Bob Ike’s blog

You’ve got to pay attention to a professor named Siddhartha. But this is Verma not Gautama

and he’s currently studying fluid dynamics at Florida Atlantic University.

In this video, he explains and demonstrates clearly what all this COVID particle transmission and control is all about. Notice that masks are all about protecting others from you, not you from others. So those nervous Nellies walking up my way as I walk down Broadway hill and stop to put on their masks are wasting their time.

It’s not long, and the images of particles being projected are pretty amazing.

I had a COVID test last week Thursday!  The real deal where they stick a test tube brush up your nose halfway to your brain and give it a good scrape.   I got hit so hard by some bug in the middle of the night Tuesday, I told enough to the triage nurse the next day to tick off enough items that she referred me to the COVID hotline nurse who got me an urgent appointment in COVID respiratory clinic.  The Nurse Practitioner who saw me thought I just had a strept throat, but did the swab anyway.  Weeks ago I had set up a Zoom get together for some of the Vicksburg High class of ’70 (46 emails on my list, 10-12 have been signing in).  I was feeling crappy enough that morning I had my doubts I’d be much of a participant.  I sent out an email to the 46 telling them this, and mentioning the COVID stuff.  I took my first penicillin later that afternoon and felt enough better by 7 PM to take part in the Zoom.  My friend and VHS classmate Jim Northam’s invite list – for the small party at his lake house he’s throwing instead of the 50^th reunion we were supposed to have the night before – looks a lot like my Zoom list.  Some intending to go to his party are sensitive about this communicable disease stuff.  One – Forrest – even emailed me (something he never does anymore) on Friday to ask about my test results.  I assured him that both the strept and COVID tests were negative.  I began to worry that perhaps some of the other guests might not be so forward with their concerns, but nevertheless uncomfortable with the situation.  For them, I constructed a placard with my COVID test results on one side and “CLEAN” in big letters on the other.  Forrest was not completely placated by my placard, sure that I was still going to give him whatever it was I’d had.

I’m all better, still with some penicillin to finish.  I was pretty limp Saturday afternoon after several hours in that withering July sun, but mercifully it got cooler by evening and I perked up.  One consequence of the illness was I went 48 hours with no alcohol other than some sips of wine while Zooming.  Bug had totally taken away my tasted for beer.  Some bug.  Think how thin I could get if I could isolate that active principle.  Happy to say I’ve totally recovered on that front.

The bioassay has been incubating for 6 days now, and there have been no positives.  All of Northam’s guests are as well now as before. So I wasn’t carrying some killer culture-negative superbug ready to wipe out my friends despite my sign, test results and penicillin.  That’s good.  These are all special friends.  The old ones are best.  So glad they’ll all get to grow a little older.

I’m taking the lazy way out today, letting some other writer tell you something I think you’d like to know. I’m still not good for much after some bug hit me so hard Monday night to tally up enough points to earn a COVID test, the up the nose with a test tube brush kind. But I feel so much better after just 2 of the penicillins the NP prescribed me for what she thought was a strept throat, I think the only COVID stat I’ll be adding to is “number tested”. I get my results later today.

Steve Hayward, a political writer not a physician or scientist, wrote today in Powerline about a study reported yesterday in Lancet in which the investigators scrutinized COVID stats from 50 countries, seeing how they relate to population demographics in those countries, and to the government policies in each country. I’ll let Mr. Hayward tell you the details, but 3 things that struck me were: 1) it hurts to be rich and fat (“ Increased mortality per million was significantly associated with higher obesity prevalence and per capita gross domestic product (GDP).“), 2) border closings and lockdowns did not have an effect of COVID mortality, and 3) smoking could be protective, which I’d written about before (https://wordpress.com/block-editor/post/theviewfromharbal.com/448). Of no surprise was their finding that recovery rate were better in countries with better health care systems.

