US deaths from Covid under-counted probably by tens of thousands

"Calculating the precise number of COVID-19 deaths is remarkably complicated for a number of reasons."

"It is an extraordinary challenge," said Dr. Sally Aiken, president of the National Association of Medical Examiners. "There just isn't really the infrastructure."

The under-counting discussed in the following news report pertains only to the United States, but the same situation would be in play with all countries where the disease has reached epidemic proportions. This is a long report, so I'm just going to start you out with select passages from the first part, and hope you'll read the rest at the ABC website. 

The most damning statement in the report is the one I quoted above. But why doesn't the United States of America, the world's hyperpower nation, have such infrastructure in place?

How accurate is the US coronavirus death count? Some experts say it's off by 'tens of thousands'
To get an accurate picture of the pandemic, US needs to test more of the dead.
By Dr. Mark Abdelmalek, Chris Francescani and
Kaitlyn Folmer
April 30, 2020 - 4:56 PM
ABC News [USA]

The novel coronavirus has already claimed the lives of more than 61,000 Americans. But experts fear that number could be far higher at this point in the outbreak -- perhaps by tens of thousands -- once the pandemic subsides enough for officials to go back and make a true reckoning of the dead.

Experts are urging leaders to take measures right now to preserve data and medical specimens so that science has the chance to determine the precise number of people who succumbed during one of the most severe global pandemics in memory.

"Under-counting deaths in this particular epidemic is happening all over," said Dr. Daniel Lopez-Acuna, an epidemiologist and former top World Health Organization official, who spent 30 years at the organization. "It’s almost inevitable."

Calculating the precise number of COVID-19 deaths is remarkably complicated for a number of reasons. But leading epidemiologists, pathologists, medical examiners, medical history professors and local, state, federal and global health officials told ABC News that more testing is the single most important factor in determining an accurate national death count.

"We need to have the testing available because the big question now with COVID-19 is the denominator -- of anything," said Dr. Alex Williamson of the College of American Pathologists. "How many people get it? How many people recover? How many are hospitalized? How many died? We don't know the true denominator. More testing is the most important thing we need to do."

Ongoing testing kit shortages in cities and states nationwide means that only clearly symptomatic patients are currently being tested in many places. There also is no uniform national system in the U.S. for investigating deaths, and until two weeks ago, the U.S. was only counting Americans who lab-tested positive, before or after death, for COVID-19.

Left out of the tally are people who died without being tested and those who died at home or some other non-healthcare facilities before they could seek medical care.

"It is an extraordinary challenge," said Dr. Sally Aiken, president of the National Association of Medical Examiners. "There just isn't really the infrastructure."

Further undermining an accurate national count are new analyses that suggest the virus was spreading in the U.S. much earlier than previously believed, likely playing a role in more deaths than currently known.

[...]

While most news organizations rely on the Johns Hopkins University figures, which are pulled directly from state and local government websites and are considered a more timely picture of the problem, the National Center for Health Statistics, a branch of the CDC, is the primary agency responsible for U.S. health statistics, which are compiled by collecting data on births, deaths and health surveys.

Due to the lack of a uniform U.S. system, the NCHS system lags about two weeks behind in reporting said, Dr. Robert Anderson, chief of mortality statistics.

Daniel Weinberger, an epidemiologist from the Yale School of Public Health, analyzed NCHS death count data to estimate how many COVID-19 deaths may have gone uncounted during the five-week period from March 1 to April 3.

He concluded the official death toll in the U.S. is "probably a substantial underestimate of the true number by tens of thousands."

[...]

********

Drudge Report Pandemic Headlines 4/30 - 2 pm ET UPDATED 3 pm ET

UPDATE
A few notes:
> Most of the reports that the Drudge Report headlines are from mainstream media outlets -- Associated Press, New York Times, Bloomberg, etc. -- although there are a number of reports from scientific journals.

