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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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!
Good news, smoking among Italians is in decline, though males are about twice as likely to be smokers.
https://www.sciencedirect.com/science/article/pii/S0954611106001259
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’ …)
-Jim,
‘Celia denier’? Ugh…. Beyond irrelevant.
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?
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.
Here are the latest numbers (infected and dead) available for Friday 20th March from the UK
http://www.vukcevic.co.uk/UK-COVID-19.htm
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?
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.
How about putting some R&D into making these a reality?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673452/
A large magnetron over the doorway of every airport, trainstation, and hospital that shatters viruses in air and on surfaces. Sounds like science fiction, but so did the technology we have today to people living not long ago.
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.
Phil
Zinc gluconate to be precise. I have found it useful to quickly knock a sore throat.
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.
Least of all can we trust Chinese and Russian “data”.
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.
Mario: How did you know you were infected???
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.
Andy
+1
“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.
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.
U instead of T in RNA.
No apology needed. A minor correction in an otherwise damn fine article!
And adenine is the nucleotide itself.
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:.
Rud Istvan, thank you for this essay.
Chloroquine seems to be a good investment lol
Novartis To Donate Up To 130 Million Doses Of Hydroxychloroquine To Treat Covid-19
https://uk.mobile.reuters.com/article/amp/idUKFWN2BD1BP?__twitter_impression=true
Some doctor/reseracher yesterday claimed a virus killer drug within two weeks
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.
Thanks Rud.
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.
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.
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.
Good explanation of the possible mechanism for Chloroquine here: https://www.youtube.com/watch?v=vE4_LsftNKM
Rid
Firstly thank you for the essay.
Secondly, is there any evidence that elderly currently on RA medication are less impacted by the virus?
Sorry RUD
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/
The humans good IV vitamin C. The mice seem to of been given oral vitamin C.
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).
Yup. apologies with NO sequelae posted above.
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. .
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.
Yup: I was pretty thoughtless wrt to the size of the wavelength.
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.)
I remember when people referred to Win NT as “not there yet”
Feedback was good!
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.
My car came with a solar powered UV sterilization feature.
I drive a convertible…
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.
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
So Rud ignored whatever fake cure you are pushing, therefore his analysis is shallow.
“p < 0.05″. Sheesh! I dearly miss edit…
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.
Thank you for your updaties. I enjoy your writing.
Is it relevant that bromo-quinine was punted in the time of the Spanish flu:
https://quod.lib.umich.edu/cgi/t/text/idx/f/flu/4640flu.0005.464/2/–flu-action-postponed-ban-lifting-seems-sure?page=root;size=150;view=image;q1=California+Liberty+Fair
Why bromo-quinine rather than chloroquine?
Maybe because chloroquine was discovered in 1934?
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.
I hear that the Germans are now panic buying sausage and cheese.
It’s the Wurst Kase scenario…..
You forgot loo paper 😀
It’s out since days 😀
When ever you come into a shop or market, empty, nada,
Dodgy,
Niiiice!
I hear the toilet paper manufacturers are really cleaning up….
Thank you! I’ll be here all week…..
You know that the situation is getting serious when the Brits start making jokes…..
Sehr, sehr gut!
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.
I have no need to insult you – you did a bang-up job yourself by so proudly displaying your abysmal ignorance of the US healthcare system.
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.)
Like other socialists, Mr. B only cares about how much he has to pay.
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.
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.
John Tillman
Sorry, Sir: You don’t understand the health care system as such.
Standard argument of one who has no arguments.
Everyone who disagrees with you just doesn’t know as much as you do.
This schtick of yours is getting tiresome.
na ja besserwisser . . .
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.
US Lend Lease shipments to USSR began in August 1941, two months after Hitler invaded.
https://www.rbth.com/defence/2016/03/14/lend-lease-how-american-supplies-aided-the-ussr-in-its-darkest-hour_575559
US aid was critical to Soviet success.
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