Pundita

Wednesday, April 15

Are Americans getting too fat?

Tuesday, April 14

Covid-19 can also affect the brain

The following is a very important report today from The Wall Street Journal. The biggest takeaway is that people must start looking beyond the standard list of symptoms to spot whether they've been infected by the virus. Are the neurological symptoms found in a significant number of cases caused by the virus itself, or touched off by the body's response to the virus? Not known at this point.

"When this virus first came out, the general feeling was that there wasn’t much in the way of neurological manifestations. This was a pulmonary process.”

Coronavirus Ravages the Lungs. It Also Affects the Brain.
By Daniela Hernandez
April 14, 2020 4:28 pm ET
The Wall Street Journal

As Covid-19 cases mount, doctors are seeing patients who are experiencing symptoms like seizures, hallucinations and loss of smell and taste.

A patient in Japan had seizures. An airline worker ended up in a Detroit hospital, where doctors diagnosed her with a rare form of brain damage. Others reported auditory and visual hallucinations or losing their sense of smell and taste.

What they share: presumed or confirmed coronavirus infections.

As the number of confirmed Covid-19 cases worldwide reaches 2 million, clinicians are realizing the disease doesn’t just ravage the lungs and hurt the heart. It also can, in a significant proportion of cases, affect the nervous system in myriad little-understood ways.

Through a growing number of papers, doctors around the globe are chronicling Covid-19’s lesser-known neurological manifestations including brain inflammation, hallucinations, seizures, cognitive deficits and loss of smell and taste. It is unknown whether these are caused directly by the virus infiltrating the nervous system, or by the body’s immune response to infection.

The hope is these reports could speed up diagnosis. Some patients say they were going out in public, potentially exposing others, due to lack of awareness of these symptoms. The reports could also open avenues of research that elucidate whether the virus gets into the brain, how long neurological symptoms might persist, and whether a full recovery can be expected.

In late March, while keeping quarantine, Dwantrina Russell noticed she couldn’t smell the bleach she was using to sanitize her Houston bathroom. Since then, most of the 47-year-old business owner’s symptoms of Covid-19, including fever and a violent cough, have receded. But she said she can only smell things like cleaning products or food if they are close by.

The range of effects could take decades to play out. Some epidemiological studies and lab experiments with other viruses suggest severe infections could set in motion molecular events that might increase the risk of developing neurodegenerative disorders, like Alzheimer’s or Parkinson’s, many years later. The links are a matter of debate among neurologists and neuroscientists.

Last Friday, Chinese doctors published a study of 214 hospitalized patients in Wuhan showing that more than a third had neurologic symptoms. The most common included dizziness, headaches, impaired consciousness, skeletal-muscle injury and loss of smell and taste. The paper—published in the Journal of the American Medical Association and the largest to date on the disease’s impact on normal nervous-system function—also documented rare, but more serious, effects including seizures and stroke, which occurs when a blood clot hits the brain.

“When this virus first came out, the general feeling was that there wasn’t much in the way of neurological manifestations. This was a pulmonary process,” said S. Andrew Josephson, chair of neurology at the University of California, San Francisco. “This article should open up everyone’s eyes that this disorder affects the brain as well.”

The novel coronavirus, called SARS-CoV-2, isn’t the only virus known to affect the nervous system. Research in humans and animals has shown that non-coronaviruses such as HIV, measles and certain influenza strains can infect the brain or affect its function through inflammatory responses elsewhere in the body. Laboratory studies have shown that other coronaviruses can infect nerve cells.

Some neurologists hypothesize, based on results from animal studies, that the sometimes fatal breathing problems seen in severe Covid-19 cases might be in part due to direct infection and subsequent malfunction of the brainstem, which is involved in coordinating breathing.

“We are certainly on a learning curve in terms of understanding what the neurological manifestations would be” of SARS-CoV-2 infection, said Florian Thomas, chair of neurology at Hackensack University Medical Center in New Jersey.

On April 4, Cobain Schofield, a 25-year-old lighting technician based in Liverpool, said he realized that he couldn’t smell a pungent brand of garlic bread he likes. He consulted government-run health sites, but these didn’t list anosmia, the medical term for the condition, as a Covid-19 symptom, so he figured he was coronavirus-free.

Days later, he developed in his nose a “burning sensation while breathing,” he said, and a nurse at a nearby clinic told him several patients with confirmed Covid-19 diagnoses also had anosmia. He has been in quarantine since.

“Knowing now that I could have been spreading it, it’s quite a horrible feeling,” he said, adding that he had probably been experiencing anosmia for days before he noticed.