> Most of the headlines relate to hard news reports, although there are links to editorials and opinion pieces relating to the pandemic that have gotten attention among mainstream commentators in the USA.  

> The wording of the headline links often reflects the Drudge staff's view of the report/editorial, which is why I felt compelled to add a note to the headline about the experiment in human sacrifices in Georgia.  That is obviously Drudge's view of Georgia's decision to suspend lockdowns in an attempt to keep business going in the state.

> Because Drudge is an American website, and because the U.S. is a big part of the global pandemic, many of the headline links relate to a report on situations in the U.S. But if you glance through all the headlines on the page, you'll see that Drudge doesn't ignore any country if the staff considers the news important to the large picture of the pandemic. 

> From all the above, Drudge's politics play a small to nonexistent role in the choice of pandemic headlines, which could be why President Trump recently got mad at Matt Drudge, who had supported Trump in his run for the presidency. But what did Trump and his officials expect Drudge to do? Sit on every report about the pandemic that the White House didn't like?  If that was their expectation, they have been solely disappointed. Where is my Kleenex box?
END UPDATE

The best that Drudge (or any other media outlet) can do is provide on a daily basis a snapshot of the vast scope of the pandemic; in this effort, Matt Drudge and his staff deserve a medal. 

The following headline links are from the top left of the page at Drudge; most of the other links at the page also relate to the pandemic, including these three that Drudge couldn't squeeze into the top left:

Stable, mending patients become critically ill with little warning. Doctors aren't sure why... 'Second-week crash'... POLL: Seeking virus data, people struggle with trust... New Reports Fuel Uncertainty on Schools...

Other top left links:

World on knife edge as cases spike and cities shut down AGAIN after lockdowns lifted...
Officials Press Spies to Link Virus and Wuhan Labs...
Florida jobless claims rise by 326,000, most of any state...
New hotspots in small cities, rural counties...
US Records 2,502 Deaths In Past 24 Hours...
TOTAL 61,568...
Miscalculation at Every Level Left Nation Unequipped to Fight...
MAG: Georgia's Experiment in Human Sacrifice... [The Atlantic's look at keeping Georgia open for business, dispensing with lockdowns]
HORROR: Dozens of bodies found in U-HAUL trucks outside NYC funeral home...
70% of tested inmates in federal prisons infected...
Food-Plant Workers Clash With Employers...
Beef prices record high...
Mortgage Rates Record Low...
Worst auto sales in 30 years...
Painkillers, sedatives in short supply...
WORLD SICK MAP...
AMERICA SICK MAP...

Here are the headline links, in big letters, at the top middle of the page:

NEW HOTSPOTS USA
MODEL: 100,000 DEAD BY END OF SUMMER
INTEL: VIRUS NOT MANMADE
DC SHUT UNTIL AUGUST?
BEEF SHORTAGES ALARM WHITE HOUSE

********

"Coronoavirus widens Europe's North-South economic divide"

This is a fascinating report, published yesterday by The Wall Street Journal. It raises many issues, covers many important points, and provides much food for thought about what's ahead for the global economy. Well worth it to read the report in its entirety -- and it's available without a subscription. Kudos to the Journal.   

********

What kind of appropriate action would ward off massive meat shortages?

"Critics have said American meat processors are partly to blame for their vulnerabilities. Decades of consolidation have left the nation’s food supply in the hands of relatively few companies. And labor groups have long criticized meatpacking plants for pushing to increase production speeds at the expense of worker safety."

"The pandemic has stretched global supply chains to the breaking point, leaving products piling up in some ports and warehouses, while elsewhere cargo ships are sailing empty. The disruptions have been catastrophic for American farmers. [In addition] Closings of restaurants and school cafeterias have dampened demand for meat, milk and cheese, while shuttered meatpacking plants prevent pork chops and hamburgers from getting to market."

