented by prof. Didier Roualt (in French)
        https://www.mediterranee-infection.com/coronavirus-diagnostiquons-et-traitons-premiers-resultats-pour-la-chloroquine/
        The table at 15:24 shows a difference between No treatment vs. HCQ alone vs. HCQ + Azithromycin, although the patient number is rather small. Concerning Azithromycin, there are several studies in the PubMed showing it having antiviral activity, too. Personally, if I would catch the COVID-19 with pulmonary symptoms, I would prescribe myself HCQ + Azithromycin + zinc.

      • I was just wanting to see if you had any new info. Azithromycin also has some antiviral properties, particularly against rhinovirus. It is a protein synthesis inhibitor and may have some secondary impacts on the ability of the virus to replicate its proteins, though I don’t know if SARScoV2 produces its own enzymes for protein synthesis or if it uses the host cell ribosomes.

        Anyway, I know it is cheap, as is HCQ, …. seems worth it to give it a try, cause as the French study noted, the CQ has an effect on its own. The Redemisvir is probably going to be expensive unless the gov makes them sell it in the cheap.

        • And price is your main concern when you are fighting for your life with viral pneumonia?

      • Also saw a report that chloroquine can also reduce or eliminate cytokine storm which for many COVID patients is the fatal factor causing lung fluid buildup. Any comments on how this works and effectiveness of chloroquine in preventing?

      • “Azithromycin inhibits constitutive airway epithelial sodium channels in vitro and modulates downstream pathogenesis in vitro” by Fujikawa’s team in Japan is available in English on line as free full text.

        I am not certain the French chose Azithromycin merely on the basis of antimicrobial action. There are some indications the drug contributes disproportionally to anti-biotic spawned bacterial drug resistance &, as such, employed with clinical discretion.

        By the way R. Istvan – I’ve enjoyed reading your WUWT comments over the years & find them well written.

      • 15% of the French Patients were removed from the trial because of death and transfer to ICU

        26 started in the trial, 1 died, 3 went to ICU,
        20 stayed in the trial, and the results are from those who stayed in

        beware the survivor bias

        I’m guessing skeptics forget the dedication to statistical significance.

    • Not to be picky, but it’s really not accurate to say “the United States”, as this pandemic is primarily isolated to NY. WA seems to plateaued. CA seems to be containing it fairly well too. All the other states are in just double digits or in the 100s.

      I’d like to see the FDA actively evaluate these treatments immediately. In particular, HCQ + Azith, both cheap generics.

      • True, the disease, if not the virus, is indeed concentrated in a few big, mainly coastal cities, although every state has reported at least one case, with WV the last to be hit.

      • I have been wondering why the U.S. experts are so resistant to using Chloroquine, which is cheap and readily available. Growing up in Pakistan, I was prescribed Chloroquine twice for malaria. Subsequently, I was advised by my company to take Chloroquine for two weeks before I traveled to malaria infested area. I never suffered from adverse side effects. Is it because they prefer the expensive, U.S. developed Remdesivir?

        • Exactly, before my trip to brazil I was given a mandatory prescription to start weeks b4. This drug MAY have some prophalaxis ?? properties or at least lessen the impact of the infection. Reports seem to indicate that quantities of HCO are being gathered. Why? My local drugstore had some weeks ago, but is now trying to get more.!!! Why would it not be immediately available to any who can tolerate it? Worst case, we don’t get malaria.(joke) If we don’t get back to normal, the cure may be much worse than the scourge. If this drug knocks down the curve dramatically we all win; if not, we ‘ve lost nothing. The cost of HCO is nothing compared to the cost of continuing in place.
          Doug

    • John Tilman: I get the same calculation as of this morning. As I have always believed, testing will bring the denominator up by at least an order of magnitude (my hunch) because there are no tests available. The measurement has been, and still is to a large extent, skewed to people who are sick enough to seek medical help.

      This site is very good. https://www.worldometers.info/coronavirus/country/us/

      • I hope that the mild, misdiagnosed or unnoticed and unreported cases are indeed an order of magnitude greater than those reported.

        If fatality be one percent, and 60 million Americans were infected, as during the 2009 swine flu pandemic, then 600,000 would die. If the mortality rate however actually be 1/10 of one percent, then “only” 60,000.

        My hope however is that Wuhan won’t infect 60 million. If we can hold the spread to, say, six million, then 1/10 of one percent would mean just 6000 lethal cases.

        At this point, who knows? We can only hope and take whatever actions promise to limit infection and severity.

        • Yes sir… and once in a while I need to ground and remind myself that this virus is a new and probably soon-to-be just part of the common cold for which humans have dealt with forever.

          With all of our efforts to stop the influenza virus and with vaccinations prevalent in society, we have many millions infected annually in the US.

          • I don’t get vaccinated for flu because so often the best guess as to the prevalent strain most likely in each winter is wrong.

            But I guess the older I get, the better the odds a flu vaccine confers.

          • I am in the same camp and same wrt flu shot. It’s always last year’s strain and this year what goes around is something new. I have not gotten flu in a decade by the way.

          • These antivirals taken seasonally in low doses might be better than vaccines or maybe would be complimentary.

          • Scissor, the keyword complimentary!

            1) The human body is a wonder of self defense especially when fortified with good ingredients.

            2) Antivirals can make life for the virus very difficult.

            I would resort to number 2) after number 1) screams for help, and only when I know that’s the case. 🙂

          • ” John Tillman March 20, 2020 at 1:24 pm
            I don’t get vaccinated for flu because so often the best guess as to the prevalent strain most likely in each winter is wrong. ”

            And twice they had it totally wrong to what was actually in circulation yet there was no increase in deaths. So nobody got vaccinated to what was in circulation and no increase in deaths shows it is in placebo category (IMHO).

            Vaccines work best against genetically stable targets. Smallpox was the best target you could ever ask for. Influenza is the other end of the chart.

          • I tend to disagree, call me a sometimes anti vaxer. I take the big vaccinations of course… the bad ones that are known to stay in circulation until wiped out largely.

        • John Tillman said:
          “I hope that the mild, misdiagnosed or unnoticed and unreported cases are indeed an order of magnitude greater than those reported.”

          Presumably you also hope that they somehow or other don’t infect others.

          • No, that is not what was meant by John Tillman. Think about what he meant. We have not been counting people who have symptom or mild symptoms and have no idea how many are actually infected. The solid assumption is that there are many more. No one wants that to be true. But we want to know how many there are that have not been counted. The common sense realization of this is that we could rest assured that this dilutes the given mortality rate. If it’s an order of magnitude greater than we have counted this far, that means the mortality rate is likely equivalent to the Flu… and panic will subside. It’s basic math or pre-algebraic.

            PS – that is where most of the spread is coming from… undetected cases mostly

          • mario says:
            “PS – that is where most of the spread is coming from… undetected cases mostly”.

            Exactly. And given the inability to test the whole population of the world (or the USA) then you need to go with the data available.

            Otherwise, it’s just wish-thinking. And, another useless academic navel gaze.

          • What Mario said.

            I was referring to the magnitude of unreported cases. However many there are are already contributing to the spread. Or not.

            The hopeful part is that fatality rate is ten times lower than derived from reported cases.

    • I’ve been looking at the data and it seems that this virus spread seems to top out at about 2 mo. Provided that China is telling the truth, their spread covered Jan-Feb. Washington State has plateaued (Jan 20-Mar 20) and is now reporting just a few cases per day. This could be good news, as maybe the NY outbreak will ease up in April, hopefully sooner with the social distancing. Italy (mid Feb) should plateau off around the middle of April if the two month window holds true.

      • Most of the dropping china cases was due to the government shutting down companies, banning gatherings, and forcing people to stay home. The number of new cases started to drop after the quarantine.

        In washington most of the original cases were in one assisted housing complex for the elderly. They were all quarantined and many of the stafff and other secondary contacts were traced down and also quarantined. South korea also did this and added extensive testing of the population allowing them to track down many unknown cases and implemented targeted quarantines.

        So the 2 month drop you are seeing is mainly due to people and governments increasing sanitation and implementing quarantines. Also note it is now believe that some of the first cases occurred in China way back in October of last year. So it continued to spread for 4 months before emergency actions were taken.

  4. Increasing temperature and humidity indoors reduces transmission of flu-like viruses. Warmer and more humid air kills viruses outside the human body faster.

    This is a well known poor man’s measure. People used it in Ukraine against the Swine Flu in 2009.

    Now a study confirmed that it works for the COVID-19 virus.

    • “Increasing temperature and humidity indoors reduces transmission of flu-like viruses.”

      So why aren’t the authorities recommending the use of humidifiers?

  5. Fascinating stuff, Rud. Thanks for your work.

    Like warfare, one needs defense in depth when dealing with complex issues; there is no one magic pill. Hopefully these drugs will give us time.

  6. Adenosine isn’t an amino acid, but a nucleotide, ie the nucleobase adenine attached to a ribose sugar and a phosphate group. It’s one of the five such nucleotides in DNA and RNA, arguably the most important.

    Remdesivir is an adenosine nucleotide analog.

  7. There’s an international trial in progress to test the various drugs. 10 countries are joining in. Guess which major country isn’t taking part?

      • He said “major” country … 🙂
        LOL. Except for size Canada ain’t major (and hockey but that season on hold).

        • G7!! Canada (used to) punch well above our weight and still is considered a ‘major’. Trudeau progressives are trying to drag us back to the stone age!

          • Basketball, insulin and Oscar Peterson! Great contributions to the human mosaic. A sport enjoyed (playing and watching) by hundreds of millions, a medical treatment that has saved the lives of tens of millions if not hundreds and one of the all time great jazz piano masters.

            Not to shabby for a small population. Not bad at all. Now, “What have you done for us lately?”….

  8. I’ve read the Chinese have also tested high dose IV vitamin C and found it to be helpful in treating COVID-19. However, I have not seen any mention of this in the US, almost as if it is being intentionally ignored. If the vitamin C efficacy is true, it would be an easy to use treatment and should be widely available and it would be a shame if it was not put to use.

      • “add lime to your…” And do what me and my wife do. We use half a lemon and a touch of pure maple syrup added to a tall glass of water every day. After washing the lemon or lime, we grate the skin to let the zest call into the drink. Huge amount of bioflavonoids and extra C

        • “a lemon and a touch of pure maple syrup added to a tall glass of water every day.”

          I’ve just discovered that adding vanilla extract can also make water more palatable.

      • For the last time tonic has quinine .. not the right thing other than it makes up part of name of the active drug being discussed. Quinine as a single ingredient has no know effect for covid19 so go an read again the name of the active ingredients.

    • 10 g per day for moderate cases; 20 g per day for severe cases. No deaths, and 3-5 day reduced hospital stays. One patient near death received 50 g over 4 hrs and survived. No bad side effects for any of the patients.

    • The vitamin C was administered by IV. Oral vitamin C is rapidly eliminated in the urine so plasma concentrations remain relatively low. As an aside, IV vitamin C was recommended by Linus Pauling (1970’s) for some cancer and other treatments. However the NIH refused to test by IV and “rigged” the studies with oral C with negative results. FDA/NIH has historically preferred denigrating or ignoring any cheap therapies for major medical issues and instead pursues approval of expensive drugs/fixes to support the pharma industry. Major distrust of the FDA by a significant portion of the public is one reason alternative medicines and approaches receive so much support.
      So just because they (FDA) say there will be “approval” of vitamin C or chloroquine for COVID treatment doesn’t necessarily mean much, as they can delay by insisting on more “studies” (which I’ve have heard Dr. Fauci refer to). Of course rapid approval of an expensive anti-viral med would be right up their alley. Possibly Trump could go around them with an executive order. I guess we will see how this plays out.

    • Yes, and here’s the biology of vitamin C that justifies its use as a vasopressor in septic shock, and, along with it’s well-known antioxidant effects, may be why the Shanghai medical authorities have recommended vitamins C for COVID-19 treatment. https://www.youtube.com/watch?v=RA7obbfGg_o

      Yet, not a peep about this in the mainstream media.

  9. The FDA seems not setup properly to deal with a novel virus that becomes a pandemic. In a perfect world we would do months or years of testing before allowing the drug. Unfortunately we do not have the time. If an older person has this virus and has underlying condition there is significant chance they will die. We have to weigh this against what we know about these drugs at the moment.

    Suppose for instance we know based on past cases an 80 year old man with a pre existing lung condition has a 70 percent chance of dying under current best case practices. Do we try the drug on him ?

    • Doctors can try these drugs under “compassionate use’ and obtain FDA approval. I uderstand that doctors are using these without FDA approval for this particular use.

      • Actually, we use drugs “off label” every day all the time.

        No need to wait for an FDA approved indication. HCQ is already FDA approved. Has a known and reasonable safety profile. We have small randomized placebo controlled trials.

        That’s being said this is NOT the first time HCQ has been studied as an antiviral. Every previous time it has nor panned out.

    • A drug can be used “off label”. None of the drugs being tried on my chronic cough are for cough, but research shows they can sometimes work. After 25 years of coughing, off-label doesn’t look so bad.

    • I generally agree with you. However playing devil’s advocate here, aspirin was the new drug they used in similar untested fashion to fight the spanish flu in 1918. Today it is widely believed that this considerably increased the death rate. Aspirin lowers fever and reduces inflammation which is why they used it. They were fighting the symptoms. However fever has a reason and a purpose. They were interfering with the body’s efforts to fight off the infection.

      • I have always thought to “sweat it out” When I get a fever, I get as warm as I can tolerate. And interestingly, your body feels cold, so it encourages you to wrap up. If you can get into a sauna (that’s not too dry) or steam room and make sure to hydrate, your cold could be quelled quite fast.

        However if you’re in bad health, you may not be able to take it… that’s where things go wrong fast.

        PS – today I would not go to a public steam room with sickness…

        • same thing works for me. If the bed isn’t soaking wet from sweat, you need to add another layer.

          • Hah! Absolutely…
            The sweat did a job on me (through evaporative cooling) when I get up to empty my bladder… Dang the shivers were intense as I crawled back into my damp sheets… Unfortunately for me it took 5 days for fever to break with this WuFlu.

      • It wasn’t just that… The dosages of aspirin that were given were absolutely huge, sometimes several grams per day. At those dosages, continued over several days, one of the major side effects is pulmonary edema, which doesn’t help at all when you are trying to fight a lower respiratory infection.

  10. Excellent summary. BTW, adenosine is not an amino acid, it’s a nucleoside.

    Anyway, it would seem that a cocktail might have good effect, and at least one is being evaluated.

  11. ” The ‘drug’ is just an analog of the amino acid adenosine, one of the 20 amino acid…”

    NO — it is a nucleoside, AKA nitrogenous base, which when phosphorylated form the bases that make up the genetic code of DNA or RNA. As far as I ever heard, there are 5 of them. There are, however 20-odd amino acids that form proteins. This kind of basic error does not induce confidence in the rest of the post.

    For stuff like this, Wiki is reliable: https://en.wikipedia.org/wiki/Nucleotide

  12. Albeit with a minor correction that Remdesivir is a nucleotide analog of one of the four nucleotides found in RNA, this is a solid summary of its drug effects (and potential limits) on this coronavirus as well as chloroquine and hydroxychloroquine.

  13. I’m learning a lot about RNA, cytosol and molecular biology. 😉 More that I think I really want to know, but this is orders of magnitude better than listening to the various talking heads on TV/radio/social media.

    Hopefully this will be a light at the end of the tunnel.

  14. The higher the number of unreported cases, the lower the actual death rate.

    Interesting, it’s been reported that virtually all of the deaths (>99%) in Italy involved patients with other serious health issues.

    • “…virtually all of the deaths (>99%) in Italy involved patients with other serious health issues.”

      Sounds like heatwave statistics.
      What would we do without nanny-governments and scary news media?

      • I found a post that said 13 healthcare workers in Italy have died from the coronavirus, so this is concerning and somewhat contradictory to the above.

        • Apparently, this is ongoing research. It appears that as death reports are sent from hospitals to the National Institute of Health, they are examined. A day or two ago the number was 105, this last one was 300+. So the numbers will likely adjust over time until all reports are examined.

        • “I found a post that said 13 healthcare workers in Italy have died from the coronavirus, so this is concerning and somewhat contradictory to the above.”

          Probably they got a heavier viral load. (But why should that make such a big difference?)

          • Immune system overwhelmed?

            Like the hero doctor in Wuhan, dead at only 36 and presumably healthy.

    • Quote below is from link in prior post. It went into moderation because the word “k!lled” is in the URL

      I’m wondering if the high mortalities in diabetes and hypertension patients are due to their pre-existing conditions or due to the ACE inhibiting drugs they take, which upregulate ACE2 expression possibly leading to nastier infections.

      According to the study, the most common of these problems in Italy include high blood pressure, heart disease and diabetes.

      Some 76.1 per cent of the patients who died of Covid-19 had previously had problems with high arterial blood pressure, the study found.

      More than a third – 35.5 per cent – had diabetes, while 33.0 per cent had suffered from ischemic heart disease.

      • Nearly every morbidity listed in that article – diabetes, hypertension, atrial fibrillation and ischemic heart disease are treated with ACE inhibitors and angiotensin receptor blockers (ARB), which upregulate ACE2 expression in the lungs (don’t know how prevalent for the last two, but they do appear to be treatments for those conditions).

        • Could this imply that not the hypertension is the risk factor, but the ACE inhibitor is the culprit?

          • That’s what I’m wondering, and researchers in that link are as well. A letter in the Lancet said that there are other options for hypertension patients, but I can’t remember what they were. Something with the word “channel” in it.

          • icisil, that’s probably the calcium channel blockers – I’m gonna switch my medication back to those tomorrow, they work well for me. Thanks for the link.

          • Yep that’s it.

            “We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs,” the article said. “Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.”

            https://www.bostonglobe.com/2020/03/19/metro/is-it-safe-take-ibuprofen-amid-coronavirus-pandemic/

          • As an aside, my doc has me on amlodipine for hypertension (high blood pressure). This is a calcium channel blocker, not an ACE inhibitor.

          • Yep, that’s the one – Amlodipine 5mg is what this Golden Age traveller is prescribed.
            Calcium Channel blocker for r-e-l-a-x-e-d heart muscle & blood vessels – Ahhh. ;>)
            That and some diuretic to keep me running! Way back in ’67 I was a DanD!
            Hey, Covid19, we can’t dance together – we go nuthin’ in common!