Whether a coronavirus infection affects the ability of receptors in the nasal cavity to detect odorants or the nerves that shuttle the odor-containing signals to the brain is unknown. Loss of smell and taste are common during other respiratory infections. (Much of what humans perceive as taste is related to smell.)

n the U.S. and elsewhere, policy makers and public-health officials have asked patients to avoid going to the hospital unless suspected Covid-19 symptoms like fever and cough don’t improve, or if they have trouble breathing. Critical-care neurologists said the messaging should expand to make patients more aware of brain-related symptoms.

Symptoms like confusion, trouble speaking or numbness on one side of the body should also be red flags. Those symptoms can signal an impending stroke, which, if not treated within a certain time window, can lead to permanent brain damage, they said. Covid-19 patients are at higher risk of stroke due to the virus’s impact on blood clotting.

For already hospitalized patients, doctors are running standard neurological exams that include low-tech tests like asking patients to follow simple commands, in conjunction with more high-tech diagnostics like brain imaging as needed, neurologists said.

Northwell Health, a health-care system in New York, plans to soon start using portable MRIs to monitor the brains of very sick patients, some of whom are sedated and on ventilators, according to Richard Temes, Northwell’s director of neurocritical care.

The hospital system is also using another type of brain-monitoring test, known as an electroencephalogram, to ensure patients aren’t having silent seizures, he said. Catching problems early increases the chances that patients’ brains can fully recover.

“As we fight this illness, we’re saving the lungs. We’re saving the heart and we’re saving the kidneys. But the brain is who we are,” said Dr. Temes.

[END REPORT]

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"How much of the coronavirus does it take to make you sick? The science, explained"

By Alex Hogan
April 14, 2020
STAT

Infectious respiratory diseases spread when a healthy person comes in contact with virus particles expelled by someone who is sick — usually through a cough or sneeze. The amount of particles a person is exposed to can affect how likely they are to become infected and, once infected, how severe the symptoms become.

The amount of virus necessary to make a person sick is called the infectious dose. Viruses with low infectious doses are especially contagious in populations without significant immunity.

The minimum infectious dose of SARS-CoV-2, the virus that causes Covid-19, is unknown so far, but researchers suspect it is low. “The virus is spread through very, very casual interpersonal contact,” W. David Hardy, a professor of infectious disease at Johns Hopkins University School of Medicine, told STAT.

A high infectious dose may lead to a higher viral load, which can impact the severity of Covid-19 symptoms.

Viral load is a measure of virus particles. It is the amount of virus present once a person has been infected and the virus has had time to replicate in their cells. With most viruses, higher viral loads are associated with worse outcomes.

“The more viral particles that get into the lungs, the more damage to the lungs that is probably happening,” said Hardy.

One study of Covid-19 patients in China found that those with more severe symptoms tended to have higher viral loads.

“It’s not proven, but it would make sense that higher inoculating doses will lead to higher viral loads, and higher viral loads would translate into more pathogenic clinical courses,” said Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center.

People with higher viral loads may also shed more whole viruses, which makes them more contagious, compounding the danger of spreading disease more widely.

If exposure to higher doses, or even frequent low doses, of SARS-CoV-2 does lead to worse health outcomes, there are significant implications for health care workers who are routinely exposed to Covid-19 patients.

“Someone caring for large numbers of patients on the wards, if they’re not wearing PPE [personal protective equipment], there might be a high frequency of exposure as well as a high dose of exposure,” Barouch said.

In Italy, a country particularly hard-hit by the virus, about 9% of reported cases were health care workers. Here in the U.S., 10% of Covid-19 cases in California were health care workers, according to the California Department of Public Health.

[END REPORT]

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Sunday, April 12

Italians should have done for Easter what the Mormon Tabernacle Choir did

Pundita, can we please not fight on Easter Sunday? Well it's too late now. I got so depressed seeing Andrea Bocelli singing all alone on Easter in that vast empty cathedral, I couldn't finish watching.

Okay, there was an organist to keep him company. But why couldn't Milan's city fathers have taken inspiration from the Italians who sung from their balconies during the Covid lockdown and the Mormon Tabernacle Choir's great use of the 'virtual' choir?

Now here's the way to sing in celebration of Easter! A three hundred-strong choir joined by two thousand people from all over the world singing their parts individually into their computers, and it all gets joined together by tech wizards for the most incredible rendition of Handel's Alleluia! Chorus I've ever witnessed. When the screens start lighting up behind the in-house choir -- I have no words.