I've pulled just a few passages, including the ones above, from an April 28 New York Times report headlined, Trump Declares Meat Supply ‘Critical,’ Aiming to Reopen Plants. Read the full report to understand more about the obstacles facing a federally mandated order meant to avert meat shortages. 

In short, the executive order sounds good on paper, but right now it's just words.     

WASHINGTON — President Trump on Tuesday declared meat processing plants “critical infrastructure,” in an effort to ensure that facilities around the country remained open as the government tried to prevent looming shortages of pork, chicken and other products as a result of the coronavirus.

The action comes as meat plants around the country have turned into coronavirus hot spots, sickening thousands of workers, and after the head of Tyson Foods, one of the country’s largest processors, warned that millions of pounds of meat would simply disappear from the supply chain.

In an executive order issued late Tuesday, Mr. Trump said recent closures of meat processing facilities “threaten the continued functioning of the national meat and poultry supply chain, undermining critical infrastructure during the national emergency.

”The president said his administration would “take all appropriate action” to ensure that meat and poultry processors “continue operations” consistent with federal health and workplace safety guidance.

[...]

The Labor Department and OSHA also indicated that the federal government would assert authority over states, which have ordered many businesses to close.

“No part of the joint meat processing guidance should be construed to indicate that state and local authorities may direct a meat and poultry processing facility to close, to remain closed or to operate in accordance with procedures other than those provided for in this guidance,” the statement said.

[...]

******** 

Untitled

Photographed at an ICU ward in Belgium.

How long to keep food - more accurate than 'sell by' dates

https://www.insider.com/how-you-know-when-your-food-has-gone-bad-2016-8

Covid-19 is a new kind of pandemic

Throughout history the normal route for a highly infectious viral disease was always outbreak-epidemic-pandemic. The 2009 Swine Flu pandemic was the first to illustrate that it was now possible to as much leapfrog the epidemic stage and go from the outbreak stage to the pandemic stage in a matter of days or even hours. 

How could this happen? A number of factors arose and converged near the end of the last century that made it possible:

> megapopulations
> urbanized societies all over the world
> megacities 
 > huge numbers of jumbo commercial jets
> huge numbers of international airports built all around the world
>huge numbers of domestic airports built 
> cheap international and domestic airfares
> virtually unrestricted air travel between most countries
> huge numbers of air travelers crisscrossing the globe on a daily basis.  

Then it only needed the right kind of virus and the right time of year, as happened with the 2009 Swine Flu, to make a new kind of pandemic. A virus no longer needed to bother with a time-consuming spread from one country to another. It could be deposited all around the world at almost the same time, then start its exponential march once inside the countries, boosted by extensive domestic air travel.

Covid-19 is just a slap on the wrist, and yet the havoc it's caused in a mere 14 weeks can be read as the last warning in a string of warnings starting with the AIDS pandemic.

********

Covid Crisis:Unprecedented threat of global famine

"Altogether, an estimated 265 million people could be pushed to the brink of starvation by year’s end. ... There is no shortage of food globally or mass starvation from the pandemic — yet. But logistical problems in planting, harvesting and transporting food will leave poor countries exposed in the coming months, especially those reliant on imports, said Johan Swinnen, director general of the International Food Policy Research Institute in Washington."

“We’ve never seen anything like this before,” Mr. Husain said. “It wasn’t a pretty picture to begin with, but this makes it truly unprecedented and uncharted territory.”

The quotes are from a New York Times report, which I've posted below. History is rife with famines, but these have been geographically limited. Now the threat of famine is cutting across large swaths of the world and even the richest countries are facing food-supply bottlenecks and shortages.  And of course Murphy's Law is in effect, as the "historic" locust plague illustrates.   

‘Instead of Coronavirus, the Hunger Will Kill Us.’ A Global Food Crisis Looms.
By Abdi Latif Dahir
April 22, 2020
The New York Times

In the largest slum in Kenya’s capital, people desperate to eat set off a stampede during a recent giveaway of flour and cooking oil, leaving scores injured and two people dead.