            Steely Dan – Hey Nineteen = https://www.youtube.com/watch?v=eAHQ-9Fniac

            I’m also blood type A+ = the only test I ever got an A+ on!!

    • I know I’ve posted this link to the Information is Beautiful website, so pardon the duplicate. They’re updating their COVID-19 graphics every 2-3 days with the latest figures, and they’ve added a section showing how “multiple conditions” increase the risk of death.

      https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/

      Now, these are serious conditions like active cancer, COPD, diabetes, stroke, etc., so contracting the Wuhan virus on top of these would be like being hit by a speeding truck. Of the deaths in this study (Italy), 25% had one condition, 26% had 2 conditions and 48% had 3 or more conditions. Of the deaths, 1% had no serious condition. (Keep in mind the usual caveats: data in flux, small sample size, etc. Check the graphic in a few days for updates.)

  15. Thanks Rud, here’s a way we can help with research.
    Right now there is a distributed computing effort to model the proteins and provide data to researchers going on at U of WA called Rosetta@Home. It is administrated by Berkeley U’s BOINC, which was born out of the now discontinued SETI@Home program.

    You must download and install the BOINC manager software, which allows you to choose when and how clients use your CPU or GPU. It’s here==> https://boinc.berkeley.edu/download_all.php
    Choose Rosetta from the client list during setup/first use. Some of the models you run will be part of the COVID research.

    Rosetta will only use CPU, so if you have a GTX series or other powerful NVidia GPU, you can volunteer it at GPUGRID, where cancer, AIDS, virus (and soon COVID-19) research is always ongoing.

    Earn badges, get intrinsic satisfaction, even signal virtue if you must, but the power of distributed computing is awesome to me and I enjoy participating in it. 😁👍

    My computers run work units 24/7 and I use them normally, with the help of a great free utility called Process Lasso ===> https://bitsum.com/ which manages how apps use the CPU.

  16. In the UK there are two malaria drugs Chloroquine (available with prescription) and Qualaquin (available without prescription to treat leg muscle cramps), both have side effects, the most serious are:
    Chloroquine – Anxiety (attempts at killing oneself)
    Qualaquin – Anxiety (behaviour change, similar to drunkenness)
    If need be, I’ll rather be drunk than suicidal.
    🙂
    Chloroquine Side Effects
    https://www.drugs.com/sfx/chloroquine-side-effects.html
    Qualaquin Side Effects
    https://www.drugs.com/sfx/qualaquin-side-effects.html

    • I miscalculated in a comment the other day, by taking the dose for prevention as being the same as for treatment of active malaria (same dose, but the prophylactic dose is weekly, not daily). Sigh…

      Anyway, having recalculated, two to three cups daily of tonic water may do the job of prevention (looking at the different uptakes). So a few daily G&Ts ARE a reasonable precaution to take. Number depending on how strong you like them.

      • Writing Observer, I have a big bottle of tonic handy and recommend squeezing a lemon into into your glass. I admit to putting a tsp of sugar in the lemon juice. Very tasty.

    • Other serious side effects are, Retinopathy (long term use or high dose) and QT interval prolongation; so should never be taken with many anti-arrhythmic / antidepressants / psychotropic / anticonvulsants.

    • They also don’t work at all on the critical ill, they help those with mild symptoms. Many cases go straight from almost no symptoms to very severe and it offers no protection at all to that group. How many it stops from going from mild to severe needs proper clinical numbers under identical situations …. so two like for like hospitals with similar patients demographics. You see wide variation in all the statistics from within a single country in different regions, so getting exactly what the efficiency is hard to calculate.

  17. Has anyone noticed that most of the links in Anthony’s original item on covid-19 and chloroquine have been barred by Google as ‘breach of terms of service’?

    Is this because he has shifted some to point elsewhere, or might it be an attack by someone trying to close the site down?

    I would be interested in a Mod or WebMaster reply….

    • Dodgy Geezer

      I read the same thing on twitter today, somebody stated that the chloroquine research done in 2005 which shows it works against corona was not showing up on google anymore…

      • That is interesting.

        There is an argument that, if chloroquine were advertised as fully proven, completely effective and readily available (which is not yet true), people would then cease self-isolating and avoiding crowds. If this happened, the medical services of major cities would be completely overwhelmed with new infections. Even if there was a simple treatment, the peak of people requiring attention would be too great for the existing infrastructure, and avoidable deaths would result.

        So it makes sense to ‘flatten the curve’, even if there is a simple cure. It will be a delicate balance, because the techniques used to flatten the curve will result in disruption, and that will probably mean avoidable deaths….

        So suppression of this news MIGHT be officially ordered. Equally, persons who see WUWT as a political enemy promoting evil ideas which will damage humanity might also be tempted to try to interfere with the free flow of information. And it would be easy for those persons to inform Google that WUWT is distributing dangerous fake news, and should be closed down – which Google would probably do as a matter of urgency. And, of course, it might just be an error….

        The administration of the web site ought to be able to determine which, if any, of the above is true.

          • LDB,
            Yup:
            Groups working in Salt Lake City and Hong Kong in 2004:
            “Compounds approved for therapeutic use and in vitro inhibitors of severe acute respiratory syndrome coronavirus (SARS-CoV) were evaluated for inhibition in the mouse SARS-CoV replication model. A hybrid interferon, interferon alpha (IFN-α) B/D, and a mismatched double-stranded (ds) RNA interferon (IFN) inducer, Ampligen® (poly I:poly C124), were the only compounds that potently inhibited virus titres in the lungs of infected mice as assessed by CPE titration assays. When mice were dosed intraperitoneally (i.p.) with IFN-α B/D once daily for 3 days beginning 4 h after virus exposure, SARS-CoV replication in the lungs of infected mice was reduced by 1 log10 at 10,000 and 32,000 IU; at the highest dose of 100,000 IU, virus lung titres were below detectable limits. Ampligen® used i.p. at 10 mg/kg 4 h prior to virus exposure also reduced virus lung titres to below detectable limits. Nelfinavir, β-D-N4-hydroxycytidine, calpain inhibitor VI, 3-deazaneplanocin A and Alferon® (human leukocyte IFN-α-n3) did not significantly reduce lung virus titres in mice. Anti-inflammatory agents, chloroquine, amodiaquin and pentoxifylline, were also inactive in vivo, suggesting that although they may be useful in ameliorating the hyperinflammatory response induced by the virus infection, they will not significantly reduce the replication of the virus, the inducer of inflammatory response. Thus, anti-inflammatory agents may only be useful in treating virus lung infections if used in combination with agents that inhibit virus replication. In summary, the data suggest that induction of IFN by mismatched dsRNA or actual treatment with exogenous IFN-α can inhibit SARS-CoV replication in the lungs of mice.”

            Note the lack of ambiguous language, focus on quantification of results, and the fact that this was not a study of pouring some chemicals on cells in a glass dish…which is very well known to not give the same results as what happens when live subjects have an infection and are given that same drug.

            https://journals.sagepub.com/doi/abs/10.1177/095632020601700505

          • _Jim, DuckDuckGo is fine I use it. There are also others that I’ve tried but didn’t like Startpage.

          • re: “DuckDuckGo is fine I use it. There are also others that I’ve tried but didn’t like Startpage.”

            Here’s “the dope” on Startpage:

            People also ask –
            Does Startpage use Google?
            1) StartPage uses results from Google, which is a good thing if you prefer Google’s result without the tracking.
            2) Ixquick, which is an independent search engine that uses its own results, developed StartPage to include results from Google.

  18. Minor point: adenosine is a nucleic acid, not one of the 20 amino acids that forms poly-peptides (proteins). It’s the “A” base precursor in the RNA and DNA coding 4 nucleic acids letters AGCU/AGCU as Rud mentioned.

  19. Sorry, adenosine is NOT an amino acid. It’s a purine ribonucleoside (nucleotide base = purine) attached to a sugar (ribose). Remdesivir is an analog of adenosine which is one of the natural substrates of the viral polymerase. The analog binds to the active site of the enzyme and cannot be processed further thus blocking this key enzyme’s activity (and viral replication).

  20. Rud Istvan, thank you for the detailed and informative posting. I am on house quarentine here in Mendoza, Argentina, and enjoying good weather and practicing golf in my backyard with my dogs as caddies. The reality of this China Virus seems to be that following guidelines to flatten the infection rate curve and give the medical community a chance to get ahead of the virus is the best practice. For sure, those of us with money have an ability to guard ourselves and families that the others simply don’t have, and no amount of government intervention will save them all. Good on A. Watts for this involved and informative website, and good luck to all.

    • Hmm. Keep research records and you could probably publish (not here) on the “Effects of Canine Saliva and Dentition on Golf Ball Putting.” I have some old work acquaintances that would probably be far more interested in that than the latest CoViD paper…

  21. Rud Istvan,
    Excellent article – important information and much appreciated!
    A point that may be of interest: On the President’s Wuhan Virus Task Force press briefing today, Dr. Deborah Birx related a emerging trend identified from the virus spread in Italy. Their experience is a mortality rate in males of twice that of females, for all ages experiencing the Wuhan virus.
    https://www.youtube.com/watch?v=AXbxNT4ncXo&feature=emb_logo
    Briefing starts at 35 minutes. Dr. Birx comments at 58 minutes.

    On a different topic… call it ‘marketing’: I distribute these and similar ‘rigorous’ articles to ‘family’ and ‘friends’ distribution lists. They serve both as solid information sources on emergent phenomena as well as illustrating WUWT as a source for reliable information on similar topics. Articles like this are the means of introducing others to WUWT as a credible source for pragmatic information on science issues.
    Keep up the good work, Anthony and crew!

      • Non-news, Scissors….
        Correlation does not establish cause and effect. You should know better….
        I’d really like to know what causes viral attacks on males to be more virulent, debilitating, and lethal, when compared to the y chromosome-deficient gender. There may be something fundamental underlying this odd phenomena that holds potential for a broad spectrum therapeutic applicable to viral infections.

        • To J Mac re: “Correlation does not establish cause and effect. You should know better….”

          WRT smoking, and males twice as likely to smoke this puts you in the category of “Celia denier”.

          https://medlineplus.gov/ency/imagepages/19533.htm

          (NEVER HEARD of “smoker’s cough” before? How about that itchy feeling smokers get in the lungs that forces them to ‘light up’ another? The “celia” coming back to ‘life’ …)

        • If the sort of drugs that are regularly prescribed for those thought to have heart disease or high blood pressure make people more susceptible to CV then there is your male bias. I know one old fellow who has some heart disease, but never had high blood pressure, so they give him high blood pressure medication that means he does not get out of a chair because he feels so bad, yet he does not have high blood pressure. They prescribe the 4 meds, cholesterol meds, blood pressure meds, Beta blockers and asprin or blood thinners to older men without thinking. They prescribed for another friend with chest pain for ages, before it turned out to be oesophagitis. Over prescribing to men could be one of the possibilities for the correlation?

  22. As for Corona virus to mutate to chloroquine resistance, that could be tough. Triggering the membrane fusion event is pH dependent conformational change that is very fundamental to how the virus able to merge its RNA package into the cytosol. That will be difficult for the virus to mutate around with chloroquine pH elevating trademark since that is host cell feature.
    Malaria is able to mutate away from chlorine sensitivity because the action of chloroquine in that pathogen is inside the malaria parasite’s lysosomes, thus sensitivity or resistance is under malaria selections control.

    Corona virus COVID-19 evolving resistance to Remdesivir is certainly quite likely as that resistance is under the control of the viral polymerase and the viral coding sequence for that being strongly selected for. It would probably evolve resistance kinetics like HIV did in the 1980’s to the first line nucleic acid analogs that quickly became useless against HIV in the same host since that was chronic infection. Thus Gilead’s “window of opportunity” for selling its Remdesivir will probably close within a 1-2 years if Remdesivir is widely adopted.

    • Also Hydroxychloroquine is a zinc ionophore and zinc acts as an inhibitor of the virus’s reversetranscriptase and therefore will stop replication of the virus. So that could be the mechanism

      • What mechanism?
        Zero evidence that either of the malaria drugs work in vivo.
        There are a total of absolutely none studies that demonstrate an inhibition of viral replication from oral ingestion of malaria drugs in humans or animals with an active viral infection.
        Is there evidence you can cite that people who take chloroquine are immune to viral infections, or have shown to be suddenly cured of any?
        None of the studies cited in these reports on coronavirus have tested for plasma viral RNA counts.
        Nasal swabs are not a generally accepted proxy for systemic viral loading.

    • “Corona virus COVID-19 evolving resistance to Remdesivir is certainly quite likely as that resistance is under the control of the viral polymerase and the viral coding sequence for that being strongly selected for.”
      Wait…what?
      I am not sure what to make of this comment.
      For one thing, there was only ever one antiretroviral approved during the 1980s, AZT.
      It is not useless, it is still being prescribed and is very effective as a combination therapy component.
      It is on the list of the WHO most essential medicines, the safest and most effective medicines in the world.
      It is not a nucleic acid analogue, it is a nucleoside analogue.

      As for viral resistance, any drug used to kill an infectious agent will hasten evolution of resistance unless it is powerful enough to block all viral replication.
      Which is one reason why almost all antiviral therapies make use of combinations of drugs.
      It does not matter what the mechanism is…if it does not wipe them out, there will be an evolution towards resistance.
      The same thing occurs with antibiotics, insecticides, fungicides, herbicides…anything.
      Survivors will reproduce and offspring will be, obviously, the offspring of the survivors.

      I am very curious about the idea that this particular one, remdesivir, will have some increased tendency to cause resistance to evolve?
      Also, what evidence is there that corona virus entry into a cell is pH dependent?
      The headline post posits a mechanism whereby the lysosomal pH changes enough to alter the shape of the ACE2 receptor such that it prevents the viral spike protein from binding to it.
      But there is little reason to think that ACE2 is the only way the virus has to gain entry into a host ell.
      In fact, it has recently been found that at least one other receptor is now known to be exploited by the virus.
      And most of this regarding lysosomes and how they may be involved in viral entry or survival is guesswork, not proven.
      It has not even been shown that these chemicals do anything with regard to viral replication in vivo.
      A whole flurry of studies in the early part of this century came to basically nothing and the research was largely abandoned.
      It is difficult to find info on why so much interest in those days, vs a wide range of viruses, was dropped, but the few sources that give a reason point to in vivo studies that were unable to confirm the results found in vitro.
      This is a familiar pattern in drug research.
      Chemicals are screened for activity in vitro, which can be done cheaply and broadly, and ones that show promise are carried forward to further stages of testing.
      The industry moved towards a focus on direct acting antivirals and monoclonal antibody drugs because those were the ones to give results that held up to scrutiny when given to living creatures infected with a virus.
      Jumping to conclusions and making unqualified statements of efficacy are not a good idea, most especially under the current circumstances.
      At this point, we all better hope we get something that works in the near future.
      People hate it when others over promise and under deliver.
      The prudent thing to do is temper expectations.
      Especially since the results are almost sure to be less than clear and unambiguous, and laypersons are very hard to convince when the details of something complex are nuanced.
      Especially if they are already sure of something which turns out to be a disappointment.
      I am seeing a lot of people painting themselves into a corner on this chloroquine thing.
      I sure hope they are right.

    • One way of estimating the mortality rate is to divide the number of new deaths each day by the number of new cases each day. This is an inexact measure due to the lag time between diagnosis and death, but the trends are interesting. Using Vukcevik’s data starting 3/12, we get daily values of 4.2%, 6.0%, 8.8%, 4.6%, 4.3%, 3.8%, and 11.3% in the UK.

      The same measure in the USA results in mortality rates less than 2.0% over the last several days and trending downward (1.3% as of yesterday), which is sharply different than in the UK.

      There may be several reasons for this difference:

      1. There may be more coronovirus tests done in the USA per capita than in the UK, so that there may be more undiagnosed positives in the UK that are asymptomatic, who pass it on to vulnerable patients. With a smaller denominator, this drives the mortality rate up for a given number of deaths.

      2. The COVID-19 virus may be more virulent in the UK than in the USA, or conditions in the UK are more conducive to severe cases.

      3. There may not be as much access to ICU’s or ventilators for seriously ill patients in the UK as in the USA.

      I’m not a doctor or epidemiologist, so I’m not qualified to draw conclusions, but somebody with medical training might want to look at these numbers and investigate why such a sharp difference. Is there something being done in the USA that is not yet done in the UK?

      • Hi Steve
        Explanation is simple. In the UK for some weeks now only the hospitalised cases are tested, while people with mild symptoms are not tested and are told to self isolate. Most of the medical experts estimate that number of infections is up to10 times greater, bringing mortality figure downto order of 1%.
        Currently there is lot of interest in the antibody testing which is much simpler and can be done by people themselves, method similar to pregnancy testing.

        • Whether the antibodies can be used as a rapid vaccine?
          The body must have time to produce antibodies before the pneumonia, which occurs with Covid-19 very quickly. Plasma preparations are often used in medicine. I know because I gave honorary almost 40 liters of blood.
          I think we have more modern laboratories than during the Spanish flu. I might be wrong?

  23. A lot of upbeat and optimistic commentary about coronavirus therapy or vaccine.

    But if it’s so apparently straightforward to treat, why is there still no vaccine or treatment for the common cold – also a coronavirus?

    • The common cold is caused by more than one coronavirus, but you’re right. Vaccines against mammalian coronaviruses have proven challenging. For birds, vaccines have been developed, but face problems:

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411447/

      However, if a vaccine works only until the virus mutates, that success would buy us time to break the cycle of spreading infection.

      • Actually, see my first post which covers this. The common cold is caused by roughly 120 different viruses: roughly 100 naked RNA rhinoviruses (~75%), exactly 4 enveloped RNA coronaviruses (~20%) , and about 20 of the near 60 DNA adenovirues (which also cause other diseases like pinkeye and PC for which there is now a vaccine for military use) (~5%). No hope of a ‘cold vaccine’.

        • True. Even if we had a cold coronavirus vaccine, we’d still have lots of cold-inducing viruses out there.

          • Well, when walking petri dishes of infected humans are mobilized beyond the doorways, their shedding of infections will near 100% defeat the benefit of the modicum of sanitized air.

            I work in nuclear… if we get any contamination, walking by a clean air station won’t stop the contamination.

            It was described like this to me.
            Radiation is like smelling dog poop. You move away and the smell is gone
            Contamination is like having dog poop on you.

            You get the gist.

          • Yeah that makes sense it only works in the air. It would only work on the infected if you increased the power enough to work within the body, but that cure could be similar to amputating the head.