Since many of our leaders are itching to do it all over again, maybe we should look at what we did the first time and not repeat our mistakes. The Lancet study is a start. https://www.powerlineblog.com/archives/2020/07/were-the-lockdowns-effective-at-all.php

For those of you who want to straight to the source, here ya go: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930208-X

With this pandemic you never know what the next piece of news will be, or what part of the world it will come from. Every once in a while it’s good news, and todays item is very much that. And we shouldn’t be surprised it originates from that little sliver of the Levant on the Mediterranean that houses a lot of the smartest people in the world. Thank God for Israel. The Israelis don’t claim all the credit for today’s feat. They had help from Mt. Sinai, the one in New York City.

Not that I can come close to getting into the head of a scientist at Hebrew U. or Mt. Sinai, let alone duplicate the workings there, but I think it went something like this:

1. coronavirus infected lungs accumulate fat
2. cells stoked with fat support more efficient replication of coronavirus
3. drugs exist to reduce fat accumulation
4. let’s do the experiment!

Despite what those emails you get say, there aren’t any drugs to keep you from putting on fat. But attempts to develop drugs that alter lipid (fat) metabolism have going on since cholesterol was declared a problem. Since 1976, when the Japanese biochemist Akira Endo of the Sankyo Company isolated a factor from the fungus Penicillium citrinum which he identified as a competitive inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMG-CoA reductase), we’ve had some pretty good drugs for this. Dr. Endo’s compound, which he named compactin or mevastatin, was the first statin to be administered to humans. It took 20 years to prove them safe and effective, and in 1996 Lipitor was released. The first cholesterol drug was clofibrate (Atromid-S), which increases the activity of extrahepatic lipoprotein lipase (LL), thereby increasing lipoprotein triglyceride lipolysis (fat breakdown!). Chylomicrons (the form fat takes to float around in your blood after you absorb it) are degraded, VLDLs (very low density lipoporotein, fat and protein complexes that can get into cells) are converted to LDLs (low density lipoprotein), and LDLs are converted to HDL (“good” cholesterol!). All the ‘DLs carry triglyceride (fat), but density goes up as triglycerides are pealed or eaten away. Where did it come from? Well, in 1954 J. Cottet of Paris reported that farm workers exposed to an insecticide which was sprayed from the air over fields in the region of Clermont-Ferrand in France became ill and were found to have remarkably low plasma cholesterol. This insecticide (phenyl ethyl acetic acid) had been developed by the agricultural division of Imperial Chemical Industries (ICI). A chemist in ICI, Jeff Thorp, recognized the potential of this substance and synthesized an analogue, chlorophenoxyisobutyrate (later called Atromid-S or clofibrate). Thorp contact Michael Oliver of the University of Edinburg to gauge his interest, which was substantial. A few years with rats, then with any normal folks hanging around he could cajole to get the dose right (no review boards in those days), then finally into clinical trials in 1964. The first big trial, conducted under the auspices of the World Health Organization, was a disappointment, with excess non-cardiac deaths and gallstones being problems. Although it never received FDA approval, clofibrate was the only cholesterol drug around in the 60s and early 70s. Other safer and more effective agents were developed and Atromid-S was taken off the market completely in 1978. Fenofibrate (TriCor) was developed by Groupe Fournier SA of France, patented in 1969, came into medical use in France in 1975, and was approved by the FDA in 2004. Its mechanism of action is basically the same as clofibrate’s. While its use to lower cholesterol has mainly been supplanted by the statins, there are some patients with high cholesterol whose main problem is with triglycerides. For them, TriCor is the drug of choice. It also lowers uric acid, and is used off-label in some difficult-to-control gout patients. I have prescribed it for that purpose myself. The problems with gallstones and excessive non-cardiac death have not emerged.

Funny how what goes around comes around. A chemical made to kill pests gives rise to a drug that lowers cholesterol mainly by breaking down fat which then shows it can break down the fat in lungs on which our biggest pest of the day is feeding, killing said pest! Take that Mr. Corona! We’re gonna get you one way or another!

https://www.jpost.com/health-science/hebrew-u-scientist-drug-could-eradicate-covid-19-from-lungs-in-days-635028

Oliver M.  The clofibrate saga: a retrospective commentary.  Br J Clin Pharmacol. 2012 Dec; 74(6): 907–10.