Virus be darned, lockdowns be darned! The Italians who sang from their balconies showed we can't be stopped from singing!

Happy Easter, everyone!

*******

Easter Dance and Singalong

Saturday, April 11

Bravo Jerome Adams!

U.S. Surgeon General Jerome Adams is under fire from America's speech police for his use of slang they consider offensive to the 'black community' while he warned blacks and other minorities to quit smoking, drinking alcohol, and taking drugs.

I think the real reason they jumped on Adams is that he's a Trump pick for surgeon general post. And the booze, cigarette, and dope lobbies are surely outraged that such a high-visibility black is encouraging other blacks to cut loose those substances. I remember what it took to get alcohol and cigarette advertising billboards out of America's inner cities. Those ads were fiendishly clever. Designed to convey the idea to the poorest blacks that with Johnnie Walker Black scotch and Newport cigarettes they could still be part of mainstream America.

But let the speech police rant. Hat's off to Adams for his strong message, and his showing of the inhaler he always carries in case he gets an asthma attack.

The Daily Mail report on the kerfuffle has video of his speech. Worth watching.

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Friday, April 10

Thursday, April 9

Drudge top of page headline links 5:40 pm ET April 9

Drudge Report New York daily death toll reaches third-straight record at 799... Inside the Epicenter... Outbreak Aboard Second Navy Carrier... Virus traces found in wastewater at high levels... DC mayor: All shoppers at grocery stores must wear masks... Major Meat Processors Shutting Down Plants Nationwide As Employees Get Sick... After Violent Night, Chicago Mayor Puts Curfew On Liquor Sales... Prison riot in Washington state... UK lockdown indefinitely... Trump Rips WALL STREET JOURNAL as 'Fake News' For Criticizing Press Briefings... White House to require coronavirus tests for journalists... How single cough spreads across supermarket... Video shows particles from runners can infect you... Immune system gone haywire doing more damage than covid itself? More and more testing positive AGAIN... Most New York Cases Came From Europe, Genomes Show... Federal stocks of protective equipment nearly depleted... Mnuchin says could be 'open for business' in May... 16.8 million Americans thrown out of work as toll rises... Fed Chair Powell says U.S. economy deteriorating with alarming speed... Pumps Another $2.3 Trillion... Why relief to small businesses has lagged... Crisis Legacy: Mountains of Debt...
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More from the physician re severe immune system reactions to COVID-19

My email exchanges with a physician I've known for a quarter century were touched off when I asked for her opinion about my 4/7 post titled The worst COVID-19 symptoms remind me of severe allergic reaction. My remarks did not go over well with her as you can see from an update to the post.

Today, after digesting the physician's comments, I conceded on this blog that I had made a couple gaffes, but after politely eating crow I posted a 4/9 Wall Street Journal report "Haywire Immune Response Eyed In Coronavirus Deaths, Treatment," which I thought tended to shore my argument, and sent it to the physician. Below is her response, prefaced by additional remarks she'd sent on April 8 in response to my first post.

"People with severe allergic reactions tend to have cardiovascular collapse rather than the kind of respiratory issues seen in Covid. They may both need to be on a ventilator, but if that is the case in the short term it doesn't matter why specifically they need a ventilator. Prior to getting on a ventilator you need to be unable to oxygenate your lungs on your own with all medical interventions failing."

[In response to the WSJ report]

"Yes but it is the virus that causes the hyperactive immune response. On death certificates they never want doctors to put respiratory arrest because everyone who dies has a respiratory arrest. If the person did not get infected by Covid, they would not find themselves eating dinner and suddenly have a "hyperactive immune response" and drop dead. They die of ARDS (adult respiratory distress syndrome) cause multi-organ system failure, but basically they die of Covid. This is ridiculous hair-splitting in my humble opinion."

All right. First, I think a little more crow-eating is in order given that cardiovascular collapse is not the same as respiratory failure. So while the symptoms of a severe allergic reaction and a severe reaction to Covid are on the face of it strikingly similar (see my 4/7 post for comparisons), it would be stretching the definition of an allergic reaction out of shape to consider it the same as a reaction to Covid or even similar.

This doesn't mean the medical description of a severe allergic reaction couldn't be revised to include the kind of respiratory issues found in extreme immune responses to Covid. But right now the point is useless; it would be a long march for scientists before they could prove or disprove it.

So at the moment, it looks as if my argument is in tatters; however, I see a way to salvage a few scraps. But now I have to get ready to go grocery shopping, a task in Covid Lockdown Washington, DC that is now as close to living in Stalinist Russia as I'd ever want to get.