    • There are over 100 viruses that cause the common cold only 6 of which are coronaviruses. One of the mechanisms by which hydroxychloroquine may act involves zinc and one of the treatments that works to shorten the common cold is Zicam, it also uses zinc.

      • I would not be surprised if all of these coronaviruses came from bats at some point in human history. Over time humans have evolved to fight them and the viruses themselves have evolved not to kill people so they can spread more easily. I would not be surprised when these viruses first came to humans they had high fatality rate.

        • That is indeed the general trend with evolution of parasites / pathogens. Their effects on the host get milder, for the reason that you gave. The process sometimes goes so far that what started as a disease becomes harmless passenger or sometimes even a symbiont.

  24. I appreciate all this interest in the therapeutics and it is understandable to want to see a cure or preventive therapy that works. That said I have to add caution. I have seen all kinds of analysis to support the efficacy of these drugs but we have learned over and over again that the preliminary type of data we have such as in vitro (test tube) testing, anecdotal case saves, case control and retrospective studies often yields optimism when eventually the reliable research that requires prospective, blinded, randomized trials yields zip.

    As someone whose job it is to prescribe therapeutics when indicated my peers and I will use these drugs in the appropriate settings for CoVID-19 and we are doing so today, not because we know they work but because there is a possibility they might and we don’t want our most ill patients to miss a chance of recovery. Till we know more however the best strategy is to prevent infections.

    The previously posted correlation between high malaria rates and low CoVID-19 rates in nations should be recognized by all who follow this blog as meaningless. We all know that correlation does not mean causation or even that the two things correlated are in any way directly coupled. The very same nations that have high malaria rates are those that have the least health resources and have done a minimum if any testing. Many countries reporting no or few cases (e.g. North Korea and much of sub-Saharan Africa, Indonesia and India are most likely not doing much testing or else hiding their results. Malarious countries also have major climactic differences that may play a role.

    Much of the statistical pattern we see is in fact an artifact of the testing strategy. Italy, Iran, China and Spain were surprised by widespread community infection when they began their testing after cases of ill individuals emerged. Most of their testing was initially focused on ill people and the high mortality reflects that. In China the highest mortality was reported near the epicenter and declined with distance (e.g. with the timing of the spread). It is very likely that declining mortality with distance from Wuhan reflects increased testing of minimally symptomatic cases or those without symptoms but history of contact (e.g. a screening strategy versus a diagnostics strategy). This is good news if true because it brings down the real mortality numbers as the denominator increases.

    Germany has a high number of detected cases, a much more generous and extensive testing policy and a death rate of 0.2% (1 in 500) so far. Granted their mortality may rise as an aggressive testing strategy will find lots of recently infected folks who may progress to severe disease but the real mortality is somewhere in the middle and won’t be known for some time.

    We can speculate all we want but we don’t know lots that we will know later: efficacy of drugs, overall mortality, whether ongoing mutation and recombination of CoVID-19 will make more or less dangerous/infectious/treatable, and whether our present extreme measure to prevent transmission are actually making a real difference or just creating social/economic harm. Time will tell.

    • Very nice summary. To add my 2 cents on one point.

      Deaths are fairly easy to count accurately since this is a mainstream function of societies. However, counting people in a general population who do not show symptoms or who are mildly to moderately infected is indeed extremely difficult and early on was quite literally impossible. So the denominator is grossly under-counted for all the reasons you so well stated!

      I was early infected with Covid 19, and could not be counted even though I tried to find out how I could be counted. So I was a skeptic of the statistics for good reason early on.

        • LOL: I am a skeptic of even so-called good data. Data is not information, which require interpretation.

          What I always want to know is, what is or what can the data telling us? How was it taken (who and what was sampled etc?

          Interpretations can be dangerous.

          Blog sites like WUWT are great for tearing through what things mean, might mean and don’t mean.

        • Sheri: It was deduced. Here’s the symptoms. Tested for Flu A/B negative. Diagnosis positive for viral infection respiratory system. Prescription Rescue Inhaler Albuterol. No way to test for Covid 19.

          Day 1: fever chills, aches, lunch rumbly, not a lot of phlegm. No throat, No Sinus issues.
          Note: When I get cold/flu it always starts in sinus/throat and after several days it goes into lungs.

          This time, started in lungs.

          Day 2 through 5: fever chills, aches, lunch rumbly, not a lot of phlegm. No throat, No Sinus issues. Through out, I needed to use Albuterol up to once per hour, two puffs.

          Day 3: Doctor offered Antibiotics for potential bacterial pneumonia. I refused

          Day 6: fever aches pains down to zero and major congestion down 90%
          Day’s 7 through 21: 95% to 100% recovery

          Day 10: visited to get released for public and work. They wrote me a note that I had no sign of viral infection. Which was weird. They said there was no way to test for Covid 19 still.

    • Assuming you are a physician, I think you are incorrect with respect to testing Hydroxychloroquine in this case. Only prescribing Hydroxychloroquine at the last possible moment before the patient dies is inhumane. Hydroxychloroquine has been around for a very long time and it’s side effects well known. A voluntary trial which prescribes Hydroxychloroquine at the first onset of the disease after the willing patient signs a consent form would seem to be called for in this instance. The results of such a test would be clear within a matter of just a few weeks if the it is anywhere near as effective as claimed. There are already thousands of people in the control group. Letting thousands or more people unnecessarily die or incur permanent lung damage because well controlled, published and thoroughly peer reviewed studies have not been completed (months to years to do) is ridiculous. The safety and side effects of this drug are already very well known… thus the possible negative side effects pale enormously with respect to the possible benefits. If after 3 to 4 weeks there is no significant benefit to administering Hydroxychloroquine then it can be announced to the public as shown to not be an effective, inexpensive and safe treatment as hoped.

      In addition, it is also irresponsible to say that the correlation between malaria countries and Covis-19 is meaningless. Maybe it is meaningless, but to say that outright without investigating the correlation is irresponsible at best in my opinion.

      • I believe right now there needs to be guidance issued to doctors on what to prescribe, at what time and for whom. Where is this guidance, I have not seen it. Obviously individual cases will differ but general guidance and best practices need to be issued. Perhaps the doctors are worried over liability when prescribing things off label.

      • Alcheson

        You said, ” Hydroxychloroquine has been around for a very long time and it’s side effects well known.” Yes, there is a long list of side-effects that have been observed. Death is rarely one of them, but others can be quite debilitating. However, there is no way to predict who will present with particular side-effects, or how severe they will be. We don’t know what the optimum dosage is, and the ‘safe’ range is not very large:
        ( https://www.msn.com/en-us/health/healthtrending/virus-drug-touted-by-trump-musk-can-kill-in-just-two-grams/ar-BB11rIHa )

        You also said, “… the possible negative side effects pale enormously with respect to the possible benefits.” This reminds me of the typical climate alarmist warnings of how such and such “could, may, possibly, etc.” have consequences. You are assuming efficacy for chloroquine that is largely anecdotal, and minimizing the known side-effects for the general population. Also, something that you are not considering is the possibility for post-cure complications such as Reyes Syndrome discovered after widespread use of aspirin with viruses.

        Remember the Hippocratic Oath: First, do no harm!

      • Alcheson
        You said, “…, it is also irresponsible to say that the correlation between malaria countries and Covis-19 is meaningless.” It is more irresponsible to uncritically accept the apparent correlation to support your advice of throwing caution to the wind.

        Roy Spencer remarked, “The map says it all: COVID-19 is where Malaria is not.”
        Malaria got its name from the Italians — meaning bad (swamp) air. Malaria was once endemic throughout most of the northern hemisphere. It was mosquito eradication programs in the developed countries that eliminated malaria. Since the people living in the countries where malaria is prevalent often cannot afford to take quinine prophylactically, and long-term use can have serious consequences, I see the maps as suggesting that the actual correlation is with the climate and not with chloroquine. The inferred correlation with chloroquine appears to be spurious. To sort out the confounding influences, I think that one should correlate the per capita use of chloroquine for each country with the prevalence of COVID-19, not with the presence or absence of malaria.

    • One popular internet meme was that the disease was caused by 5G, which is why some places have no COVID-19.
      The correlation looks good on a map.
      As noted, that means nothing.
      I think it may be a simple question of wealth.
      The places with significant malaria remaining are poor places with terrible infrastructure, hence little ability for people in those places to travel widely and quickly, combined with fewer people with the resources to have traveled abroad and brought the illness home, resulting in a later onset of the contagion and slower spread once it has appeared.

      Or maybe they have fewer touchy-feely types, chronic huggers, and close talkers.

    • “Many countries reporting no or few cases (e.g. North Korea and much of sub-Saharan Africa, Indonesia and India are most likely not doing much testing or else hiding their results.”

      Maybe they don’t want to discourage tourist revenue, or have flights to or from them blocked.

  25. Correction and apology. Above comments are correct. Adenosine is the A nuceloside in the ACTG ‘alphabet’ for RNA and DNA. My bad.; a real inexcusable brain cramp.
    The 20 amino acids are what build all proteins.

    • Some organisms also use two other amino acids, Selenocysteine and Pyrrolysine. Humans are among those in all three domains of life which make selenoproteins, while only some methanogenic archaea and bacteria use Pyl.

      • Around 1966, working for CSIRO, we sampled a natural legume Neptunia amplexicaulis that was causing sheep deaths in N-W Queensland. We extracted the toxin and confirmed that its mechanism involved substitution of Selenium for Sulphur in an amino acid. Neptunia was an sccumulator plant. Others are known and for more elements than Se. We later investigated some accumulators for help in mineral exploration using biogeochemistry.
        Just for interest, John. Geoff S

        • The soil in my native region happens to be high in selenium, so we don’t have to supplement it in grazing livestock, or in local hay.

      • Adenine is the nucleobase which, when attached to a ribose sugar, forms the nucleoside adenosine. The nucleotide, with further addition of a phosphate group, is also called “adenine”, rather than its technical name, “adenosine monophosphate:.

  26. So if a virus can kill say 20,000 in the USA we don’t shut things down in order to control the virus. But if a virus can kill 100,000 we do shut things down. I wish to know the rules for when things are shutdown and when they stay open.

    It seems to me people panic much more when they hear daily death numbers from every media outlet. We don’t hear these daily death numbers with any other disease.

    • This is a mod of a previous possible post AW nixed because NOT optimistic enough.

      We have the data from Diamond Princess. 705/3711passengers and crew ultimately infected despite horrible conditions. So ~17% infected. Hopeful.
      WE posted an analysis here previously. 392 symptomatic, 313 not, defined as fever 50 die, the numbers say there will be ~390000 deaths by Christmas. NOT GOOD.

      OK, lets do another scenario based on Europe. Only 4% test positive instead of 8.5%. Right, run the math, only about 280,000 die by Christmas. Not good.

    • SteveK
      The rules are a changin’! This is the first time in my long life that we have shutdown the economy for concern that a couple hundred deaths may explode into more than the ~50,000 deaths we experience annually with seasonal flu(es). But, yes, there don’t seem to be objective guidelines as to what is an acceptable death rate and what isn’t. It is interesting that we rarely hear anything about seasonal-flu deaths, except in particularly bad years.

  27. Does the 2019 Coronavirus Exist?
    The Coronavirus scare that emanated from Wuhan, China in December of 2019 is an epidemic of testing. There is no proof that a virus is being detected by the test and there is absolutely no concern about whether there are a significant number of false positives on the test. What is being published in medical journals is not science, every paper has the goal of enhancing the panic by interpreting the data only in ways that benefit the viral theory, even when the data is confusing or contradictory. In other words, the medical papers are propaganda.
    https://infectiousmyth.podbean.com/e/the-infectious-myth-david-tackles-the-coronavirus-panic/

    • The answer to your question is: Yes, yes it does exist.
      As for the rest of that malarkey…haven’t we all got enough of fake news in our lives?
      The truth is a big enough PITA without a vomitous horde of modern day Luddites and biological flat-Earthers peeing in the soup.

  28. Rud, thanks for filling in all these details. I only understand some of them, but this is really well-written.

    • I agree with Roy, the article is very well written. Rud makes things easier to understand.

  29. Rid
    Firstly thank you for the essay.
    Secondly, is there any evidence that elderly currently on RA medication are less impacted by the virus?

  30. There is strong evidence that Vitamin C in high doses (e.g. 1000 mg every 4 hours) is effective in killing viruses. This has been studied in some depth in previous flu epidemics. My personal experience is that it was 100% effective at least 5 times in returning me to health with 24-36 hours when combined with a doubling or tripling of fluid intake, no solid food and extra sleep.

    If Covid-19 has the same vulnerability to Vitamin C as H1N1, SARS and MERS (why not??) then it is an excellent overlooked therapy not subject to patenting.

    Here are some published (peer-reviewed) articles on the subject:

    https://isom.ca/article/high-dose-vitamin-c-influenza-case-report/

    https://www.hindawi.com/journals/bmri/2015/675149/

  31. Rud,

    A few people have mentioned but you should change in post. Adenosine is not one of 20 Amino acids but one of four RNA bases/nucleosides.

    • The base is adenine (also a convenient way to refer to the nucleotide adenosine monophospate). The nucleoside is adenosine, as I belatedly recalled.

      Nucleobase: adenine;
      Nucleoside: adenosine (adenine attached to ribose sugar), and
      Nucleotide: adenosine monophosphate, aka “adenine” (with phosphate group added).

  32. Seems one of the problems with this disease is it takes while for some patients to either recover or pass away. That means respirators, ventilators, hospital beds become in short supply. .

  33. Where are the resonant frequency transmitters that will shatter these bugs in air? Is anyone actually working on making these a reality or will they forever be a neat lab experiment?

    • Microwaves work pretty well. I’m not going to volunteer. Just imagine the number of cells in the body that resonate at similar death frequencies!

      • re: “Microwaves work pretty well.”

        Heh. More like nano-waves (look at the size of the virus THEN you get an idea of the wavelength that would be most effective!)

        Per wiki: The size of the virus particles is in the 80–90 nm range.

      • re: “Microwaves work pretty well.”

        Heh. More like nano-waves (look at the size of the virus THEN you get an idea of the wavelength that would be most effective!)

        Per https://www.ncbi.nlm.nih.gov/books/NBK554776/ a diameter of approximately 60–140 nm

        Even smaller than “millimeter” wavelength. Anything of fractional wavelength isn’t going to be intrinsically resonant (think: “tuning fork”) to applied EM energy and will respond minimally to an applied field … 1/2 Lambda (cut to length like a “dipole”) would be the ideal wavelength so an exciting ‘frequency’ with a wavelength of ~200 nm would be ideal (somewhere in the UV/EUV range).

        BTW, to give you an idea of relative size, visible light is 700 nm (red) to 400 nm (violet).

        • I totally get it about freq, wavelength and then ability to resonate or make a standing wave based on natural frequencies…

          • Didn’t mean to double-post either; a fat-finger on this end caused a ‘post’ when I was gearing up for a more in-depth verbiage on the 2nd version! (It is either that, or I have now confirmed that Windows is _not_ the deterministic OS we ALWAYS thought it wasn’t.)

        • Not sure about that. The question is about whether there is a molecular vibrational mode or other mechanism (fluctuations in dipole moments in the case of water) that can be tuned into. Water, a tiny molecule compared with a virus absorbs very well at microwave frequencies, as we know.

          http://www1.lsbu.ac.uk/water/microwave_water.html

          • _Jim is correct. A wavelength of microwave range is too large to do anything but pass through nano sized particles. It will have no affect on them. _Jim is 100% correct…

          • re: ” Water, a tiny molecule compared with a virus absorbs very well at microwave frequencies, as we know.”

            Sry, and no offense, but Dunning-Kruger effect on exhibition here; assumptions made on one ‘front’ assumed applicable to another w/o knowing the principle and exactly WHY the ‘effect’ works in the first place.

            Did you know, for instance, that industrial heaters employ equipment operating in the 900 MHz ISM-band to ‘heat’ foodstuffs too, once again by exciting the ‘water’ molecules (they are not ‘absorbent’ to the applied RF) by literally, instead, ‘making them dance’ in an applied and rapidly changing “E” (electric) field. Kinda blows the whole ‘microwave resonance theory’ apart doesn’t it, because, the theory of water molecules ‘absorbing’ a specific ‘frequency’ of microwave RF EM energy to ‘heat’ the polar (polarized) water molecule is faulty …

            Here’s the theory behind the “Dielectric Heating” of ANY polar molecule, including PVC (yes, PVC warms in a uWave oven, because, ‘polar’ molecule): Because of their ‘electric’ polarity, molecules like water will constantly align themselves (using their inherent ‘electric dipole moment’) with an externally applied electric field to which they have been subjected … Those rapid shifts (due to an applied RF field) make polar molecules like water start spinning (moving with the applied field) as they try to keep up with the changing, applied field. As the molecules spin, move, they generate heat. This process is known as dipole rotation.

        • “(somewhere in the UV/EUV range).”
          Well how about that! We installed UV air sanitizers in some of the university buildings where I retired from. Hopefully that will help (once they resume operation).

      • According to what I read the power used was assumed safe for open public, but they didn’t exactly test that on mice or anything and you’ve got to wonder about the trillions or so microbes within us that are beneficial/necessary.

        • Exactly… there’s no way to push an animal into a nano or microwave excitation device and target a virus without cooking the good life within us! Though now I am getting too silly and off topic.

      • mario
        On a Christmas Eve decades ago, I went to my uncle’s house to celebrate Christmas. My mother, who was living out of state, had sent a package for me, and it had been laying under the Christmas tree for several days. It contained homemade chocolate cookies, which the little brown Argentinian ants that are endemic in California had found before I opened the package! I didn’t want to throw them away. So, I took the cookies — ants and all — over to the microwave oven. The intent was to kill them, knock them off the cookies, and enjoy my mother’s cooking. Unfortunately, the ants hadn’t gotten the message about microwaves being deadly. They continued to walk around as though it were a nice sunny day. Occasionally, one might fall into a molten chocolate chip and die immediately. However, the majority were not affected in the least. I then had to put a small cup of water in the microwave oven, and boil it, to let the steam kill the ants now infesting inside. My guess is that they were just too small and had too little water to be affected by the microwaves.

        • That is a wonderful experiment… Yes the microwaves are like several inches and so would pass right through the ants without vibrating their water content! So no heating.