It always used to be ten, that being the length of the pole with which you wouldn’t want to touch the ugly girl in school.  But ever since the CDC started making announcements in February about what we need to do to protect ourselves from COVID-19, it’s been six feet we’re to be kept apart, 2 good arm’s lengths of a pretty tall person.  WHO, lording over the rest of the world, mandates only 3 feet of separation (a meter, 39.37 inches, actually).  But where are they getting this stuff?  Well, it turns out they’re not totally making this up.

The obvious notion that respiratory illness is spread by droplets containing the bug emitted by the infected person dates to an 1897 report by Carl Flügge, a German bacteriologist and hygienist.  Engineer William Wells of Harvard reported in 1934 on the travel of droplets containing the most important respiratory pathogen of that day, tuberculosis. He used a very simple calculation to conclude that large droplets travelled about 3 feet but no more than 6 feet before falling to the ground.  He also discovered that small droplets were too light to succumb to gravity so could travel even further.  This informed the WHO’s guidelines.  The CDC leaned on more recent research, conducted after the 2003 SARS outbreak (COVID-19’s full name is “SARS-CoV-2”; it’s a very closely related coronavirus).  16 investigators coordinated by the CDC, but flung as far as Singapore, Taiwan, China and Thailand, looked at passengers who had acquired SARS on 3 long distance flights carrying known infected patients (https://www.nejm.org/doi/full/10.1056/nejmoa031349).  One flight carrying 315 passengers from Hong Kong to Taipei contained one passenger who only got sick later and did not infect anyone else.  In a flight from Hong Kong to Beijing, surprise, it was riskier to sit close to a SARS patient, with 8 of the 23 passengers who were seated in the same row as the patient or in the three rows in front of him becoming infected, as compared with 10 of the 88 passengers who were seated elsewhere (relative risk, 3.1; 95 percent confidence interval, 1.4 to 6.9). It is notable that 56 percent of the passengers who became infected were not seated in the same row as the index patient or in the three rows in front of him.  Of course, there’s no better place to promulgate an airborne infection than the cabin of an airplane with its pressurized non-circulated air. In a flight that followed from Hong Kong to Taipei, 4 of the infected passengers from the previous flight were among the 246 aboard.  Of 166 later interviewed, only one got sick (fever and cough) but tested negative for SARS. But there’s your 6 foot rule.

Dr. Bourouiba of The Fluid Dynamics of Disease Transmission Laboratory at MIT found that a good cough or sneeze can propel droplets as far as 23-27 feet (https://jamanetwork.com/journals/jama/fullarticle/2763852).  Yikes!  And that cloud can stay airborne for quite a while, even wending its way through air circulation systems.  More reason to get outdoors as much as possible.

Just last month, 6 authors on behalf of the COVID-19 Systematic Urgent Review Group Effort (SURGE) published in Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext) “Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and metanalysis”.  They identified 172 observational studies across 16 countries and six continents. Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m; protection was increased as distance was lengthened.  Face mask use could result in a large reduction in risk of infection, with stronger associations with N95 or similar respirators compared with disposable surgical masks. Eye protection also was associated with less infection.

So, yep, getting farther away and putting up barriers seems to help protect.  But only this guy is really safe:

Sad state.  Me, I’m for as many to get infected as soon as possible to build up that herd immunity.  In the meantime, let me propose a couple of theme songs for this issue:

It’s a cliché by now, but stay safe.