So, tomorrow or late tonight will be the next post. Until then, stay safe Pundita this is not the time for sarcasm.

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"Haywire Immune Response Eyed In Coronavirus Deaths, Treatment": WSJ UPDATED 5:30 PM

UPDATE
I've had to eat more crow. Please see this Pundita post, just published: More from the physician re severe immune system reactions to COVID-19
END UPDATE

" ... an increasing number of experts believe a hyperactive immune response, rather than the virus, is what ultimately kills many Covid-19 patients."
-- The Wall Street Journal, Haywire Immune Response Eyed In Coronavirus Deaths, Treatment; April 9

"But I think most suggestive of all is that for some who are infected with COVID-19, their immune system goes crazy fighting the virus, which is exactly what happens with the most severe allergic reactions, both of which are life-threatening. It looks to me as if it could be the same situation, only that physicians do not associate the symptoms of COVID-19 infection with an allergic reaction."
-- Pundita, The worst COVID-19 symptoms remind me of severe allergic reaction; April 7

For those who asked why I didn't initially defend the argument I made in the April 7 post, because there was no defense for what I did. I lost my temper over a remark made to the press by a physician about COVID-19. Loss of temper is okay, but it's not okay for me to write for a public platform before I've calmed down. If I'd been thinking straight, I would've asked the physician I knew to review the post before I published it. Instead, I asked for help as an afterthought. So I was left to eat crow in public, which serves me right. (See the physician's remarks in the update to the April 7 post).

Doesn't matter that I believed my key point still held value. I was flagrantly wrong in certain respects. I take the physician's word for it that I misread the abstract I used in the attempt to shore my argument. The topper is that I didn't need the abstract to make my key point. And I shot off my sarcastic remark about the use of beta-antagonists without knowing what I was talking about; for that I certainly needed to be corrected. And yet my essay didn't need that remark.

All right, that's enough crow-eating. I want to move on to The Wall Street Journal report. From my reading it seems the scientists studying the coronavirus have yet to zero in on the striking similarity between hyperactive immune responses to allergens and the virus. But it looks as if they could be 15 minutes away from doing so. I'll have more to say about this is the next post; for now:

Haywire Immune Response Eyed In Coronavirus Deaths, Treatment
Researchers are looking at treatments to suppress ‘cytokine storm,’ increasingly linked to the most severe Covid-19 cases

By Joseph Walker and
Jared S. Hopkins

April 9, 2020 7:00 am ET
The Wall Street Journal

Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.

Much remains unknown about the path the virus takes in the sickest patients, but an increasing number of experts believe a hyperactive immune response, rather than the virus, is what ultimately kills many Covid-19 patients.

The out-of-control immune response eventually causes the patients’ lungs to stop delivering oxygen to the rest of organs, leading to respiratory failure and in some cases death, the experts say. The malfunctioning immune system may be driving the rapid decline in lung function experienced by some patients, including younger and relatively healthy ones, after the initial onset of symptoms, doctors say.

[Graphic] Anatomy of a Cytokine Storm

An overactive immune response is thought to play a role in the disease progression of the sickest Covid-19 patients. [See WSJ site for the graphic.]

As scientists race to better understand the [phenomenon], pharmaceutical companies including Roche Holding AG are partnering with hospitals to explore whether drugs proven to tamp down an out-of-control immune response could help the sickest Covid-19 patients.

Some doctors are already administering the drugs to patients who are unable to breathe without the support of ventilators, or to prevent deterioration of patients who appear ready to slip into respiratory failure.

“You remove one piece of the storm, and it can quiet the whole thing,” said Kevin Tracey, president of the Feinstein Institutes for Medical Research at Northwell Health, which is testing Kevzara, an anti-inflammatory drug from Regeneron Pharmaceuticals Inc.

Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

In the most severe coronavirus patients, the disease appears to have two stages, doctors and researchers say. First the immune system fails to respond quickly or effectively enough to the virus. Then the immune response becomes too aggressive and floods the body with cytokines.

The surge of cytokines damages blood vessels and allows fluids to seep into the lungs, filling them up like water balloons, doctors say.

“The virus initiated it,” said Ya-Chi Ho, an assistant professor at the Yale School of Medicine who studies infectious diseases. “The second problem is our immune system handled it wrong, and induces this cytokine storm and clogs our lungs. That’s why patients die.”

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

On Tuesday, a federal agency that supports health research said it is committing $25 million to accelerate a late-stage study of Actemra in Covid-19 patients.