          Now, eating the cookies? Your call 🙂 The ant waste and potential diseases would have me not interested in the wonderful cookies. Probably safe but the thought of ant scat…

          • mario
            People eat chocolate-covered ants, with apparently no harm, despite their intestines being intact. I’m unaware of ants being vectors for any human diseases. However, because I was not able to find an efficient way to remove the ants, I only ate a few of the cookies before throwing the rest away. Colleagues have made fun of me for eating rattlesnakes. I try to live by the principle that I eat what I kill. Although, I did pass on a skunk.

          • Clyde: I have no disagreement with any of your logic or statements. I was just thinking of the amount of contact time in which ants are living in the cookies. That kind of grosses me out…
            Otherwise, I think no harm especially through the smart use of heat disinfection. 🙂

    • I have read that low level chlorine gas is effective on flu virus. The level is very low, the same amount you would get in the air beside a swimming pool.

      • Sodium Hypochlorite keeps our drinking water pretty darn safe in very low qty’s.

        I do not like breathing the level of gaseous CL at swimming pools. For me, it used to lead to irritation and then sinus infections later on.

    • UV photons do a pretty good job of destroying organic compounds (paint, plastics, leather, bacteria, viruses, skin, etc.) The source is provided to us for free by the local star.

        • I have a hand-held UV sterilizer about a foot long that you wave over whatever you want to sterilize.

          • re: “hand-held UV sterilizer”

            Sounds like the classic UV EPROM “eraser” … used one on many a 2716 thru 2764 “windowed” EPROM devices on projects in the ’80-90s …

          • I had a tooth brush UV sterilizer that made a blue light. It was a gift from my dad.
            Of course it was completely fake, and probably made in China. I have some plastic beads that turn color to show UV A, B and C. It’s used for welding safety.

            None of these changed color in the POS toothbrush sterilizer. The beads are so sensitive that in the shade, on a sunny day, the ambient light is enough to change the color on all three of them (just not nearly as intensely as with real UV light.

            I use it to tell me when to change the two UV A and B lamps for my Bearded Dragon.

          • The ones I’ve seen like that are usually UV-C which is what’s needed to kill the viruses, while the sun emits UV-C it is effectively blocked by the atmosphere. Need to be careful when using them, don’t get light on your skin or eyes, keep them away from children. I have UV sterilizing lamps built into my AC system at home.

          • “None of these changed color in the POS toothbrush sterilizer.”

            That’s interesting. I wonder if the magazine Consumer Reports knows about this test. Consumer Reports tests all sorts of products.

            And here I was thinking about getting a new toothbrush sanitizer. Now I’m going to have to do more study.

            Thanks for the tip.

          • Look up uv detection beads, they are not costly! As a process control engineer, I am keenly skeptical of product claims and love to test them… esp when it’s easy and fun to do.

          • SonicCare toothbrushes come with a little UV sterilizer.
            It never occurred to be that it might not be doing a darn thing!
            Now I need to test it…

          • When hydro perox’ works well, why spend the money on a UV contraption that probably does nothing. But I would be curious if some of them work, for toothbrushes I mean.

  34. Rud.

    I red your piece here.

    Beautiful, mind blowing, very shallow though… and biased, in favor of some medication which has a less
    and poor track record versus another that has better one, for both, safety and positive impact, not mentioning the cost.

    The hipper duper sciency staff, like how it works, or this fancy terminology there, the hypothetical part of it, no matter how fascinating,
    it means no much and holds no much without any real data supporting it’s impact, either good-positive or not.

    In what you have brought here as information, I see not much of any support for your conclusion.
    Besides, this latest corona virus incubation period is not 12 or 14 hours.
    So how the sciency working of this high tech drug actually works as per explanation given in a 24 hr window!?

    Maybe I am missing something here!

    cheers

    • “Maybe I am missing something here!”
      whiten: Certainly you’re missing more than something.

      The grammar lacking drivel is disappointing.

    • @whiten – there is no treatment, including Remdesivir, that has a “proven track record” in dealing with SARS-CoV2. Or any coronavirus, for that matter. Studies are only beginning with either of these treatments that could be be “conclusive” – as in double-blind, large sample, with p<0.5 results.

      • Writing Observer
        March 20, 2020 at 3:25 pm
        ———————

        Thanks.

        But, I do not understand the point of your reply!

        Yes indeed, as you say;
        “there is no treatment, including Remdesivir, that has a “proven track record” in dealing with SARS-CoV2. Or any coronavirus, for that matter.”

        My main points in my comment to Rud:
        1) ….very shallow though… and biased, in favor of some medication versus another.
        2) In what you have brought here as information, I see not much of any support for your conclusion.

        The Rud’s conclusion:
        “Remdesivir may be a longer-term therapeutic solution, because it tricks the conserved RNA polymerase. But its cost and efficacy remain to be determined.”

        cheers

    • Whitten, you are missing a lot, like my last two posts on this that CtM conveniently provided below the header.
      Dunno where you are coming from.
      Facts. The mean incubation time to symptoms is 5.1 days. The median is 5-7 (skewed long by exposed viral titer. The 97.5% is 12.5 days. All public information.

      So a 24 hour window is nowhere except in the Seattle patient zero anecdote. Except that was on symptom day 10.

      Read more, comment less. It will improve your standing here immensely.

  35. remdesivir could be for cases that don’t respond to chloroquine. One downside of remdesivir is that recent study showed increased liver enzymes on it which can indicate risk. But if you will die anyhow, or have high chance of death then it may be a risk worth taking.

  36. I hear that the Germans are now panic buying sausage and cheese.

    It’s the Wurst Kase scenario…..

  37. Rud Istvan

    Many thanks for your evaluation, well reminding me the quality of your and Wim Röst’s excellent contributions weeks ago.
    *
    The results of Germany’s tests are that chloroquine and derivates are way less promising than therapeutic medicine having emerged from Ebola, Marburg and co, and – surprisingly – less dangerous over the long term.

    But without the constraining policies first introduced today by two of our sixteen federal states, and hopefully extrapolated tomorrow Germany-wide, we can anticipate that there would be by far less success to expect.

    Especially (but not only) youth partly behaves extremely undisciplinated.

    I’m still afraid of what expects the US: simply because the US health system globally is by dimensions less efficient than e.g. in Germany or France, as it is for a great extent reserved in the US to those who have enough money to invest in their own health.

    Those having less – or nearly nothing – to invest will in this extraordinary situation be the great losers.

    But they will be a danger for the entire country as well: simply because they will be afraid to check for being infected, what automatically would exclude them from earning the few money they obtain.

    And again and again and again: stop looking at the death toll, let alone at the irrelevant cases per million inhabitants: look at how the new cases increase instead, every evening at 0:00 GMT+0 – after having sorted the list by these ‘New cases’ of course!

    https://www.worldometers.info/coronavirus/#countries

    Simply because even in your giant and rich country, hospitals – including those of the US army – will get by dimensions quicker full than will do your cemeteries.

    KEEP AT HOME UNLESS YOU HAVE TO LEAVE.

    Good luck!

    J.-P. Dehottay (Germany)

    P.S. Commentators feeling the need for insulting me should feel free to do, if that helps them. While I’m still 100% OK but not at all immune against SARS-CoV2, I am pretty good against… insults.

      • Writing Observer

        Are you a US citizen?

        If you are, then maybe you write, but certainly you are no observer.
        Observing a system requires to be outside of it.

        The same remark I wrote to Mr Tillman applies to you as well:

        “Sorry, Sir: You don’t understand the health care system as such.”

        • Of all the dumb things you have ever written, that has got to be in the top 2 or 3.

          Your argument is that only those who know nothing about something are qualified to observe it?

          Given your comments, you give no evidence that you understand the health care system. You are just upset that it isn’t socialist enough for you.

          Regardless your claims of efficiency, study after study have found just the opposite. But then again, you actually believe that enhanced CO2 is dangerous.

        • Observing a system requires to be outside of it.

          Ok, bist du Deutscher?

          Then surely you contradict yourself with this statement don’t you?

          ” . . . simply because the US health system globally is by dimensions less efficient than e.g. in Germany . . . ”

          WO is correct, deine Dummheit presents itself gorgeous from your own logic.

    • re: “I’m still afraid of what expects the US: simply because the US health system globally is by dimensions less efficient than e.g. in Germany or France, as it is for a great extent reserved in the US to those who have enough money to invest in their own health. ”

      Unfounded; I went through state-of-the-art eye (cataract) surgery in 2018, paid cash and didn’t “break the bank” as is said when something is priced reasonably. I also went with the top-rated surgeon in a major metro area given the difficulty of my case (won’t go into details, but I was going blind fast in the year 2018. Cataracts, it seems, are sensitive to heat/IR and can be hastened to become opaque given sufficient quantities of both.)

    • Re: Binindon : Your problem is that you don’t understand human nature very well. People pay for health insurance so that they will get health care when they need it. In a private system the insurance company absorbs a LEGAL obligation to finance the health care you have paid for when you submitted premiums for your policy.
      In a socialized scheme you are only entitled to the health care the government thinks you deserve. And if the government thinks your future productivity is low and you current expense is high, you are an “inefficient” usage of financial resources that can be used to fly bureaucrats around the world to conferences about the latest public policy agendas. You see this as a hypothetical and most of us that have dealt with bureaucracies see it as inevitable.
      Just as inevitable as the country with the worst demographic problem that we know of, has a unexplained problem with a virus in a town that contains a top secret virology lab.
      And this virus is discriminatory against the most expensive and least productive members of the public.
      And this problem occurs just before millions of travelers visit the city for a huge New Year celebration.
      And when the bureaucracy got reports of this disease instead of acting to prevent the spread, they acted to muzzle those trying to raise the alarm, which directly prevented the containment of the disease.
      I don’t think this is a random event. The true cause may never be known, but the probability of nested coincidences occurring with these characteristics on this schedule is low.
      I am glad I do not have to depend on a system the will weigh my value to a bureaucracy that weighs the future valuation of revenue versus the cost of providing me care. I prefer to have a guarantee of a “legal contract” compared a guarantee of the bare minimum of whatever “bureaucrats are willing to pay for” in order to maintain a grip on public sentiment.

      • Agreed. It is really a coincidence that the Wuhan lab opened 3 tears ago, was approved to study first an African disease then SARS. And now we have an outbreak of SARS 2 in Wuhan, which looks a whole lot like SARS with a modification to the spike that is known to make other viruses more dangerous. And then the Chinese government moves very quickly to lock everything down, restrict outside investigation, bury the evidence and go on a worldwide disinformation campaign.

        Where there is smoke there is fire.

  38. Janice Moore

    Thanks for your thoughtful, respectful and intelligent reply to my previous CoV2 comment:

    https://wattsupwiththat.com/2020/03/17/an-effective-treatment-for-coronavirus-covid-19-has-been-found-in-a-common-anti-malarial-drug/#comment-2942063

    Be sure that thought being about 70, I don’t forget that we in Western Europe were all saved from the Nazis’ terror by both the US and… Stalin’s Russia, even if for many he was even worse than Hitler.

    They can’t understand.

    Regards
    J.-P. Dehottay

    • You don’t understand the US health care system.

      Poorer people get public care via Medicaid. Most people get private health insurance via work or pay for it themselves, with subsidies. Older people get the Medicare into which we’ve paid during our working lives.

      Those who are still uninsured chose not to be, maybe because they make too much for Medicaid, but usually simply because they are young and healthy and don’t want to spring for catastrophic insurance. The idea behind Obamacare was to force people to buy an expensive plan covering things that individuals don’t need or want, in order to bring in enough money to cover existing conditions.

      Paying for existing conditions is enforced charity, not insurance. Americans are generous, so we went along with the scheme.

      • Well stated. However the last statement?
        “Americans are generous, so we went along with the scheme.”

        No… the scheme was never described to American people or congress when it was enacted. You had “to sign the bill to read it”

        forced confiscation is not generosity, but that is an opinion of mine so I understand some will disagree.

      • I am somewhat sceptical about the US health system. A few years ago I made a visit to a University Hospital ER for a urinary tract infection while at a conference in the US. The total bill came to about $850 USD. This did not include any lab work, just the physician treating for symptoms, and the cost of the antibiotic was en plus. Thank goodness for my university travel insurance plan.

        • re: “I am somewhat sceptical about the US health system.”

          Is your complaint with the fee structure, or the medical diagnosis? Your post is a little unclear regrading a specific point or complaint.

        • Fees are too high. To be transparent all prices should be posted online that are charged. This is what stock exchanges do. It leads to fair market.

          • Which fee?
            The fee that a person paying cash would be charged?
            The fee that the doctor negotiated with Humana?
            The fee that the doctor negotiated with Blue Cross/Blue Shield (or health care provider of your choice)?

    • You forget Great Britain and the Commonwealth, the only countries to fight against Germany from the beginning of the war until the end. If Britain had made peace with Germany, the United States would probably not have gone to war against Germany and even if it had done so it would have concentrated on Japan instead.

      If Britain had made peace with Germany Hitler would have been able to devote all Germany’s strength against the Soviet Union which would have received no assistance from other countries during the first autumn and winter of the campaign because most of the aid it did receive then came from Britain and Canada and constituted a significant proportion of the tanks and planes used by the Russians in that first winter when their situation was desperate. The United States initially concentrated on building up its own forces after the Japanese attack on Pearl Harbor and only later did it start supplying large quantities of equipment to the Soviet Union.

      The Allied successes in breaking German codes were vital to the war effort and that was almost exclusively a British achievement (although information the British got from Polish code breakers was useful). Radar, a British invention, was vital in winning the Battle of Britain and when the Americans eventually entered the war they benefited from British work on that and other techonologies.
      The Allied assistance to resistance movements was provided by Europe was provided mainly by Britain.

      I could go on but I think I have written enough to make the point.

      • Also, without US aid, Britain would have been starved into submission before America officially entered the war. That’s why Hitler declared war on us after Pearl Harbor. He incorrectly calculated that we couldn’t fight both Germany and Japan. His U-boats did however enjoy a happy time off our unprepared East Coast in 1942.

        • John, no, the Battle of the Atlantic was won by redevelopment of our own Convoy System; and British Technology eg radar, asdic, Code breaking, warship and Plane improvments including superbright aerial lights and radars.
          The world-girdling Commonwealth provided the food, plain but sufficient.

          Meanwhile our Royal Naval supremacy was starving more and more Germans each year, millions. We do not under-estimate USA help, but USA always over estimates it.
          US war spending took until August 1944 to catch ours. Much of our technology including Nuclear was ahead of yours. And we won the first campaigns before USA got involved. Our 16th Army even gave Japan its biggest Land Defeat of the war, in Burma.
          This helped MacArthur greatly in the Philipines by draining off troops.
          Our problem at the start was like yours, we had leaders blind to the warlike intent of certain Dictators…. Luckily some non-politicians and one Leader to be were up to it.
          The burdens carried by the British Peoples in two World Wars were immense, but we do not denigrate yours, that would be churlish. Brett Keane

  39. I recently read a report that the University of Minnesota was testing the blood pressure drug losartan against Covid19.

    • Maybe that’s why there’s a shortage of it? My pharmacy can’t get any. My doctor had to change my BP med.

      • Grumpy Bill March 20, 2020 at 5:41 pm
        Losartan, made in China. Or Indian. There have been recalls on a number of batches over the last year or so. Not the case now. Indian has stopped all medical exports. China has threatened to, and may have.
        There are some pill factories in Porta Rico that were knocked out by the hurricanes 2017. There is talk of getting them open again

        michael

  40. Hello Istvan,
    What’s the chance the World, and especially Italy take China to curt over the delay of the warning?
    The communist party new it in late November or early December but had no problem to sign a MoU with Italy to triple the direct fly/week between China and Italy. That was signed in early January!! Then a 1000s of Chinese tourist, buseniss pearson and relatives of the local Chinese community rushed in unchecked.
    ———–

      • Well: Didn’t China send propaganda videos to Italy to get them to hug on Chinese people to prove they were not racist –before the Covid 19 ramp in Italy? I can provide links to articles and videos. I am pretty sure this is not a conspiracy theory…

  41. Rud,
    Thank you for stressing the reservoir of high quality scientific knowledge assembled by the medical profession over the years; and more, for pointing to the lack of such among climate researchers.
    In my ideal world, groups of scientists like medical, chemical, botanical, geological etc. would benefit from this “professionalism” displayed by medical, which long has been the most closed shop of the professions. It is also one that has examinations for continued or more specialised membership, also legislated permissions to conduct forms of research denied to others (like surgeons cutting people with scalpels).
    The other professions have been less selective about membership. Almost anyone can self-name as a climate specialist, not so for medical.
    Perhaps amusingly, some of the bloggers here are contributing personal medical observations as if they were medical professionals, without stating authorisation. This causes a difficulty when reading the comments of bloggers because one does not know who to believe most.
    Rud, you correctly laid out your standing from the start as a benefit to readers. Myself, a Science graduate with Chemistry emphasis, but little formal work on medical topics.
    In summary, I wish for more medical-style professionalism in other scientific sub-disciplines. Among other benefits, less of the blatant advertising advocacy that we see in climate research. Geoff S

  42. Cheers for injecting some data and sanity into the discussion.
    The nonsense being pushed around by anti-vaxxers and what not is getting ridiculous.

  43. Around 1966, working for CSIRO, we sampled a natural legume Neptunia amplexicaulis that was causing sheep deaths in N-W Queensland. We extracted the toxin and confirmed that its mechanism involved substitution of Selenium for Sulphur in an amino acid. Neptunia was an sccumulator plant. Others are known and for more elements than Se. We later investigated some accumulators for help in mineral exploration using biogeochemistry.
    Just for interest, John. Geoff S

  44. I believe this is going to sink Trump in the election. It seems obvious to me that even though he correctly shut down the flights into this country early on, he failed to get testing ramped up in this country. And now the cases are going up dramatically. This could have been more easily thwarted had our Government got test kits out much quicker. Compared to South Koreas actions and apparent success, it is obvious that the US government has failed us once again.

      • Clever, James.

        But it may soon be obvious that Trump and the US government failed to act as swiftly as South Korea to recognize the threat and to get something done about it.

        I could never vote D, so this concerns me quite a bit.

        • re: “But it may soon be obvious that Trump and …”

          Nonsense; literally: “the writing of a child.” I will defer to MarkW and others on the other points.