Anthony Stephan Fauci, M.D., Head of the National Institutes for Allergy and Infectious Diseases (NIAID), is a hero to many. Not me. But once upon a time he was. Just as I was entering Rheumatology (’82), Fauci had been publishing the results of his breakthrough treatment of the rare, sexy, and serious rheumatic disease polyarteritis nodosa. In affected patients, medium sized arteries, like the coronaries that supply the heart or the renals that feed the kidney, would become inflamed, often block up, and sometimes rupture, with sheer misery from the ongoing systemic inflammatory response followed by organ failure and death all too commonly. Corticosteroids could dampen the inflammation, but the doses needed were so massive as to leave the patient wracked with the complications of steroid excess: profound weight gain, weakened muscle, bones and skin, diabetes, hypertension, and susceptibility to infection. Fauci added an old chemotherapy poison – cyclophosphamide (Cytoxan), derived from mustard gas (yes, think WWI) – which knocked back the blood vessel inflammation much more effectively. Docs had been doing this now and then for 2 decades, but Fauci had the patients and organization of the NIH behind him, culminating in a nice New England Journal paper (N Engl J Med 301:235–238, 1979 https://www-nejm-org.proxy.lib.umich.edu/doi/full/10.1056/NEJM197908023010503). The “Fauci regimen” is still used for vasculitis, although some newer biologics, like rituximab, have begun to replace it. Many articles followed and there was a slim book with coauthor Thomas R. Cupps that became the bible for treating vasculitis.

I’ve never met Dr. Fauci, but I must have heard him speak. He used to be everywhere in rheumatology. But my friend Deb from Barnes has. She’s 4 years behind me so we never overlapped as house officers. As a 4th year medical student from Louisville, she rotated for a month at the NIH. Dr. Fauci was her main attending. Deb found him to be an excellent teacher, but was “intimidated by his intellect”. Deb towered over him (she’s 5’10” to his barely 5’7″), and couldn’t help but notice how he was turned out sartorially. In the NIH of the early 80s, everyone “dressed like janitors”, except for Deb’s attending. He showed up to work every day in a fresh 3 piece suit, his Phi Beta Kappa key on proud display. I guess dressing for success worked, as not long after that he left the world of vasculitis and jumped on the AIDS bandwagon. Immunosuppression – doing it and dealing with the complications – was what he was all about anyway, so why not look at it from the virus’ point of view? He quickly was placed at the top of his new institute – NIAID, funded for 2020 to the tune of $5.89 billion – and is into his fourth decade on the job. His training and experience is in immunology not infectious diseases, although he certainly bumped up against viruses in his time with AIDS. I wish they would trot out his boss – the esteemed future Nobel Prize winner and head of the NIH Francis Collins, once of U of M and a serious, devout and thoughtful doctor.

Once of my favorite writers – Victor Davis Hanson of Stanford’s Hoover Institute – has a piece today that begins with his take on Dr. Fauci. The whole piece also gets into presidential politics and racial issues (https://amgreatness.com/2020/07/05/an-industry-of-untruth), but I paste in below just the section on Dr. Fauci and coronavirus.

Viral confusion

Unfortunately few in authority have been more wrong, and yet more self-righteously wrong, than the esteemed Dr. Anthony Fauci. Given his long service as the director of the National Institute of Allergy and Infectious Diseases and his stature during the AIDS crisis, he has rightly been held up by the media as the gold standard of coronavirus information. The media has constructed Fauci as a constant corrective of Trump’s supposed “lies” about the utility of travel bans, analogies with a bad flu year, and logical endorsement of hydroxychloroquine as a “what do you have to lose” possible therapy.

But the omnipresent Fauci himself unfortunately has now lost credibility. The reason is that he has offered authoritative advice about facts, which either were not known or could not have been known at the time of his declarations.

Since January, Fauci has variously advised the nation both that the coronavirus probably was unlikely to cause a major health crisis in the United States and later that it might yet kill 240,000 Americans. In January, he praised China for its transparent handling of the coronavirus epidemic, not much later he conceded that perhaps they’d done a poor job of that. He has cautioned that the virus both poses low risks and, later, high risks, for Americans. Wearing masks, Fauci warned, was both of little utility and yet, later, essential. Hydroxychloroquine, he huffed, had little utility; when studies showed that it did, he still has kept mostly silent.