Last month, doctors from Seattle’s Swedish Health Services used Actemra to treat a 45-year-old emergency-room physician who was infected while caring for patients from a nursing home in Kirkland, Wash.

The man was transferred to Swedish and put on life support after his lungs and kidneys began to fail, said Samuel J. Youssef, a cardiothoracic surgeon at Swedish. Lab tests showed the man’s inflammation levels were 200 times greater than the normal range, indicating he might be suffering from a cytokine storm.

The doctors at Swedish decided to administer Actemra after discussing a small Chinese study that had shown that 21 Covid-19 patients with high levels of inflammation had been successfully treated with the drug.

Over the next two days, the patient’s inflammation levels began to decline and his blood-oxygen levels increased, Dr. Youssef said. After a week, he was well enough to be taken off life support on March 23, and was released from the hospital on Sunday.

“All we did was quiet the storm and support his body—his kidneys, his lungs, his heart—to give him the time to fight the virus,” said Dr. Youssef, who attributes the recovery both to Actemra as well as other interventions like being put on life support.

CytoDyn Inc., a Vancouver, Wash.-based biotech company, said 10 severely sick Covid-19 patients showed signs of recovering three days after being infused with its experimental HIV drug leronlimab, which may block the production of inflammatory cytokines. Three of the patients were taken off ventilators, including two who have since been discharged from care, according to CytoDyn.

The company is studying its drug in a trial for patients with mild-to-moderate symptoms and expects to start one for severely sick patients.

Swedish Orphan Biovitrum AB expects results in July from a study evaluating its rheumatoid-arthritis drug Kineret in combination with an antibody called emapalumab in patients in Italy, said Milan Zdravkovic, Sobi’s head of research and development.

Novartis AG and Incyte Corp. said they plan to start clinical trials of their drug ruxolitinib in Covid-19 patients with cytokine storm. The drug, marketed as Jakafi in the U.S., is approved to treat rare blood cancers.

Write to Joseph Walker at joseph.walker@wsj.com and Jared S. Hopkins at jared.hopkins@wsj.com

[END REPORT]

Not for humans to visit the god realm. But we can imagine.

Tuesday, April 7

The worst COVID-19 symptoms remind me of severe allergic reaction UPDATED 3X

UPDATE 5:30 PM April 9

More from the physician re severe immune system reactions to COVID-19
UPDATE 1:05 PM April 9
See Haywire Immune Response Eyed In Coronavirus Deaths, Treatment; April 9; The Wall Street Journal

I'll have more in my next post.

UPDATE April 8
This comment is from a physician I asked to read my post -- after I published it:

"You misread the essay [abstract]. That is ridiculous. Every single person in respiratory failure is getting beta-agonists both before and while on the ventilator. That’s one of the many things we do before deciding to begin ventilator treatment."

My reply:

Ah so. Thank you! So -- no chance that the most severe COVID-19 symptoms in younger people without serious health issues is a severe allergic reaction. Well, another bright idea for the circular file.

I should have run my idea by you before I published. Now I will have to eat crow for my readers rather than simply deleting the essay because what I wrote is so misleading.

END UPDATE (There may be more updates to this post.)

Cold or flu symptoms can mimic many symptoms of an allergy, but is it possible to be allergic to a virus? If I've correctly read the abstract from a study published in 2011, it looks as if the answer would be yes -- or so close to a yes that medical intervention to treat a severe allergy might be tried with those who exhibit severe symptoms associated with COVID-19 infection.

See "Airway allergy and viral infection," published in 2011 by the Asian-Pacific Journal of Allergy and Immunology and available for free from the U.S. National Library of Medicine, National Institutes of Health.

As to whether an allergic reaction can touch off fever, there is an indirect route. From Healthline's article, Is Fever a Symptom of Allergies?

But can allergies cause a fever? Generally, no. Sometimes, however, allergy symptoms can make you vulnerable to a bacterial or viral infection. And a bacterial or viral infection can lead to a fever, so you can indirectly blame the fever on your allergy.

Healthline also explains --

When an allergic reaction is so severe that your breathing is jeopardized and you lose consciousness or are at risk of losing consciousness, it’s called anaphylaxis. Anaphylaxis is a medical emergency that requires immediate medical attention.

The treatment for anaphylaxis, from Healthline's article about it:

At the hospital, people with anaphylaxis are given adrenaline, the common name for epinephrine -- medication to minimize the reaction. ... In addition, you may receive oxygen, cortisone, an antihistamine, or a fast-acting beta-agonist inhaler.