        • Every country in the world dropped the ball on this, or so one could argue if so inclined.
          It makes as much sense as arguing we should have had treatments lined up and stocked on the shelves in case this virus ever appeared.
          Recall what was happening at that time in the US?
          Impeachment was 24-7.
          Is the President a virologist, or epidemiologist?
          Does he have 200/20 Amazing Kreskin precognition?
          Is it obvious ahead of time which of the “experts” at the CDC or any other of the extensive public health entities in the US are more qualified to be cleaning bed pans that the advising a leader of a large country on the proper response to an emerging infectious disease?
          How many countries forbade anyone who had been to China from entering, as of one second past being alerted a new virus had emerged in Wuhan?
          That, plus complete closure of the border and a strict policy of zero admittance from the rest of the world, was the only policy that had a single chance of containing this outbreak by the time China got around to telling anyone what was going on.
          The virus was likely widespread in Wuhan by mid- and possibly early-December, if not before.
          How many flights in and out of that city to the rest of the world in that time?
          Who exactly brought the virus to each of the hundreds of thousands of people around the world who now have it, and when? No one has any idea.
          Testing would not have preventing anything, because the only way to know to test anyone is when they show up in an emergency room with viral pneumonia. Even then it could be anything.
          But by that time it is far too late to trace contacts and contain even that one single lineage of viral propagation. There are several days to as much as two weeks perhaps of latency, in which no symptoms are experienced, and yet a person may be contagious. Then it takes several days to as much as a week before some get to the stage of seeking medical care: We do not run to a hospital when we have a cold or the flu…at least most do not.Some do not even call in sick from work, and in fact many employers offer no sick time, and may even react badly if someone tries to call in sick.
          And only then might an alert caregiver administer a test, if they were available, and if that one patient was distinguishable for the many people who get sick in every town every day.
          And all that time, the person who infected the patient considered in this example, is infecting others, as is any persons infected by the patient prior to his/her going to a hospital.
          And many are getting and spreading the virus with no symptoms whatsoever.
          Zero. This group seems to be the majority in fact.
          And that is only a partial rundown of the futility and illogic of what you are suggesting…that the President might have somehow been the first man in history to stop an emerging global pandemic in it’s tracks before anyone ever knew a serious threat existed, let alone had any clue what to do about it, or even to identify it in real time.
          The nature of this virus makes it increasingly clear, to me anyway, that this die was cast before the person who caught the index infected animal, and brought it to the Wuhan market, ever did so. It was likely cast when, some 20 to 70 years ago, this viral strain evolved in some bat somewhere and passed it to the ancestor of that index animal.
          The particulars of a cryptic infection, that has a long latency period, a high proportion of asymptomatic carriers, a high incidence of serious disease in those that do get sick, and is highly transmissible…means that it was always impossible, in my analysis, to catch this in time to do anything about it.
          The lesson here is…leave wild animals alone. Do not catch them, do not touch them, do not eat them, and do not bring them into a crowded city and put them in a cage in a crowded food market…EVER!
          Let this be the last time this disaster befalls us.
          There are plenty more viruses out there, and plenty of other potential disasters.
          There has been far too large a number of instances of this exact type of zoonosis in just the past two decades, for anyone to think it will not happen over and over again, as long as people do the sorts of things that led to SARS, Ebola, MERS, and many many others, and now this one.
          It is far beyond ludicrous to suggest, let alone believe, one person with no background in any relevant discipline might have prevented such an outcome.
          If it was Trump’s fault in the US, whose fault was in everywhere else where they took less decisive actions than he did?
          He was excoriated by Democrats and the MSM for ending any flights at all, back when he did so in the case of China.
          Amnesia on that.
          Even after it was plainly obvious a catastrophic disease outbreak was ongoing on Wuhan, other world leaders did nothing…zero, zip, zilch.
          Last week when Trump ended flights from Europe, he was castigated by leaders like Merkel, who said she would not be closing any borders…prior to closing her borders the next day.
          Europe refused to close the border crossings though the Alps from the outbreak areas in Italy, even long after it was obvious things were very bad there.
          After Merkel closed her borders, the EU President, whose name I do not recall (anyone that stupid should be out of a job retroactive to the day she was installed), said it was a bad idea.

          The numbers are looking not good.
          We have a guy here claiming that because of Trump, we are all but dead here in the US, and him and his will be fine over in Germany.
          A look at the numbers makes him a liar and a fool.
          Consider the EU has about as many people as the US, and add all the numbers for those places together, and compare it to the US.
          Yesterday in Italy 627 new deaths made the tally 4032 total deaths; 5,986 new cases brought that total to 47,021 total cases. In Italy, the total recovered, 5,129, is over 850 less than the new cases in one day.
          New cases yesterday (today’s numbers appear not to have posted in all cases):
          Germany: 4,528
          Spain: 3,494
          France: 1,617
          Switzerland: 1,393
          Austria: 470
          Netherlands: 534
          Belgium: 462
          Norway: 169
          Sweden: 200
          Denmark: 104
          The list goes on and on and on.
          And new deaths…look at them!
          Germany, 24; Spain, 262; France, 78; Switzerland, 13; Netherlands, 30; Belgium, 16…
          (These numbers of new deaths, from places that have adopted chloroquine as treatment of choice many days ago, …is not cheery news, in case no one else noticed or was looking at that. Italy has been using it, and the rest of those places, or at least most of them…)

          Total cases per million people for these EU countries, are Italy, 778; Spain, 461; Germany, 237; Switzerland, 649 (!…shoulda closed that border to Italy…WTF were they thinking?); Austria, 294; Netherlands, Norway, Sweden, Denmark…175, 361, 162, 217.
          Let’s hope those deaths are not in people who got experimental antivirals.

          While I am holding this bucket of cold water, might as well point out that it is very hot in Florida, has been for weeks, most of the past few months in fact have been very mild.
          And cases here are spiking, as they are across the southern tier of the US.
          Florida, Georgia, Louisiana, Texas, South Carolina, California…large numbers of new infections.
          A lot of the rapid increase can be attributed, no doubt, to having more tests done, but this is not the hopeful sign I was considering it might be when i had not thought about it very carefully.
          Whatever the numbers are showing now only gives a partial picture of what was happening with regard to new infections a few weeks ago…when people were mostly not doing much to protect themselves.
          The past two weeks have been a mad house of throngs of people crowding into stores and standing shoulder to shoulder to get in, check out, etc.
          Not to mention similar but worse scenes in airports.
          Tens of thousands of international travelers came back to the US last weekend alone. And I suppose it was about the same in most places.
          So, it is very likely we aint seen nothing yet, even if there is not one single new infection from this moment forward.
          Ditto for the EU and the rest of the world.

          And then tropical countries, including those with malaria?
          Cases are rising sharply across Africa (where in Nigeria, to name one example, large numbers of people are showing up in ER’s with chloroquine poisoning, after stripping this important medicine from shelves around that country and indeed the world), and in South America and other warm weather locales it is about the same.

          Brazil, yesterday 330 new cases, total now 970 (two weeks ago people were remarking the number seemed to be zero in Central and South America), Chile, 92 new, 434 tot; Ecuador 166 new, 426 tot; Saudi Arabia, Qatar, Bahrain…those hot locales are now well into the hundreds of cases and rising fast.
          I suspect the places with low numbers have either bad reporting, no testing, or had a late start in having the virus introduced, but it is now spreading apace.

          I think places with malaria tend to be places that have relatively little mechanization, low road penetration and travel infrastructure in general, relatively impoverished populations not given to world travel and possibly not a lot within their country. And that is how it spreads…so why would anyone be surprised that places with no roads and little ability for widespread rapid transportation, would have a lower rate of virus transmission.
          Rapid travel, far and wide, by many people, in less time than it takes to become too sick to move around, is exactly why we have these pandemics after all.

          I am too tired and ill to offer clarifications regarding what are, IMO, the many errors in the virology, pharmacology, and immunology in the headline post.

          I will just leave a few links:
          In animal models, chloroquine failed to work as it did in cell cultures vs HIV and SARS, and did not block viral replication, but did work as and anti-inflammatory and immune system modulator. (The ability to function as an immune modulator, down regulating immune response, is why it is used against RA.)
          But there was success in newborn mice given chloroquine through their mother’s milk when used to block infections of a lethal coronavirus, OC43:
          https://www.asbmb.org/asbmb-today/science/020620/could-an-old-malaria-drug-help-fight-the-new-coron

          Remdesivir is being badly characterized by most who write about it.
          It worked stunningly well against Ebola in vitro, ditto against all filoviruses and about the same in MERS and SARS and Nipah and Hendra.
          But like a very long list of new drug candidates, it was not quite as effective in clearing virus from people who were already in the advanced stage of a viral infection. In fact, most substances that kill viruses in a glass dish cell culture either do not work or work only weakly in a human body. One reason is achieving the proper concentration within cells is not so easy in a person as in a dish. Many substances do not spread evenly through the various tissues of the body. Some reach toxic levels in some tissues long before they are present in the target cell populations at sufficient concentration to be effective.
          Chloroquine, for example, is 200-700 times more concentrated in the liver, spleen, skin and kidneys that in plasma, and the concentration is for some reason even higher in the tissues of the eye, in particular in melanin containing tissues of the eyes…so more in the iris and choroid than in the retina, sclera, and cornea.
          This tendency to concentrate is one of many reasons why some drugs that work just amazingly well in vitro are useless for curing diseases in people. There can even be huge differences between people and various animal models, and even between different demographic groups, and between people who are healthy and who are patients, and for patients who are gravely vs mildly ill.

          Drugs that work in the body must concentrate in the target cells at sufficient level to be therapeutic without building up to dangerously toxic level elsewhere, unless such toxicity weighs favorably against the antiviral activity.
          The gold standard is all cause mortality.
          Remdesivir would have been a blockbuster vs Ebola had there not been two monoclonal antibody drugs that became available at the same time.
          With only standard of care, 80-90% of the Ebola patients were dying.
          Remdesivir far outperformed the existing “miracle drug” called ZMAPP, lowering the case fatality rate to less than 34% if given soon after Ebola symptoms appeared in human patients.
          This was far less than the response seen in animal models of simians infected with filoviruses.
          But even when given late in the disease progression, remdesivir saved many more patients than standard of care alone…bringing the CFR down to about 50-53% or so.
          The two mAbs were hardly cure-alls, either, even though they outperformed ZMAPP and remdesivir. The lowest CFR seen was with the Regeneron drug, which got survival rates up near 90%…but only if given immediately after a patient was exposed. Patients who had progressed to a later stage of illness had a CFR no better than 30-35%.
          Anyone who hopes to understand what we are likely to see with any of these drug’s results needs to know how to interpret these results and put them in context.
          Remdesivir worked very well against Ebola.
          If it was all there was, it would have been immediately accepted as the new standard of care.
          It outperformed the existing SOC significantly.
          Also, it must be understood that a lot of people still died, and as far as I know no trial ever was done to see if remdesivir plus a monoclonal antibody might have achieved a cure rate closer to 95 or even 100%.
          If I had Ebola…I would want both.
          And there is one more point to make with Ebola and remdesivir, also completely overlooked by every other writer I have read on the subject: Remdesivir will work equally well against all the strains of Ebola. There has been a new strain with almost every major outbreak of Ebola.
          The monoclonal antibodies will only work against that one exact strain…so when the next outbreak hits, the best drug on the shelf will be remdesivir, with it’s 45-67% cure rate, until a monoclonal antibody can be isolated, manufactured, tested, and then produced in quantity for the new strain…assuming that an effective antibody to the new strain can be isolated.

          Virology is not bean bag.
          The stakes are life and death, and nothing works against all viruses all the time in any stage of illness…not by itself anyway, at least nothing I can think of off the top of my head.
          Even the best antibiotics do not work perfectly in all people against run-of-the-mill infections.
          Antivirals are even more capricious.

          Some are allergic, some seem to metabolize drugs differently, or concentrate them in tissues wrong, etc.

          “Remdesivir (formerly GS-5734) is a prodrug of a
          modified adenine nucleoside analog GS-441524.
          Remdesivir undergoes efficient metabolic
          conversion in cells and tissues to active nucleoside
          triphosphate metabolite that inhibits viral RNA
          polymerases, but not host RNA or DNA polymerases.
          Remdesivir exhibits a potential for clinical efficacy
          against Ebola virus and other filovirus infections based
          on the following:
          1) Potent in vitro activity in multiple relevant cell types
          against multiple Ebola virus isolates, including the
          Ebola virus variants isolated during the 2014-16
          outbreak in West Africa.
          2) Potent and consistent in vitro antiviral activity
          against diverse species of the ebolavirus family,
          including Zaire, Sudan, and Bundibugyo viruses, as well
          as Marburg virus.
          3) Preclinical pharmacokinetic profile in non-human
          primates and other relevant animal species indicating
          high and persistent levels of pharmacologically active
          nucleoside triphosphate metabolite in peripheral
          blood mononuclear cells (PBMCs); this measurement is
          used as a surrogate for drug levels in cells relevant for
          Ebola virus infection, supporting once daily
          administration.
          4) Preclinical safety profile supporting safe clinical
          administration at doses potentially active against Ebola
          and Marburg virus infections.
          5) Clinical safety profile from > 100 human subjects
          dosed with intravenous remdesivir supports the
          clinical dosing regimen recommended for the
          treatment of Ebola. Single and repeated doses of
          remdesivir were safely administered in Phase 1 studies
          in healthy human subjects, PREVAIL IV study in male
          Ebola virus disease (EVD) survivors, as well as during
          compassionate use for the treatment and post
          exposure prophylaxis of Ebola infection.
          6) Potent therapeutic efficacy in Ebola virus-infected
          rhesus monkeys, the most relevant in vivo preclinical
          model of EVD, at drug exposures that
          were well tolerated and can be safely achieved in
          humans. The in vivo therapeutic efficacy has been
          demonstrated in non-human primates against multiple
          Ebola virus variants including Kikwit/1995 and
          Makona/2014 as well as against Marburg virus
          Angola/2005 infections.
          7) Tissue distribution studies in non-human primates
          indicate effective penetration and distribution of
          remdesivir into immune privileged sites (genital tract,
          eye, and to some extent brain) that may represent a
          persistent reservoir of Ebola virus. Relatively high
          levels of remdesivir metabolites were also detected in
          human semen following single and repeated
          administration of remdesivir, suggesting potential for
          antiviral effect in human genital tract.
          8) Sufficient supply of remdesivir drug product is
          available in a stable lyophilized formulation that does
          not require cold chain for transport and
          storage”

          And this:
          “Consistent antiviral activity against all tested filoviruses
          (Ebola Zaire, Sudan, Bundibugyo, and Marburg).
          Similar antiviral activity was observed also against
          pathogenic coronaviruses (MERS and SARS CoV) and
          paramyxoviruses (Nipah and Hendra).”

          Gilead, as well as research teams in China, did not need to look at the genome of SARS-Co-V-2 to ramp up production and immediately initiate clinical trials and compassionate use all the way back in January… as they already knew it worked equally well in vitro against a broad swath of related and unrelated viruses groups.

          https://www.who.int/ebola/drc-2018/summaries-of-evidence-experimental-therapeutics.pdf?ua=1

          A long list of people who are professional biotech analysts have dismissed the chance of remdesivir “working” against COVID-19 patients , on the basis of an erroneous understanding of what was found in the Ebola trials, numerous animal studies against a wide range of viruses, and the same vs a wide swath of viruses in in vitro cell cultures.
          But look at what the vast majority of clinicians are saying, and what medical researchers and medical educators are saying.

          To some degree, the cat is out of the bag regarding chloroquine, it seems. It has disappeared from shelves and pharmacies around the world, and people with malaria or at risk for it cannot obtain it, people who do not need it are taking it, and some of them are landing in emergency rooms…poisoned.
          One whole family in Nigeria.
          I would feel terrible if I was the one who told everyone it was safe as can be and, in some cases for some people far and wide, implied or said outright that everyone oughta get some and take it.
          https://leadership.ng/2020/03/21/lagos-hospitals-flooded-with-chloroquine-overdose-patients/

          • one other point about chloroquine and malaria. As has already been stated in most areas of likely malaria this drug is ineffective, but it is of course cheap – so the poor use it in belief that it works.
            “Chloroquine (Avloclor) is only effective in a small number of countries, mainly in Central America, and should never be taken to prevent malaria in Africa, South East Asia or South America where the malaria parasite has developed resistance to Chloroquine (Avloclor). ”
            https://www.nomadtravel.co.uk/blog/travel-health/which-malaria-tablets-should-i-take

          • Ghalfrunt,
            Yes, all true.
            I can expand a bit on this point, with regard to chloroquine and it’s usage vs malaria.

            There are two distinct usages for any anti malaria drug: One of them is treating people who have become infected with malaria and are very sick.
            The other is for what is known as prophylaxis, which is a big word meaning “something that protects”. From the Latin, ‘pro’ meaning “before” or “prior to” + ‘phulaxis’, “the act of guarding”.
            Simply stated, you take a drug if you are going to be somewhere that malaria carrying mosquitoes are or may be present, in order to prevent malaria from getting a toehold in your body if one of those mosquitoes bites you.

            The dosage given to use as a protection for people who do not have malaria, is similar to the dose used to cure malaria, but it is given every week instead of every day, so it is a far smaller amount overall.
            The dosage taken if you have malaria is in the same range as the dosage required for people taking it for RA, short for Rheumatoid Arthritis (a crippling and incurable autoimmune condition), or other autoimmune disorders of a crippling nature like Lupus Erythematosis, abbreviated to simply Lupus.
            Many patients of these disease find they cannot tolerate chloroquine, and many others get great relief from it and take it long term.
            It appears the dosage given to Covid patients is similar to these two usages.
            The dosage is sometimes given in milligrams, but is probably better stated as milligrams per kilogram of body weight, because the “dosage window” is particularly narrow for this drug.
            What the term dosage window refers to is the amount which is therapeutic, in other words the amount at which it acts as a medicine.
            Too little will not work, and too much is very toxic.
            Every drug which is used as a medicine has a dosage window.
            But few have such a narrow range that is effective while not being toxic, as chloroquine.
            It is not at all clear that everyone who is giving out what sounds like medical advice is aware of any of this.
            For most drugs, accidentally or ignorantly taking two instead of one dose, will not kill anyone. For most drugs a child taking an adult dose will never kill them.
            But for this one the amount that can kill a child is not far above the amount used as a medicine for an adult.

            Also complicating dosing is that there are two version of drug that are similar in name, hydroxychloroquine, and chloroquine, and they have different dosing and may have different levels of effectiveness.
            A large family of related drugs exists, all related to and based on the original natural drug called quinine…but they are not quinine.
            Anymore that heroin is opium or even morphine.