At various times, he emphasized that social distancing and avoiding optional activities were mandatory, but earlier that blind dating and going on cruise ships were permissible. Fauci weighed in on the inadvisability of restarting businesses prematurely, but he has displayed less certainty hedged about the millions of demonstrators and rioters in the streets for a month violating quarantines. The point is not that he is human like all of us, but that in each of these cases he asserted such contradictions with near-divine certainty—and further confused the public in extremis.

In terms of how the United States “fared,” it is simply untrue that Europe embraced superior social policies in containing the virus. The only somewhat reliable assessments of viral lethality are population numbers and deaths by COVID-19, although the latter is often in dispute.

By such rubrics, the United States, so far, has fared better than most of the major European countries—France, Italy, the United Kingdom, Spain, Sweden, and Belgium—in terms of deaths per million. Germany is the one major exception. But if blame is to be allotted to public officials for the United States having a higher fatality rate than Germany, then the cause is most likely governors of high-death, Eastern Seaboard states—New York, New Jersey, Massachusetts, and Connecticut in particular. They either sent the infected into rest homes, or did not early on ensure that their mass transit systems were sanitized daily as well as practicing social distancing.

New York Governor Andrew Cuomo, more than any other regional or national leader, is culpable for decisions that doomed thousands of elderly patients. He did not just suggest long-term-care facilities receive active COVID-19 patients, but ordered them to take them—knowing at the time that the disease in its lethal manifestations targeted the elderly, infirm, and bedridden.

Then in shameful fashion, after thousands died, Cuomo claimed that either the facilities themselves or Donald Trump were responsible for the deaths. In truth, in the United States, the coronavirus is largely a fatal disease in two senses: the vulnerable in just four states on the Eastern Seaboard that account for about 12 percent of the nation’s population but close to half of its total COVID-19 fatalities, and/or patients in rest homes or those over 65 years old with comorbidities.

Why are there currently spikes in cases among young people in warmer states and those of less population density in late June? No one is certain. But one likely reason is that millions of protestors for nearly a month crammed the nation’s cities, suburbs, and towns, shouting and screaming without masks, violating social distancing, and often without observant hand washing and sanitizing—most often with official exemption or media and political approval.

The period of exposure and incubation is over, and the resulting new cases—for the most part asymptomatic and clustered among the young—are thus no surprise. Still,  what is inconvenient is the rise in these cases—given that the Left either had claimed its mass demonstrations would not spread the disease, or, if they would, the resulting contagion was an affordable price to pay for the cry of the heart protests.

Perhaps, but the real cost of four weeks of protesting, rioting, and looting was to undermine the authority of state officials to enforce blatant violations of the quarantine. Obviously, if some can march with impunity in phalanxes of screaming, shoulder-to-shoulder protestors, while others are jailed as individuals trying to restart a business, then the state has lost its credibility with people and they will simply ignore further edicts as they see fit. Now what adjudicates quarantines are the people’s own calibrations of their own safety.

Mismanagement of the virus? There have been four disastrous official policy decisions: sending patients into rest homes; allowing millions en masse for political reasons to violate state mandates on masks and social distancing; retroactively attempting to reissue quarantine standards that their advocates and authors had themselves earlier de facto destroyed; and consistently issuing pandemic alerts solely on the flawed basis of new positive cases, without distinguishing those who were asymptomatic, or who were infected and recovered without ever being tested, or who were asymptomatic and tested positive for antibodies, or who were only briefly ill, recovered, and by no means still a case-patient.

Sorry if I seem to be getting lazy by just posting other’s articles. I’ve posted several times about Plaquenil and Mr. Corona. Me, if I were on the front lines, I’d be taking it just like President Trump is. But this study, conducted by our neighbors at Henry Ford in Detroit, didn’t focus on that aspect. What is it that people have against old, cheap, available and safe?

https://justthenews.com/politics-policy/coronavirus/trump-touted-covid-19-drug-hydroxychloroquine-works-according-new-study

Those whining lupoids and rheumatoids are just going to have to share. We’ve got a life-and-death pandemic here. Plus cook up those vats, Sanofi-Aventis, Covis and Concordia!