Here is Healthline's list of symptoms associated with anaphylaxis:

mental confusion

throat swelling

weakness or dizziness

blue skin

rapid or abnormal heart rate

facial swelling

hives

low blood pressure

wheezing

Also from the article:

... in the case of anaphylaxis, the immune system overreacts in a way that causes a full-body allergic reaction. ...... Some people may go into anaphylactic shock. It’s also possible to stop breathing or experience airway blockage due to the inflammation of the airways.

Sometimes, it can cause a heart attack.

Hives and facial/throat swelling are, I think, symptoms commonly associated with an allergic reaction to an ingested substance or a insect sting, so they wouldn't apply to any allergic reaction to the COVID-19 virus. But the rest of the symptoms listed by Healthline are suggestive of the immune system's reaction to the virus.

Here is a list of the most severe COVID-19 symptoms from a Houston Methodist Hospital article:

Serious symptoms of COVID-19 include:

Severe shortness of breath

Low blood pressure

Elevated heart rate (above 100 bpm)

Dehydration

Profound weakness

High fever

Blue lips/facial skin are also signs of severe COVID-19 symptoms -- of course, if the person is having trouble breathing. And the elevated heart-rate symptom, if untreated, can lead to heart failure, stroke, or cardiac arrest -- a 'heart attack,' as the Healthline list terms it.

But I think most suggestive of all is that for some who are infected with COVID-19, their immune system goes crazy fighting the virus, which is exactly what happens with the most severe allergic reactions, both of which are life-threatening. It looks to me as if it could be the same situation, only that physicians do not associate the symptoms of COVID-19 infection with an allergic reaction.

I'm not a physician but sometimes I follow the Quacks Like school of reasoning: If it looks like something, and it quacks like something, maybe that's what it is.

Might be worth a shot, especially when you consider that a "fast-acting beta-agonist inhaler " would be much easier on the patient than a ventilator.

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COVID-19 actually came from a lab

Now it can be told. Some dogs will do anything to get their humans to stay at home with them.

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Sunday, April 5

Since Climate Change failed at global government, guess what now?

I'm posting the following op-ed in its entirety because it's receiving a lot of attention, naturally, given the author, and because Dr Kissinger's thoughts on the pandemic are surely useful to those in power who don't want to let this crisis go to waste; they want to parlay it into something like a global government. Gordon Brown is already calling for such to deal with the post-pandemic era.

So I think it's helpful to become familiar with the kind of verbiage that will be deployed to rationalize the next attempt by well-connected lunatics to control the human race aka The World Order.

The Coronavirus Pandemic Will Forever Alter the World Order
By Henry A. Kissinger
April 3, 2020 6:30 pm ET

The Wall Street Journal

The U.S. must protect its citizens from disease while starting the urgent work of planning for a new epoch.

The surreal atmosphere of the Covid-19 pandemic calls to mind how I felt as a young man in the 84th Infantry Division during the Battle of the Bulge. Now, as in late 1944, there is a sense of inchoate danger, aimed not at any particular person, but striking randomly and with devastation. But there is an important difference between that faraway time and ours. American endurance then was fortified by an ultimate national purpose. Now, in a divided country, efficient and farsighted government is necessary to overcome obstacles unprecedented in magnitude and global scope. Sustaining the public trust is crucial to social solidarity, to the relation of societies with each other, and to international peace and stability.

Nations cohere and flourish on the belief that their institutions can foresee calamity, arrest its impact and restore stability. When the Covid-19 pandemic is over, many countries’ institutions will be perceived as having failed. Whether this judgment is objectively fair is irrelevant. The reality is the world will never be the same after the coronavirus. To argue now about the past only makes it harder to do what has to be done.

The coronavirus has struck with unprecedented scale and ferocity. Its spread is exponential: U.S. cases are doubling every fifth day. At this writing, there is no cure. Medical supplies are insufficient to cope with the widening waves of cases. Intensive-care units are on the verge, and beyond, of being overwhelmed. Testing is inadequate to the task of identifying the extent of infection, much less reversing its spread. A successful vaccine could be 12 to 18 months away.

The U.S. administration has done a solid job in avoiding immediate catastrophe. The ultimate test will be whether the virus’s spread can be arrested and then reversed in a manner and at a scale that maintains public confidence in Americans’ ability to govern themselves. The crisis effort, however vast and necessary, must not crowd out the urgent task of launching a parallel enterprise for the transition to the post-coronavirus order.