            (OK, I am seeing futures jump up quite suddenly and the VIX took a dive, but I am not sure why…so I lost my train of thought…
            Also saw a report from Barron’s that Gilead has halted compassionate usage program after a flood of requests, an exponential increase, had overwhelmed their system for issuing such approvals. All except pregnant women and children who have “severe manifestations” of COVID 19. But it is increasing what is called the expanded access programs. More on this as I find out what is what)

            Anyway, trying to get back to my train of thought is proving elusive.
            I was going to give details on why the idea that countries with malaria do not have as much COVID 19 is due to chloroquine is poorly supported at best.
            In fact it appears that there was little attempt to confirm the basic conclusion or the premises of the assertion.

    • Oh Go home, will ya. Test kits had to be developed that worked. Are you saying Trump could have just said, “order the test kits right away” and they go out?
      What about the test kits that gave 50% false positives offered from Germany when our test kits just got ready to start shipping?

      Meanwhile, regarding S Korea. They did not act like Trump to prevent China from seeding us so here are the stats right now today.

      S Korea: Population, 51MM; Deaths 94, cases 8,652. So they have 1.8 deaths per million and 170 cases per million.

      US: Population; 330MM; Deaths 256; cases, 19,387. So we have 0.77 deaths per million and 58 case per million.

      • That’s true now, but give it a week as testing gets ramped up in the USA (because we delayed getting test kits out). Then you will see what I fear right now.

        • You will find that the mortality rate will continue to drop as detected cases go way up. It’s a bad cold virus… it will spread

          • Mario,

            Only a unethical statistician would hide behind “the rate”.

            What counts to humanity is raw numbers of death.

            Death. Numbers.

            You’re happy with how many deaths, Mario?

            How many is good?

            When does good become bad, to your way of thinking?

          • Mario,
            Only a unethical statistician would hide behind “the rate”.
            What counts to humanity is raw numbers of death.
            Death. Numbers.
            You’re happy with how many deaths, Mario?
            How many is good?
            When does good become bad, to your way of thinking?,

            Your kind of thinking is dangerous and small minded.

            Based on your ridiculous understanding of what I wrote, let me ask you a question.

            Do you think the current novel Covid 19 is worse than the Flu?

            Because by your logic, the flu is infinitely worse since it kills around 600,000 people every yearand Covid 19 so far has killed just under 13,000. Why is that?

            Next time you accuse someone of ill intent, you should think about it.

          • A lower death rate is good and as you indicate, so far, the mortality rate has been dropping.

          • Who said anyone was happy, Sam?
            What is this crap about “unethical statisticians”, or people hiding behind “rates”.
            What exactly are you talking about?
            What Mario said was true.
            None of this, or any other such discussion, has anything to do with how many are gonna get sick and die.
            Would test kits a month or two weeks ago have prevented deaths today, or yesterday, or tomorrow?
            I would like to understand how, if anyone believes that to be the case?
            How many deaths are you happy with Sam?
            To your way of thinking, apparently you can blame a pandemic and thousands of deaths on someone if you do not agree with their understanding of the concept of numerical analysis, is that it?
            In that case, I think we have the culprits you are looking for…they are called epidemiologists.
            Is this their (the epidemiologists) fault, because they study patterns, numbers, and correlations, and make logical inferences based on data?
            When did participating in online discussion become the same as being happy about people dying, “to your way of thinking”?

            Is this a blame game for you, Sam?
            Are people you disagree with responsible for a virus, while you are smugly free of blame?
            Does who one voted for in the last election, determine how many people you can accuse that person of being happy with?
            In a world quickly becoming unhinged, to the point it is getting very hard to be surprised, I am astounded by this attack on Mario.
            You should be ashamed of yourself, Sam.

          • Thank goodness for people like you Nicholas McGinley, we are lucky for your amount of thoughtful and informed discourse. Us non medically trained folk are doing our best to put some clarity to our reality.

            Thank you!

            PS : Sam has obviously been indoctrinated into the plague of simple minded thoughtlessness —inability to understand basic knowledge.

          • “What counts to humanity is raw numbers of death. Death. Numbers. How many is good?”

            Well, since I suspect you’ve never demanded a global shutdown of the economy over the flu (which would definitely lower the death rate), I’d say your “good” number of deaths is between 12k and 60k.

            This is why appeals to emotion are fallacious. If “every life matters” and you are “unethical” for caring about the rate, then YOU are unethical for never being outraged about flu deaths.

            If you respond with “this isn’t like the flu”, I will take that as admission that you have failed to even begin to understand why you are wrong. A dangerous place to be.

          • Josh Postema: Hi Josh: I am not sure whom you are referring to with the use of the pronoun “you” in your post “Well, since I suspect you’ve never demanded a global shutdown…”

            I assume your comments are for Sam who does not understand how to interpret a string of words larger than 3 or 4 in length and wrote a scornful reply to my factual and non emotional assessment.

          • Well, that got the hares running.

            The point is, Mario, you admit you have no medical background and you are “trying to put some clarity to your reality”. Your reality? What’s that beast when it’s at home?

            Does “your reality” understand that 795 people died in Italy last night from your “flue”? Or is it just playing intellectual tiddlywinks on the Internet?

            There is no data on the untested. Hence you choose to surmise, project and diminish the reality. Not “your” reality. The reality. Seven hundred and ninety five. Last night.

            Comparing this to the flue is an invalid comparison. An irrelevancy.

            If you persist in to playing mind- games in an area where you are unqualified, you do no more than demonstrate that you are blind to your bias.

          • SSam. You’re posts are diluting the value of this page. Every time you write something, it is a pure distraction. Until people become immune to the idea of responding to you, your ilk will never go away.

            You need to get a GED first before you start criticizing other people’s credentials.

          • I believe his remarks are directed at Sam, Mario.
            In fact I am sure.
            He is pointing out yet more reasons why Sam is not only off base, not only wrong, but he has it backwards in fact.
            Engineers know how roads and bridges are designed.
            At some point in the calculations, one has to assigned a dollar value to a life saved or lost.
            We do not make highways lanes 40 feet wide and put thirty feet of Styrofoam padding on each side of each lane, with traffic going the other way 100 feet away.
            How wide should Interstate setbacks be? How close should trees be allowed to encroach? How much is spent on the railings and abutment padding, like those trashcan things full of water where toll plaza concrete dividers start?

            The same goes for medicine, but in many more, and more complex ways.
            If Standard of Care gives a survival rate of 87%, and a new treatment gives a survival rate of 92 %, but in another cohort the numbers are somewhat different, 83% and 89%, but both cohorts have a rate of severe adverse events in the range of 6% to 12%, including a few fatal ones, and the all cause mortality after 12 month is statistically equivalent, then what do we do?
            People who have decided ahead of time what they “know” is true, will have a very hard time accepting a logical decision to turn down a new drug application for such a treatment, ewven though it is logically the correct decision, given that with the drug, 6-12% of people who had an 83-87% chance of being fine a year later, are instead living with a permanent harm. And the same amount of people were still alive a year later…or maybe less, if some of those adverse events were strokes, heart failure, kidney failure, etc.

            People who have payed close attention over many years to new drug candidates, how they arrive with promises of great benefit, that have failed clinical trials, or who are aware of how the results are very rarely clear cut and dramatic, know that the only way to have a hope of remaining objective is not to decide ahead of time what is going to work.
            We have to let the process work.
            IN a well designed and run clinical trial, inclusion and exclusion criteria must be laid out in advance. And endpoints must be clearly delineated.
            Clyde has it exactly right when he points out the example of aspirin and Reyes Syndrome.
            Other sorts examples might be what happened with a drug like Fen-Phen, or one like Vioxx.
            In all of these cases, unexpected harms appeared but only after a period of time had passed.
            In the case of aspirin, a drug which might be the most widely used and generally safe medication ever, was found to cause a terrible harm when used in one particular circumstance in one subset of the population: Kids who have the flu. For everyone else it is fine. For kids it is fine, except a certain number of ones who take it for the flu, or certain other viral infections like chicken pox. It is rare, but devastating for those it afflicts.

            I was not even talking about any of those sorts of things when I urged caution regarding the safety profile, and also to remain skeptical, but by all means cautiously optimistic, regarding chloroquine.
            There are reports from China of a wide array of drugs and combinations that have supposedly “worked” in patients with Covid-19.
            We do not want the cheapest, or the newest.
            We want quantified results of everything that warrants consideration.
            If the value of chloroquine is as an anti-inflammatory, is it the best drug for this purpose?
            The interleukin 6 monoclonal antibody drugs sound far more promising to me, if what we are looking for is a way to prevent damage from Cytokine Release Syndrome.
            But only trials can answer such questions.
            I have seen reports that the sensational press reports have made the clinical trials process very difficult. By having unapproved drugs widely available for compassionate use exceptions, they are having trouble finding people willing to enroll…more and more people are demanding compassionate use of whatever it is they read about.

            The Chinese tried many separate treatments, and most of them seemed to say words to the effect of “Hey this is good”.
            Kaletra they panned.
            Others have said Kaletra seems to work.

            The results of all fo the trials may well be difficult to parse.
            It seems unlikely we will be seeing a result that is 100% for any particular treatment.
            If millions of people have taken Chloroquine for many decades, and done so in places with endemic viral infections, how is it no one noticed that they not only keep people from getting infected with viruses, but cure viral infections?
            After all, the benefit to RA and Lupus patients was discerned all the way back in the 1950s.
            Counter intuitive results are not at all unheard of in immunology, though.
            Back in the latter part of the first decade of this century, clinical trials were conducted on a cyclosporin derivative which was a cyclophilin inhibitor, for use with combination antiviral therapies in the long fight against HCV.
            There was also some data that indicated that Hep C patients who underwent antiviral chemotherapy with Interferon Alfa and ribavirin, had a higher rate of successful treatment if they were on one of the immune system inhibitors typically used for RA and other autoimmune disorders. Humira or Remicade I think…cannot recall which one.
            There are also specific mutations called single nucleotide polymorphisms, SNPs, which were found to be highly predictive of whether a particular treatment regimen would be likely to work for any specific individual.
            One of them, the gene for IL28B, was highly correlated with whether or not interferon plus ribavirin would work for a patient. Other SNPs in the same region are highly predictive of not just who is likely and who is unlikely to respond to a particular therapy, they are predictive of who will become chronically infected and who will clear the virus spontaneously and never need any therapy because their own immune system overcame the infection soon after becoming exposed.
            These findings have been subsequently expanded upon immensely.
            I am confident that in the very near future, researchers will be able to determine why it is that some proportion of individuals become asymptomatic carriers, and which get sick, which become the most ill, and who is likely to die, or to be cured, by dint of a particular intervention.
            It has long been known that when a person is infected by the hepatitis C virus, they may clear the virus or they may become chronically infected, and that for some people, viral clearance was far more likely than others.
            Among the factors that were strongly predictive of chronic infection or viral clearance were being female (higher incidence of clearance), being young (higher incidence of clearance), and the size of the infective dose (larger dose gave far higher chance of chronic infection).
            It may well be there is something akin to that going on with this virus.
            I am certain we will see a surge in our understanding of the complexities of how environmental factors, genetic predispositions, and how such factors as age and overall health of the immune system interact to protect us from viruses and other infectious diseases, with spillover into oncology a near guarantee.
            We may get to that singularity yet.

          • Wow: I have saved this wealth of information so I can digest it later. Much appreciated.
            Mario

          • Mario, I appreciate you have difficulty dealing with a pricked ego.

            Ad homs are not the solution. Rather, they’re an indication you’re out of ammo.

            Confront your reality Mario.

            Answer the questions:

            1. What is a good number of deaths?

            2. What is a bad number of deaths

            3. Why do you seek to diminish the death rate for the Chinese corona virus?

            And finally, why is the comparison to flu (the mortality rate for which is lessened by the existence of a vaccine) a valid comparison, in your view?

          • Sam you’re a moron:

            Answer the questions:

            1. What is a good number of deaths?
            0
            2. What is a bad number of deaths
            >0
            3. Why do you seek to diminish the death rate for the Chinese corona virus?
            so fewer people can expect to

            again: You’re a moron

          • Mario asserts:

            “Sam you’re a moron:

            Answer the questions:

            1. What is a good number of deaths?
            0
            2. What is a bad number of deaths
            >0
            3. Why do you seek to diminish the death rate for the Chinese corona virus?
            so fewer people can expect to

            again: You’re a moron”

            You’re losing it Mario. Calm down ,and take a deep breath.

            Your answers to the first two questions are correct, Mario.

            The third tells me that you don’t check before shooting your mouth off.

            “So fewer people can expect to”…….what, exactly, Mario? Die? Nope, that’s illogical. Get infected? Nope. That doesn’t work either does it, Mario?

            So what’s the answer?

            The fourth remains unanswered.

            Your ad homs provide evidence to the hypothesis that you’re out of ammo.

            I hope you don’t design bridges.

          • Sam, this is a tense and unhappy time for an awful lot of people.
            Maybe a little more light, and less heat, eh?

        • You keep making the claim that we delayed getting the tests out. Yet you fail to provide any evidence that there was anything the government could have done to speed up the rate at which tests were deployed.

          • Nicholas
            Besides the surprises that there are differences in susceptibility correlated with gender and blood type, I think that we have collectively forgotten the role that smoking and persistent air pollution may play.

            I see many people here who are so desperate for a quick solution that they have adopted the “Ready, Fire, Aim!” approach with their suggested solutions.

          • I am concerned at this point that successful treatments are being all but promised.
            The language used makes it sound like at this point clinical trials are a formality, as these drugs are shown to be effective.
            We also see an undercurrent of belief that the only reason why an old and inexpensive medicine has not been widely adopted is because no one can make money on it.
            What it adds up to, in my view, is a situation where an ambiguous but less than stellar result will be disbelieved by many.
            Let’s look at the example of remdesivir tested vs Ebola.
            A look at the actual results showed something that is fairly common for a antiviral against a awful disease: Some are cured, some are not. And several factors are identified that may influence efficacy, such as initial viral loading, at length of time since symptoms became apparent, etc.
            So remdesivir had results far superior to anything that existed prior to the time of the study. Over two thirds of patients getting it were cured if they got it soon after presenting with symptoms.
            Patients that were worse off had almost a 50% cure rate.
            With no treatment almost 90% of patients in that outbreak were dying, a particular virulent and deadly strain, evidently.

            So it saved a lot of people who would have surely died without it.

            It was far more efficacious than what had been accepted as the best drug known, called ZMAPP.

            But it turned out two other new drugs worked better.
            Much better if given soon after symptoms began, under 10% in some cases, but none of the drugs cured everyone.
            Even the strongest of the monoclonal antibody drugs were unable to save over 1/3 of people who were in more advanced stages of illness.
            So the MAbs, as they are known, outperformed remdesivir…for sure.
            But no one looking at that result ought to be able to conclude that remdesivir had no effect.
            And yet that is how it has been described by a long list of writers, including some at major scientific publications…in at least one case the very publication that had reported the Ebola results.
            This publication seemed to me to go out of their way to be completely inconsistent in how they described the history and prospects of each drug being tested vs corona virus.

            Here are the articles i am referring to, first the Ebola article describing how effective remdesivir was:
            “In the 41% of trial participants who sought treatment early after infection and had lower levels of Ebola virus in their blood, the two new treatments had astonishing success: Mortality plummeted to 6% in the Regeneron antibody group and to 11% with mAb114. (With ZMapp and remdesivir, mortality rates in people with low viral load were 24% and 33%, respectively.) There is far less hope for patients with a high viral load, however: Even with the best treatment, REGN-EB3, their death rate was 60%.”

            https://www.sciencemag.org/news/2019/08/finally-some-good-news-about-ebola-two-new-treatments-dramatically-lower-death-rate

            And now a new article in that same publication on a new megatrial organized by WHO, describes the results, summarized above, like this:
            “Researchers tested remdesivir last year during the Ebola outbreak in the Democratic Republic of the Congo, along with three other treatments. It did not show any effect. (Two others did.) But the enzyme it targets is similar in other viruses, and in 2017 researchers at the University of North Carolina in Chapel Hill showed in test tube and animal studies that the drug can inhibit the coronaviruses that cause SARS and MERS.”

            They say remdesivir DID NOT SHOW ANY EFFECT!
            Then they characterized the animal and in vitro studies of it as favorable, when those same animal and in vitro studies vs Ebola gave about the same results in all of the viruses tested against!
            This is astoundingly bad reporting, and I really have no idea what to make of it.
            Some tentative results that are not quantified, used tiny sample sizes, and do not characterize any viral loading in an objective way, are hyped as if they are proof of efficacy.
            A combo with clinical trial results that show no effect are described using some comments made prior to the trials, this in the case of the Ritonavir/lopinavir.

            See here:
            https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments

            On the whole this all makes no sense.
            If it turns out that chloroquine is only weakly effective and the effects are in the anti inflammatory aspects, it is probably a mistake to waste time when far better drugs for that are available, such as the IL-6 monoclonal antibody drugs that have saved the lives of people undergoing intense cytokine storm, and are safe and approved and in stock in hospitals.

      • mario lento March 20, 2020 at 6:52 pm
        Meanwhile, regarding S Korea. They did not act like Trump to prevent China from seeding us so here are the stats right now today.

        S Korea: Population, 51MM; Deaths 94, cases 8,652. So they have 1.8 deaths per million and 170 cases per million.

        US: Population; 330MM; Deaths 256; cases, 19,387. So we have 0.77 deaths per million and 58 case per million.

        S. Korea acted very aggressively regarding testing, anyone who showed up sick with the virus was tracked for contacts, and those contacts tested and the appropriate quarantine measures taken. Consequently they were able to ‘flatten the curve’ very early, ~300 cases over the last 4 days (number of active cases declining), compared with the US, still in the exponential growth phase, with ~13,000 more cases in the same period.

        • South Korea did a good job, however, their task was not as difficult. The U.S. obviously has more routes of entry given much larger area and population.

          Had the Chinese not hidden this outbreak, the entire world would have been better off.

        • Importantly the number as a fraction of the population is about way less. Said another way, Korea as a fraction of the population saw it spread there more than 4 times more violently. We have way more people and it spread here way way less per capita. They tailed off and that is yet to be seen here since they got it earlier than the USA. They also used medicine that we are still testing that I think we should speed up, which I think we are.
          Look at the statistics I posted again.

        • re: ” how did Korea ramp up the tests so fast compared to us???”

          What so-called “testing” do you think they perform? This is _not_ like “CSI” where one swab from inside the mouth provides a suitable ‘sample’ for follow-on lab work (where the processing leads to an eventual ‘result’ used to make the diagnosis.)

        • Go Home March 20, 2020 at 8:14 pm
          You are omitting one important point. We got the test kits out as quick as the Germans.
          When the first “kit” which is for 800 tests was being tested in Washington it was found to be defective. All testing was stopped until new ones could be made. Normally the CDC does not have a problem with production runs.
          So did a lab worker make a mistake or was it more insidious .
          president Trump did not neglect to get the test kits made. The folks making the test kits had a “Boeing” moment.
          That should answer your question.

          https://www.reuters.com/article/us-china-health-test-kits/u-s-agency-investigating-production-of-faulty-coronavirus-test-kits-idUSKBN20P09Y

          • People often expect too much from diagnostic tests. They expect them to be infallible when they are not in the real world. We already know that China, which had a big head start on this, abandoned one testing protocol in favor of CT scans. Tests give false positive and false negative results.

            There was a problem with the first tests, at least, that the U.S. rolled out. There are questions about a death in South Korea even though the patient tested negative multiple times. Japan’s testing is being questioned with some asking whether there is an “Olympics” bias that leads to few cases being found.

            Death is less ambiguous. The low rate of death among German patients is raising suspicion that perhaps too many false positives are occurring, or perhaps the test is good but the actual severity of the illness is low. Hopefully, the latter is true.

            Back to China, this article that is in review, suggests a much lower infection fatality rate in Wuhan. https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v2

            The truth is between the extremes, somewhere. BTW, one more of the cruse ship passengers succumbed and there are now 8 total deaths from the Diamond Princess. He was a Canadian man in his 70’s.

          • If sabotage is possible, then AG Barr has an even fuller plate than last month. I’m willing to believe that some Trump haters would be willing to kill old people in order to torpedo his reelection.

        • GH, If you are claiming that the Korean government is responsible for the faster production of tests by Korean companies, then please detail how. You are the one making the claim. Support it.

        • Go Home uses mealy mouth words like “may”. Evidence does not support anything close to the trajectory in Italy here in the US. Not close. Evidently, you’re just not able to process information. You’re a waste of time.

          What trajectory are you writing about?
          Our mortality rate has been steadily dropping from about 3% early on (without reporting) to now just over 1%. I submit, that as more counting goes on it will fall far below 1%. Italy on the other hand has been between 8% and 10% which is alarmingly high. Again, we do not know how well the counting is being performed. But you are flat wrong based on any measure.

      • Another bottleneck is the people collecting the sample, I’m told this is slow process. I understand inow there are enough tests but getting the sample is time consuming due to safety protocol.

    • Most problems were due to regs and rules by Obama. Tests were only to be developed by CDC and Masks like the 95 could nor be used medically, and on and on.Not sure about director of CDC — though everyone wants a 100% guarantee he seems to be dragging his feet and quite reluctant to get things done

    • The Obama administration made the CDC the sole provider of viral test kits. But the CDC screwed the pooch and produced faulty kits. Trump rescinded the order, so that private enterprise could make more and valid kiits. That took time.

      He also had to overrule FDA regulations.

      The administrative deep state is to blame for the lack of and flaws in the early kits.

    • Go Home
      Might it be that the reason that the Asian countries have done a better job of getting testing kits produced quickly is because the western world has forsaken manufacturing for the advantage of cheaper products? That is, Asian countries have now become the world’s experts on rapidly meeting consumer demands.

  45. Rud – any thoughts on angeotensin II blockers (ARBs)?
    I take olmesartan-HZT to control hypertension (it does a very good job, at least in my case).

    I have seen claims that it could be protective, and claims that the effect could be the reverse.
    Since (as I understand it) they block the conversion of angiotensin I into angiotensin II I don’t see it having much effect on the ACE-2 receptors, other than leaving them “unoccupied”, so I could see a negative effect wrt covid-19 infection progression

  46. Original Post focus on the repurposing of the anti-malarial drug function reconfiguring the Wuhan virus’ enzyme receptor, thus allaying viral “docking” for cell entry, could use some context of the drug. For example chloroquine also modulates human immunological aspects; however my poor ability to parse immunology means I’ll only mention it.

    What is easier to convey is that chloroquine (& derivatives) allays our cellular process of auto-phagy; akin to cellular housekeeping, it performs interior functions & recycling. Inside cell stations (so to speak) called lyso-somes is where auto-phagy occurs & optimal functioning requires a lower pH than it’s internal cellular surroundings.

    As a lyso-some finishes up performing auto-phagy the recyclables it has are released. Viruses pirate recycled bits of membrane from lyso-some auto-phagy to incorporate those into the viral forms that the infected cell proliferated.

    Then the formation of the replicated virus is survivable outside that infected cell & can circulate within the human body. Thus, as a consequence of normal human auto-phagy the virus can move to other cells; but the anti-malarial drug chloroquine raises lyso-some pH – thereby inhibiting auto-phagy limiting what the virus needs in order to spread.

    • maybe True but then would we not expect chloroquine to work on many virus like Ebola and hiv ? Seems this drug may work because of something specific to this virus or this family of viruses.

      • Hi Stevek, – As I indicated, my comment was skipping immunological aspects. Since you asked about HIV see this research as a sample of the drug’s potential: (2010) “Chloroquine modulates HIv-1-induced plasmacytoid dendritic cell alpha-interferon: implication for T-cell activation”; free full text available on-line .

      • Clinical trials that have investigated chloroquine for anti-HIV/AIDS activity:
        https://clinicaltrials.gov/ct2/results?cond=HIV&term=chloroquine&cntry=&state=&city=&dist=

        Summary of a careful review of all of them is very simple: No benefit has ever been found after many trials and many years of looking for a benefit by numerous researchers.
        Unfortunately.
        Most studies were either terminated or did not even bother to post results.
        The ones that did made it very clear that no clincial benefit has been seen.

        Here is the same for hydroxychloroquine.
        Same result.
        The one that compared to aspirin showed little difference between the two.
        The others either did not even bother to complete the study or ended it and did not report results.
        Looking at these drugs vs every other virus or cancer they have been tested for activity against have failed to show a benefit, with the exception of the well known immunomodulating effect.
        But this immunomodulation can be found with many other drugs, many of which have a better safety profile.
        https://clinicaltrials.gov/ct2/show/NCT02475915?term=hydroxychloroquine&cond=HIV&draw=2&rank=3

  47. If I would have no conventional medical support (and even if I did, as additional treatment), I would place my bets on Elderberry (Sabucus Nigra) for its antiviral properties from anthocyanidins and other components it contains, see for example:

    https://www.naturalmedicinejournal.com/blog/elderberry%E2%80%99s-anti-viral-activity-update

    The most interesting paragraphs (imo) from the article:

    “While elderberry was shown to have inhibitory effect at all stages of influenza infection, it had a significantly stronger effect on the late-stage of infection than at early stage; smaller concentrations (higher dilutions) of elderberry had partial or no inhibitory effect during the early phase but those same concentrations had significant inhibitory effect during the late-phase of infection. Furthermore, the antiviral activity of elderberry on influenza was strongest when used in pre-treatment, during infection and post-infection, rather than when used solely during infection. The study confirmed that elderberry exerts its antiviral activity on influenza through a number of mechanisms of action, including suppressing the entry of the virus into cell, modulating the post-infectious phase, and preventing viral transmission to other cells.”

    “No human clinical trials have been published on the prevention of influenza with elderberry, however, black elderberry extract has previously been shown to inhibit human influenza A (H1N1) infection in vitro by binding to H1N1 virions, thereby blocking the ability of the viruses to infect host cells.2 The same study showed elderberry to be effective against 10 strains of influenza virus and compared its effectiveness favorably to the known anti-influenza activities of oseltamivir (Tamiflu) and amantadine.”

  48. “one of the 20 amino acid (only, in all life on Earth, proving a common genetic ancestor)” Or, proving a common Designer.

    • It’s impossible to “prove” a Designer, which is exactly how the Christian God would want it, otherwise faith would have no value.

      OTOH, the use of just 22 out of at least hundreds of amino acids, and almost all of the same chirality, is evidence of common descent.

      Descent is a scientific concept, since subject to conformation or falsification by testing predictions based upon the hypothesis. Design is a religious belief, incapable of such tests by experiment or observation.

      Behe’s “irreducible complexity” of structures such as bacterial flagella was shown false shortly after he proposed it. A scientist would have tried to find out how such structures evolved. Instead Behe acted like a theologian, leaving it for others to discover how flagella, for instance, evolved.

      • re: “It’s impossible to “prove” a Designer, which is exactly how the Christian God would want it, otherwise faith would have no value.”

        Picking and choosing select evidentiary material; Excluding events, claims made and recorded / documented in the NT?

        • Jim,

          Sorry, but I don’t get your point.

          If you think you have testable physical evidence for the existence of the NT God, that would be a major breakthrough after 2000 years of looking.

          The concept of God of course changes greatly during the course of the OT, from an anthropomorphic Being Who Personally builds the foundations of the immobile, flat Earth, makes people, talks to and strolls with them, sits on the edge of the world looking down at them, who appear as insects, walks on the firmament operating the levers of the storehouses of the rain and snow, to speaking only from storms and vegetation, finally to see Him is to die.

  49. Q1 is there any indication that elderly Coronavirus patients who are currently on RA medication having less impact from the virus?

    Q2 Here in Australia Diabetes is a bigger killer than hypertension. But it is the other way around in Italy. Is it possible that the “mix” of pre-exiting conditions of elderly Italians have just as important as their age?

  50. Lots of useful info on Wuhan flu in an article over at medium.com title is evidence over hysteria. Don’t know how to link it https:\medium.com\six-four-six-four. iirc

  51. Burning questions:
    After surviving a SARS COV 2 infection, is there a lasting immunity?
    How long does the immunity last?
    Is there permanent or lasting damage?

    • The answer to all three, for an individual, is “It depends.”

      Statistically, “Yes,” “For survivors, quite a while,” “Usually not.”

      I can’t give track odds for the population as a whole – not that I would apply track odds to myself. One can only predict history.

  52. I am posting to philincalifornia because that post would not allow me to respond.

    “commented on Hopeful: Summary of Wuhan #Coronavirus Therapies and Potential Cures.

    in response to mario lento:

    Good for you! That’s why a sample size of 1 is never enough data for true analysis… But whatever you’re doing, keep on doing it… and get sleep unless the pay off is worth it…”

    I saw what you did there ……

    I thought I was being cute/clever? Please expound sir!

      • Thank you Phil… I should have use a sarc/ or humor tag indeed! Humor is a sign of intellect… and that you and most on this site have.

  53. These are actually two closely related anti-malarials, hydroxychloroquine (the small French trial) and chloroquine phosphate (the larger Chinese trial). Both were developed in the 1950’s,
    There is a book, the fever tree which details how quinine from the bark of a tree high in the Andes somehow worked on malaria a protozoan found at low altitudes.
    Totally amazing.

    Since safety is well known (the main side affect is retinopathy [vision problems] in 25% of patients over 50 that resolves [slowly] after discontinuation), the main FDA legal issue (FDCA Act of 1906 as amended) issue is to determine dosing and duration for this new indication.
    I used Quinine on patients for many years as a treatment for leg cramps, then malaria risk travelers and then restless leg syndrome before the use in RA became known.
    As far as I was aware eye problems were rare not 25%, but maybe it is the synthetic drugs??
    Quinine is added to some soft drinks, tonic water.
    If the Quinine does not work I am sure the gin will help.

    Many thanks for the clear explanation Rudd

  54. It makes no sense to close businesses because people are just as likely and even more likely to catch COVID-19 in a grocery store as anywhere else. How many people touch the produce? No one has proposed closing grocery stores. The mall I go to has little more than 2 stores open, the grocery store and Walmart’s. Almost everything else is closed. Too many people going out of business with this shutdown. South Korea has been testing everybody and mandatory isolating individuals. The problem is that the false negatives are up to 40%. So if South Korea has the same tests I dont understand how they have been able to hold death rate to 1% about the same as Canada. The difference is that South Korea has not closed their economy down like we have. This is madness.

  55. A complication of the flu is most often bacterial pneumonia, which is treated with an antibiotic. Covid-19 causes viral pneumonia quickly.

  56. Quinoline derivatives such as natural quinine, quinidine, and synthetically produced chloroquine are well known for their use in the treatment of malaria. Chloroquine is the big pharma one for mass production reasons so this was the study drug. There is no reason to dismiss natural quinine. It may be more effective we don’t know. It certainly is used in cases where chloroquine has become ineffective due to resistance.

  57. If no antibodies form in the body, then no medicine will help. You need to focus on your own immunity.
    Slowly suck the zinc tablets and take high doses of vitamin C.

  58. In the case of infection, you need antioxidants that protect the heart. It’s best to take high doses of coenzyme Q10. This is particularly true for older people.

    • The race is on and all prior records will probably be beaten, but this is a long term process. On top of that, whatever vaccine is produced must accommodate mutations to be effective.

      https://nextstrain.org/ncov from yirgach on other thread

    • re: “Once the vaccine is developed, it will take at least 90 days to complete the regulatory process and potentially more to enter the marketplace.”

      NOT an inviolate ‘law of nature’ (the ’90 days to complete …’); some ‘countries’ aren’t so encumbered by a ‘regulatory hurdles’ of that kind …

  59. A can anyone explain the difference between this Whuhan corona virus and other corona viruses, all of which have been around a long time?

    • This differences might not be exclusive, but is important in Wuhan’s infectiousness. As you may know, coronaviruses are spherical, with knobby spikes which give the group its name.

      Wuhan (SARS-CoV-2) is closely related to the virus that caused the South China outbreak of severe acute respiratory syndrome (SARS) in 2002-03.

      In Wuhan virus, the “hook” part of the spike has evolved to target a receptor on the outside of human cells called ACE2, which is involved in blood pressure regulation. This makes the spike proteins effective at attaching to human cells.

    • Although some believe that Wuhan virus was engineered in the bioweapons lab there, rather than evolving naturally via bats and pangolins or other intermediary mammal.

      If it evolved without human intervention, then it remains to be seen whether the hook mutation occurred in the presumed pangolin or other mammalian intemediate host, or in a human.

      • From my limited investigation, the “hook” in SARS2 is not found in coronaviruses but is known to make other families of viruses more pathogenic.

        • It’s a newly observed mutation in the SARS group, but frequent mutation is SOP for RNA viruses. I don’t know whether the same or similar mutations have occurred in other coronaviruses, but given the vastness of time and frequency of mutations in such a small genome, I’d be surprised if it hadn’t happened before.

          I can’t rule out its having been engineered in a lab, but IMO odds are against it. The suggestion that it was transferred from another group of viruses, such as HIV retroviruses, IMO doesn’t hold water, since they don’t have spikes. More like bumps. And are retroviruses, which coronas aren’t, albeit RNA.

  60. You have to tell the truth. We don’t have a medicine that destroys the Covid-19 virus. You can only count on your antibodies. Take care of your immunity.

      • Ren is one of those people who say things because they do not understand slightly complex concepts.

        Ren: The drug enables Zn to enter cells, which drastically interrupts the virus RNA process, which drastically slows and stops new growth.

        This is not in contrast to the other thing called immune response, which is needed to combat the virus. Or to make it simple for you. That a drug can harm the virus in no way implies there is no need for an immune response.

        In conclusion: Your claim of a lie reveals your complete misunderstanding of simple things laid out for you. Further, when dumb people call smart people dumb, it’s actually quite revealing.

      • We know that there are antiviral drugs now, particularly for RNA viruses as they have to have enzymes that we lack and we can interfere with those enzymes. Also, we know how to interfere with the proteins that viruses use to bind to cells. This was the strategy for cleaning out HIV. Flood the body with chemicals that occupy the virus binding sites and they simply cannot reproduce and then be eliminated. It works quite well.

        Chloroquine, an antimalarial used for years, has been known to be effective against coronaviruses since 2005. We just have been unimaginative in applying it as a prophylactic or as a treatment.

        Do not be myopic. There is a lot out there you do not know. I am indeed learning every day.

        • “Chloroquine, an antimalarial used for years, has been known to be effective against coronaviruses since 2005.”

          If by “known to be”, you mean “thought by some researchers to possibly be”, I agree with you

          Of course, other researchers have shown that in animal models, the drug may help but only for the effect of acting as an anti inflammatory, and that it does not inhibit viral reproduction.
          Large numbers of people used the drug over many decades, all over the world.
          Many of those places have viral disease that are severe and endemic.
          Almost everyplace has occasional outbreaks of viral disease.
          Does it not seem odd that no one has ever shown that when people take chloroquine, they are immune to certain viral infections, or are cured of if they already have one?
          I find that odd.
          I am agnostic on whether and how much it will be shown to help, and when, and by how much, and if it is superior to other things that perform the various functions…inhibiting viral replication, modulating down immune response, acting as an anti-inflammatory, halting cytokine storm…even better that either chloroquine or hydroxychoroquine.

          Also this thought: There are closely related compounds for treating malaria that are preferred in most cases over chloroquine and hydroxychloroquine. Has anyone tried any of them?
          If they are better at treating malaria, and some are safer, might it not also be the case that they are better antivirals or anti-inflammatory drugs?

          Study data that contradicts an antiviral effect in animals for chloroquine:

          https://www.asbmb.org/asbmb-today/science/020620/could-an-old-malaria-drug-help-fight-the-new-coron
          Many more confirm this finding. Known? Not really.
          Suspected at best.

  61. “It was a Chinese study published on March 9 [2020] that first put the spotlight on this anti-malaria drug [[hydroxychloroquine] in the context of the current pandemic. Researchers at the University of Beijing demonstrated its effectiveness in an in vitro trial – that is to say, an experiment on cells in a laboratory.

    ‘Difficult’ to interpret results

    But when it comes to human trials, the picture is foggier. “Tests on human patients [except for malaria] have so far produced contrasting results that are difficult to interpret,” D’Alessandro observed.

    Hence the interest in Didier Raoult’s work in Marseille: he is the first scientist to have carried out trials with human patients that seem to have produced conclusive results. But there are still doubts: the precise data from the clinical trial have not yet been published in a scientific journal, and so have not yet been subject to peer review, noted MedScape, a specialist publication for healthcare professionals.