Leaders are dealing with the crisis on a largely national basis, but the virus’s society-dissolving effects do not recognize borders. While the assault on human health will—hopefully—be temporary, the political and economic upheaval it has unleashed could last for generations. No country, not even the U.S., can in a purely national effort overcome the virus. Addressing the necessities of the moment must ultimately be coupled with a global collaborative vision and program. If we cannot do both in tandem, we will face the worst of each.

Drawing lessons from the development of the Marshall Plan and the Manhattan Project, the U.S. is obliged to undertake a major effort in three domains. First, shore up global resilience to infectious disease. Triumphs of medical science like the polio vaccine and the eradication of smallpox, or the emerging statistical-technical marvel of medical diagnosis through artificial intelligence, have lulled us into a dangerous complacency. We need to develop new techniques and technologies for infection control and commensurate vaccines across large populations. Cities, states and regions must consistently prepare to protect their people from pandemics through stockpiling, cooperative planning and exploration at the frontiers of science.

Second, strive to heal the wounds to the world economy. Global leaders have learned important lessons from the 2008 financial crisis. The current economic crisis is more complex: The contraction unleashed by the coronavirus is, in its speed and global scale, unlike anything ever known in history. And necessary public-health measures such as social distancing and closing schools and businesses are contributing to the economic pain. Programs should also seek to ameliorate the effects of impending chaos on the world’s most vulnerable populations.

Third, safeguard the principles of the liberal world order. The founding legend of modern government is a walled city protected by powerful rulers, sometimes despotic, other times benevolent, yet always strong enough to protect the people from an external enemy. Enlightenment thinkers reframed this concept, arguing that the purpose of the legitimate state is to provide for the fundamental needs of the people: security, order, economic well-being, and justice. Individuals cannot secure these things on their own. The pandemic has prompted an anachronism, a revival of the walled city in an age when prosperity depends on global trade and movement of people.

The world’s democracies need to defend and sustain their Enlightenment values. A global retreat from balancing power with legitimacy will cause the social contract to disintegrate both domestically and internationally. Yet this millennial issue of legitimacy and power cannot be settled simultaneously with the effort to overcome the Covid-19 plague. Restraint is necessary on all sides—in both domestic politics and international diplomacy. Priorities must be established.

We went on from the Battle of the Bulge into a world of growing prosperity and enhanced human dignity. Now, we live [in] an epochal period. The historic challenge for leaders is to manage the crisis while building the future. Failure could set the world on fire.

Mr. Kissinger served as secretary of state and national security adviser in the Nixon and Ford administrations.

[END]

COVID19 came from China. The pandemic came from Europe.

CORONAVIRUS STARTED IN CHINA, BUT EUROPE BECAME THE HUB FOR ITS GLOBAL SPREAD
By Joe Penney
April 2, 2020

The Intercept

... But as China, South Korea, Taiwan, and Hong Kong were stabilizing their coronavirus rates through a combination of massive testing, rigorous contact tracing, and strict lockdown measures, infections in European countries were shooting up. Despite witnessing the devastation in China, and the rapid response put in place by its neighbors, European countries were flatfooted as the virus spread rapidly from Milan, Paris, and London to countries in Africa, Latin America, and its European neighbors. ...

Now just why were they flatfooted? Joe Penney takes a whack at the puzzle. Interesting analysis.

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Saturday, April 4

More evidence the virus is causing outbreaks of common sense in USA

Soda, the wine delivery dog

The evidence for a resurrection of common sense can be buried in news reports but seek and you'll find it. Take for example this 4/3 report from Reuters grimly headlined U.S. dairy farmers dump milk as pandemic upends food markets.

Despite strong demand for basic foods like dairy products amid the coronavirus pandemic, the milk supply chain has seen a host of disruptions that are preventing dairy farmers from getting their products to market.

But wait --

Mass closures of restaurants and schools have forced a sudden shift from those wholesale food-service markets to retail grocery stores.

This, as Reuters notes, has created "logistical and packaging nightmares for plants processing milk, butter and cheese." Yet the shift in food distribution from wholesale to retail outlets is evidence that many Americans are now preparing their own meals. As Michael Snyder noted on 3/30 at his blog:

Normally, Americans get a lot of their food from restaurants. In fact, during normal times 36 percent of all Americans eat at a fast food restaurant on any given day.

That's just takeout food; the stat doesn't include meals at sit-down restaurants. But it all adds up to the fact that a great many Americans have been setting their paychecks on fire just to eat.

As to hoarding -- it used to be called 'stocking up.' Stocking up when you visit the grocery store, as distinct from buying only one or a few items of a product you know you'll use several times in a year or even in a month. That type of inefficiency also adds up to wasted money not to mention wasted time.