    Another reason for caution is that the trial was “only carried out on a few patients”, D’Alessandro emphasised. The Chinese study on March 9 was criticised by many in the scientific community because it was carried out on a group of “only” 100 patients – four times more than the experiment conducted in Marseille. The French government’s spokesperson highlighted this point, stressing the importance of carrying out trials on a larger scale before trying to reach conclusions on hydroxychloroquine’s effectiveness.”

    Just saying – in vitro tests and small sample sizes.

  62. Good grief! If we did not have a test for this specific virus, all of this illness and death would not even be a blip in the flu statistics and the same types of people, immunocompromised, hidden conditions, and elderly with complications, would be dying. The flu season is a salad of viruses moving around the world and we are probably not immunized against most of them at any given time, they are just not largely deadly viruses. We also cannot assume that a person does not have more than one virus at a time.

    Just because we can identify one virus, we are laser focused on it, while 100s of thousands (800+k worldwide) will die of other viruses this flu season. It makes no sense.

    If we panic about a single virus like this, why do we not panic about the flu season which takes more than 100-400 times more people very year? It makes no sense.

    If we lose 30–60k Americans every year and many of the serious victims are elderly and infirm and many of these end up on respirators near their end, why would we suddenly be short of respirators? Do not forget that respirators are freed up everyday as people either die or recover; there is turn over—the machines are not gone and are reassigned. Again, it makes not sense.

    Here in W. Virginia, it seems that we have already had this virus come through here, as in January and February quite a number of people had symptoms the same as this virus, but, as no one was testing for the virus at all here, it was just another flu episode. Since we do not have a test for antibodies against this virus, which would indicate if someone had it in the past, we have no way of detecting such people. We can only tell who has it now or not. We are basically looking through a pinhole at the world. An entire country does not have the virus, until you start testing for it and, even then, you only detect those who have it now and not those who did have it in the past. Wow. Myopic.

    Epidemiology is a great and useful study, but not when your tools are lacking or inadequate.

    Italy has an average flu death rate of 23k per year, compared to 30-60k in the US. However, Italy has 1/5th the population, which means their normal flu in the US would be 115k on average! If our average is 45k, this equivalent would be 225k a year in the US. Italy’s problem is not this virus, it is systemic to the country—lousy healthcare system, old population, lots of smokers, and gregarious social life. Italy is not an example of how virulent this little virus is, but it illuminates Italy itself.

    Our current lockdown strategy is great. Normal “flu” and this virus move in exactly the same manner and sequestering is a great way to stop this, along with good anti-flu habits. The virus, if it was an altered virus, might bind to cells more strongly, but then it progresses the same way it would without the binding alteration. Largely, it is simply easier to catch once it enters the body, all other things are normal.

    Sequestration has an added benefit. It will break the flu season if we do it right. As all flu-type viruses have a limited time course, something around a month should do it. We beat the Hong Kong flu in 1968 by suspending college for a month. It worked perfectly.

    • Charles Highley

      “Italy has an average flu death rate of 23k per year, compared to 30-60k in the US. ”

      Wrong, Sir. I don’t know about how Italy works, but it is known that US and Canada put pneumonia and flu in one and the same stat bag.

      In Germany this is not done; so flu stat is way lower.

      J.-P. D.

      • Bindidon
        You have touched on an important point. Not all countries use the same definitions for cause of death. That probably is a reason that Germany has such an apparent low rate from COVID-19. If someone is in ill health for one or more reasons, and succumbs after catching COVID-19, I have read that the German coroner is likely to attribute the death to the chronic condition rather than the immediate acute condition. Consider the situation where someone is terminally ill, as with cancer, and is only expected to live another month or two at most. If their partner actively intervenes to prevent further suffering, even to assist with suicide, in the US they will be charged with homicide. Thus, the legal system views the circumstances that immediately led to death, and not the comorbidities that contributed and would have led to the same result.

        I would be surprised to see evidence supporting your claim that the US considers bacterial pneumonia and viral flu to be equivalent for cause of death.

        • Clyde Spencer

          I searched weeks ago for such info and found it in CDC documents.
          Sorry: I won’t do the job again.

        • There are broad classifications of how mortality stats are reported.
          This does not mean that there are not separate stats on known cases of one or another particular cause of death.
          Mortality charts would be unreadable if every different disease had a line item.
          So mortality charts list “pneumonia and Influenza” as one stat.
          But look elsewhere, and you will find breakdowns of separate specific causes of such.
          Also, some stats listed by the CDC are estimates.
          The numbers of total annual flu deaths are estimated.
          A separate stat of confirmed flu deaths is far smaller…but they know that the confirmed numbers are only a fraction of the actual numbers, because some deaths are not confirmed by autopsy or post mortem testing.
          Many who die of flu do so at home and never see a doctor…they are people who are bedridden in nursing homes or in their own bed.

          Finally, “equivalent” is not the same thing as “lumped together on annual mortality charts”.

    • “If we panic about a single virus like this, why do we not panic about the flu season which takes more than 100-400 times more people very year? It makes no sense.”

      its not about the deaths over a year.
      currently 1 person is dying per hour in NY
      currently 1 person is dying per every 2 minutes in Italy

      Its the “Acceleration” not the rate over a long time.
      That acceleration will/has swamped hospitals.

      So rule number 1.

      Ignore anyone who talks about a yearly death rate of anything.

    • Charles,
      Do yourself a solid and do some reading before putting your reputation as a Thinker on the line by saying stuff like this:
      “The virus, if it was an altered virus, might bind to cells more strongly, but then it progresses the same way it would without the binding alteration. Largely, it is simply easier to catch once it enters the body, all other things are normal.”
      Along with what else you wrote, it seems you are out of your depth on this subject, and also that you are not keeping up with current events.
      Spain was mocking this virus too, just a little under two weeks ago.
      They are on a clear path to having the third largest amount of victims of any country in the world, and it seems it is due in large measure to their failure to recognize something never seen in our lifetime…but familiar to students of history.
      The pandemic is real, and it is not a particularly horrific one as merging infectious diseases go, but it is not just another cold or seasonal flu.
      If we had not taken the steps we did, our hospitals from coast to coast would be overstuffed with hordes of viral pneumonia patients left to die alone on cots in the hallways and basements, just like ones in some other places were, or are, or will be.
      And it is not for sure yet if we will have dodged such a bullet.
      After that part…people dying in hospital hallways alone due to an unprecedented influx of gravely ill people who require urgent supportive care, arriving so suddenly that their are simply no beds for them all, and not enough people to care for them all…after that comes the part we really want to avoid…dead people stacked up like cord wood outside the hospitals in all of our towns and cities.

      • Nicholas: I have been rethinking that this might have been an overreaction based on how it passed through me. When I was younger I ate a ton of candy (worked since I was 12 so could buy what I wanted)… and I had asthma allergies and got tonsillitis or strep throat, sinus infections, colds more than twice per year. I was most of my life. It would always lead to my lungs. I remember many times before I ever bought myself Primatene tablets, how often I was about to suffocate but did not want to complain any more about it at 10 years old and through my teens. I’d just try not to panic and breathe short shallow breaths and concentrated on not suffocating.

        Given that, when I recently got this virus, I had to use Alberterol up to a pair of puffs an hour for several hours and then every 2 to 3 to 4 hours for about 3 of the 5 days. I was almost ready to go to the clinic to get onto a nebulizer and ask for steroids to reduce swelling in my lungs. Anyway I made it through and it was not as bad as many other times for me.

        When at the clinic, I asked for a rescue inhaler because my back up supply was running low. The clinic had not thought to ask if I needed something to help me breathe.

        Do you think doctors are not offering rescue inhalers to get people through this virus? That would make a world of difference I think. The stuff is magic if you know when and how to use it.

  63. We also have the problem that the new “tests” for Covid-19 have never been tested for actually properly discriminating for the virus, which means either false positives or false negatives. And the results from different tests cannot be compared as a result.

    The original test version was a PCR test that is quite complex and conditional, which is why it took so much time to gain an answer. New tests have been popping up and some hospitals have claimed to have created their own tests. None of these tests, including the original, have been properly vetted and approved by the WHO for accuracy. We are designing local, state, and country policies on this?

    We need to step back and look at this. No tests in a country does not mean it has no cases–politically this translates in the claim of no cases, when not admitting to little or no testing. A lousy test used in a country, still not meaningful conclusion. And the world is assuming every country has these tests available for use and have been using them. No way. The lack of data from many countries probably came from them having no test kits to use. Instead of admitting to no testing, they just say no cases.

    We are looking at a completely inadequate situation for assessing the virus in any country. Just the rate of testing is an issue. Only the presenting? Only the sick? Only those critical? Random testing? All produce different results and all but the last produce horribly skewed results.

    • Charles

      Here’s a counter-argument from E.M. Smith – please read carefully:

      This Is NOT The Flu, Comparison To Flu Is Stupid

      We are only at the start of this pandemic. There is no immunity. We do not have proven vaccines available. It is rising exponentially. The death rate in actual practice in places with enough resolved cases for valid data is about 3.4% with good medical care, and up to 12% once the medical system is overwhelmed. Those not dead are often hospitalized for weeks to months and have significant lung damage.

      The Flu is at the end of season. We have many immune to flu, and we have vaccines for flu. The death rate is about 0.1%. Recovery generally does not require weeks on respirators nor result in permanent disability.

      Anyone attempting to equate the two is ignoring the time axis, the exponential math, the death rate differential, the damage, and more. They are not thinking.

      https://chiefio.wordpress.com/2020/03/20/20-march-2020-covid-19-usa-16000-cases-italy-4000-dead/

      I beseech you, in the bowels of Christ, think it possible that you may be mistaken.

      Oliver Cromwell, 1650.

  64. Charles your logic is solid. We’re destroying the globale conomy for a minor and I do mean minor change in normal winter death rates. Less than 1 %

  65. This is great news. But I will always maintain that keeping our personal immune systems in top shape should be a priority. A big issue is the lack of vitamin D in the winter. That alone weakens the immune system. We don’t get enough sunlight in the winter and we don’t supplement to make up the difference. Most of us, anyway. So that is the place to start.

    Talk to your physician to get the proper amount. Too much is bad for you. Then look into anti-oxidants and the bacteria-killing ability of zinc. All strengthen your immune system.

    • True.
      A, D, E, and K, vitamin groups are fat soluble, meaning excess will not be excreted but stored, and as a consequence these are very dangerous to take in excessive dosages.
      Max safe dosage for a normal adult is about 4,000 units/day.
      Those with a deficiency may need injections of as much as 60,000 units, often repeatedly.
      But this sort of amount for a person who is not deficient can be extremely hazardous, as it is well over the limit of toxicity.
      Also those large doses are delivered by intramuscular injection, while an oral dose of the same size can be absorbed into the blood over a short span of time…minutes to an hour, IIRC.
      Having a hundred times what your body needs will not help many people.
      It will not help anyone if one ignores other nutritional requirements.

    • The originally French article contains some errors. The estimate of 30,000 human genes is outdated. The best guess now for protein-coding sequences is 19,000 and could fall further.

      Also, while civets belong to Order Carnivora, they are omnivores or herbivores in diet. That’s why they eat coffee beans, which makes their scat so valuable.

  66. I see a number of people talking of boosting immunity. They should all read up on the 1918 flu. The 20 to 40 age group was hit hard. The cause is believed to be too robust immune response termed a cytokine storm.

    • There are at least three ideas regarding why that particular flu ant that particular time did what it did.
      Cytokine storm is one of them, and the one most are familiar with that know anything about it.
      But it is not the only theory, and there is no way to prove anything one way or the other.
      Having said that, it is the one that seems the most plausible to me….at least until one takes a deep dive into other ideas, and to criticisms of the CRS theory.

    • Because the virus is new, some people will experience a cytokine storm.
      Lower the pressure with fresh garlic. Suck zinc, take high doses of vitamin C and avoid infection.

  67. This headline post must have a warning hence I have repeated this post in a number of places:::

    “”The drug touted by the U.S. President Donald Trump as a possible line of treatment against the coronavirus comes with severe warnings in China and can kill in dosages as little as two grams,” the story began.
    “A Wuhan Institute of Virology study found that the drug can kill an adult just dosed at twice the daily amount recommended for treatment, which is one gram,” the story later noted.”

    Read the side effects here and be warned!!
    Side-effects
    Rare or very rare
    Cardiomyopathy; hallucination; hepatitis
    Frequency not known
    Abdominal pain; agranulocytosis; alopecia; anxiety; atrioventricular block; bone marrow disorders; confusion; corneal deposits; depression; diarrhoea; eye disorders; gastrointestinal disorder; headache; hearing impairment; hypoglycaemia; hypotension; insomnia; interstitial lung disease; movement disorders; myopathy; nausea; neuromyopathy; neutropenia; personality change; photosensitivity reaction; psychotic disorder; QT interval prolongation; seizure; severe cutaneous adverse reactions (SCARs); skin reactions; thrombocytopenia; tinnitus; tongue protrusion; vision disorders; vomiting
    Side-effects, further information
    Side-effects which occur at doses used in the prophylaxis or treatment of malaria are generally not serious.
    Overdose
    Chloroquine is very toxic in overdosage; overdosage is extremely hazardous and difficult to treat. Urgent advice from the National Poisons Information Service is essential. Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).
    https://bnf.nice.org.uk/drug/chloroquine.html#sideEffects

  68. I tried posting this a couple of times in this thread but it seems to have triggered a spam detector! So here it is just once:

    chloroquine is a safe drug if taken as directed but an overdose of 2x is deadly! It also has some pretty dire side effects:
    Chloroquine
    Side-effects
    Rare or very rare
    Cardiomyopathy; hallucination; hepatitis
    Frequency not known
    Abdominal pain; agranulocytosis; alopecia; anxiety; atrioventricular block; bone marrow disorders; confusion; corneal deposits; depression; diarrhoea; eye disorders; gastrointestinal disorder; headache; hearing impairment; hypoglycaemia; hypotension; insomnia; interstitial lung disease; movement disorders; myopathy; nausea; neuromyopathy; neutropenia; personality change; photosensitivity reaction; psychotic disorder; QT interval prolongation; seizure; severe cutaneous adverse reactions (SCARs); skin reactions; thrombocytopenia; tinnitus; tongue protrusion; vision disorders; vomiting
    Side-effects, further information
    Side-effects which occur at doses used in the prophylaxis or treatment of malaria are generally not serious.
    Overdose
    Chloroquine is very toxic in overdosage; overdosage is extremely hazardous and difficult to treat. Urgent advice from the National Poisons Information Service is essential. Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).
    https://bnf.nice.org.uk/interaction/chloroquine-2.html

    The antimalarial drug chloroquine is the most severe and frequent cause of poisoning in Africa’,2 and the Far East.3 The mortality rate in the published studies ranges between 10 and 30% and is amongst the highest in clinical toxi- c~logy.~ The high mortality rate in chloroquine poisoning is related to close dose-dependent toxicity and to rapid onset of severe cardiac symptoms.
    https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1990.tb14629.x

    • ghalfrunt
      From my personal experience, I think that we can add elevation of systolic blood pressure, almost immediately, to the long list. My rheumatologist said that I was atypical. However, that doesn’t mean that there won’t be others with the same sensitivity. That could be a concern to those who are already experiencing hypertension.

    • With a few exceptions, Notably from Clyde, I got zero traction and was even criticized for pointing this out last week.
      Right now at least one country has ER wards clogged with chloroquine overdose patients.
      I expect this to be more frequent over time at least for a while.
      Likely store shelves will be emptied of the drug and people who need it for RA, lupus, or malaria, will not be able to get it, and many will take it who do not need it, while many who need it will not have any.
      Safe is a very relative concept in medicine.
      Generally safe can also mean “fatal for some, dangerous for others, not dangerous when used exactly as directed for most”.

      • Nicholas McGinley
        this is why I tried posting throughout this thread but hit a spam filter!

        A warning needs to be in all headlines advocating this drug. Without knowledge it is not safe. What is the dosage rate for covid-19? is it the same as for malaria – weekly 2 tablets – or is it 2 tablets per day?
        and even what is the tablet active ingredient weight – it seems to vary?.
        Without knowledge this is potentially incurably fatal

    • Hydrochloroquine is as effective as Chloroquine when used against malaria with lower side effects so I suspect if effective then it will be what will be used.

  69. No new cases or deaths yesterday in Italy. No new cases but eleven in the UK. New cases and deaths in the US 2944 and 47, vs. 3,076 and 372 in Spain.

    Current deaths per million:

    Italy 79.8
    Spain 37.9
    UK 3.65
    RoK 2.03
    US 1.05

    • John Tillman

      “No new cases or deaths yesterday in Italy.”

      Is it so difficult to look at the right source on the right moment?

      https://www.worldometers.info/coronavirus/#countries

      Click on ‘Yesterday’, and sort the table by ‘New cases’ (two clicks on the column’s header):

      21.03.2020

      1. Italy: cases 53,578; new cases 6,557; deaths 4,825; new deaths 793
      2. USA: 24,207; 4,824; 302; 46

      and so on…

      Click on ‘Now’ (the best is around 0:00 GMT+0)

      22.03.2020

      1. USA: 32,356; 8,149; 414; 112
      2. Italy: 59,138; 5,560; 5,476; 651

      and so on…

      Death toll and especially cases per million are here secondary, because the major problem is not ‘How many will die?’.

      The major problem is ‘How quick will the hospitals in all smaller towns across the US become totally submerged by severe new cases?’, what is a much more relevant cause for… more and more deaths.

      You have ZERO idea of what happens in the hospitals in Italy, Spain, France… Medical staff there must decide whom they help and whom they can’t because there is not enough personnel for keeping them alive. A terrifying issue.

      I guess you won’t (want to) understand, because you usually know everything better. But… maybe others will.

      J.-P. D.

      • The data update daily. Day before yesterday there were in fact no new cases. Yesterday, there were.

        That site allows you to look at prior days. I suggest you do so before rather than after posting.

      • Go to the update for March 21. You’ll see no new cases or deaths in Italy for the prior day, the 20th.

        Maybe you didn’t look at the time of my comment, or perhaps you simply didn’t want to check. The site updates at midnight GMT daily.

  70. Three most recent polls on Trump’s handling of Wuhan virus pandemic:

    Poll Date Sample Approve Disapprove Spread

    Emerson 3/18 – 3/19 1100 RV 49 41 +8
    ABC/Ipsos 3/18 – 3/19 512 A 55 43 +12
    Axios-Harris 3/17 – 3/18 2019 A 56 44 +12

    RV: Registered Voters
    A: All Adults

    Average: +10.7

    Had been slightly negative before March 17.

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