Synder's report, headlined "Supplies Are Starting To Get Really Tight Nationwide As Food Distribution Systems Break Down," discusses another important shift that points to breakouts of common sense in the USA:

Because of the coronavirus pandemic, more people are showing an interest in starting home gardens. Oregon State University‘s (OSU) Master Gardener program took notice of the growing interest.

To help citizens who want to grow their own food, the university kindly made their online vegetable gardening course free until the end of April. OSU’s post on Facebook has been shared over 21,000 times.

Food is only going to get more expensive from here on out, and growing your own food is a way to become more independent of the system.

But if you don’t have any seeds right now, you may want to hurry, because consumer demand is spiking.

“It’s the largest volume of orders we have seen,” said Jere Gettle of Baker Creek Heirloom Seeds in Mansfield, Missouri. Peak seed-buying season for home gardeners is January to March, but the normal end-of-season decline in orders isn’t happening.

Customers are gravitating to vegetables high in nutrients, such as kale, spinach and other quick-to-grow leafy greens. “Spinach is off the charts,” said Jo-Anne van den Berg-Ohms of Kitchen Garden Seeds in Bantam, Connecticut.

So instead of paying for membership in a gym Americans with the lawn space can get their exercise doing vegetable gardening. (Those without the space, light permitting, can also raise some vegetables indoors.) They can also set up a chicken house so they can have fresh eggs.

As to who will guard the chickens while the family isn't at home, well, a great many American dogs have become neurotic -- even requiring medication -- because they don't have anything to do all day while the master is away during the day. The family dog can be taught to guard the chicken house.

They can make themselves useful in other ways, as well. Here's a report about a Boxer dog now making curbside deliveries for the owner of a wine store whose customers practice social distancing in the time of the virus.

In consideration of all the above and much more, I do have one quibble with Michael Snyder; his blog is called "The End of the American Dream." The American Dream is resurfacing, not ending. We were conditioned to act stupidly. Now a virus is forcing us to wise up.

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Tuesday, March 31

"New data shows social distancing may be working:"

From the Boston Globe: "New data shows that social distancing restrictions could be helping, with fewer fevers being recorded across the country."

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I don't know why

Years ago I featured this old 3-1/2 minute music video from the great Malian Wassoulou singer Oumou Sangaré and suddenly it popped into my mind. What do the lyrics mean? Who knows? I just know it makes me smile to listen and watch.

Wait -- now I remember; someone at YouTube wrote that she's saying, "Oh my love the importance of immigration is going back to be with your family and share the happiness, love, build a house and make all good things for them."

Well, those were the days, probably the 1990s, when globalization held nothing but promise. But if that truly is the meaning of the lyrics, then from the expression on her face and gestures in several parts of the song, it seems Oumou had reservations about all the rushing to and fro around the world to earn. It seems she was wondering what that did to a person's sense of identity. Something like that.

Monday, March 30

An Italian and his Chihuahua doing Yoga in a time of quarantines

Now just see how this virus is bringing families together. The dog has been taught to be serious about Yoga. not like those Yoga Studio dogs who roll around and look cute for the human practitioners.

The video of the Yoga session is posted at Twitter. And yes, "Amanda in Atlanta," thank you for this.

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Pundita

Translate

Wednesday, April 15

Are Americans getting too fat?

Tuesday, April 14

Covid-19 can also affect the brain

"How much of the coronavirus does it take to make you sick? The science, explained"

Sunday, April 12

Italians should have done for Easter what the Mormon Tabernacle Choir did

Easter Dance and Singalong

Saturday, April 11

Bravo Jerome Adams!

Friday, April 10

Top of page headline links Drudge Report 4/10, 11:50 PM ET

Thursday, April 9

Drudge top of page headline links 5:40 pm ET April 9

More from the physician re severe immune system reactions to COVID-19

"Haywire Immune Response Eyed In Coronavirus Deaths, Treatment": WSJ UPDATED 5:30 PM

Not for humans to visit the god realm. But we can imagine.

Tuesday, April 7

The worst COVID-19 symptoms remind me of severe allergic reaction UPDATED 3X

COVID-19 actually came from a lab

Sunday, April 5

Since Climate Change failed at global government, guess what now?

COVID19 came from China. The pandemic came from Europe.

Saturday, April 4

More evidence the virus is causing outbreaks of common sense in USA

Tuesday, March 31

"New data shows social distancing may be working:"

I don't know why

Monday, March 30

An Italian and his Chihuahua doing Yoga in a time of quarantines

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