In India, thousands of workers are lining up twice a day for bread and fried vegetables to keep hunger at bay.

And across Colombia, poor households are hanging red clothing and flags from their windows and balconies as a sign that they are hungry.

“We don’t have any money, and now we need to survive,” said Pauline Karushi, who lost her job at a jewelry business in Nairobi, and lives in two rooms with her child and four other relatives. “That means not eating much.”

The coronavirus pandemic has brought hunger to millions of people around the world. National lockdowns and social distancing measures are drying up work and incomes, and are likely to disrupt agricultural production and supply routes — leaving millions to worry how they will get enough to eat.

The coronavirus has sometimes been called an equalizer because it has sickened both rich and poor, but when it comes to food, the commonality ends. It is poor people, including large segments of poorer nations, who are now going hungry and facing the prospect of starving.

“The coronavirus has been anything but a great equalizer,” said Asha Jaffar, a volunteer who brought food to families in the Nairobi slum of Kibera after the fatal stampede. “It’s been the great revealer, pulling the curtain back on the class divide and exposing how deeply unequal this country is.”

Already, 135 million people had been facing acute food shortages, but now with the pandemic, 130 million more could go hungry in 2020, said Arif Husain, chief economist at the World Food Program, a United Nations agency. Altogether, an estimated 265 million people could be pushed to the brink of starvation by year’s end.

“We’ve never seen anything like this before,” Mr. Husain said. “It wasn’t a pretty picture to begin with, but this makes it truly unprecedented and uncharted territory.”

The world has experienced severe hunger crises before, but those were regional and caused by one factor or another — extreme weather, economic downturns, wars or political instability.

This hunger crisis, experts say, is global and caused by a multitude of factors linked to the coronavirus pandemic and the ensuing interruption of the economic order: the collapse in oil prices; widespread shortages of hard currency from tourism drying up; overseas workers not having earnings to send home; and ongoing problems like climate change, violence, population dislocations and humanitarian disasters.

Already, from Honduras to South Africa to India, protests and looting have broken out amid frustrations from lockdowns and worries about hunger. With classes shut down, over 368 million children have lost the nutritious meals and snacks they normally receive in school.

There is no shortage of food globally, or mass starvation from the pandemic — yet. But logistical problems in planting, harvesting and transporting food will leave poor countries exposed in the coming months, especially those reliant on imports, said Johan Swinnen, director general of the International Food Policy Research Institute in Washington.

While the system of food distribution and retailing in rich nations is organized and automated, he said, systems in developing countries are “labor intensive,” making “these supply chains much more vulnerable to Covid-19 and social distancing regulations.”

Yet even if there is no major surge in food prices, the food security situation for poor people is likely to deteriorate significantly worldwide. This is especially true for economies like Sudan and Zimbabwe that were struggling before the outbreak, or those like Iran that have increasingly used oil revenues to finance critical goods like food and medicine.

In Venezuela, the pandemic could deal a devastating blow to millions already living in the world’s largest economic collapse outside wartime.

In the sprawling Petare slum on the outskirts of the capital, Caracas, a nationwide lockdown has left Freddy Bastardo and five others in his household without jobs. Their government-supplied rations, which had arrived only once every two months before the crisis, have long run out.

“We are already thinking of selling things that we don’t use in the house to be able to eat,” said Mr. Bastardo, 25, a security guard. “I have neighbors who don’t have food, and I’m worried that if protests start, we wouldn’t be able to get out of here.”

Uncertainty over food is also building in India, where daily-wage workers with little or no social safety net face a future where hunger is a more immediate threat than the virus.

As wages have dried up, half a million people are estimated to have left cities to walk home, setting off the nation’s “largest mass migration since independence,” said Amitabh Behar, the chief executive of Oxfam India.

On a recent evening, hundreds of migrant workers, who have been stuck in New Delhi after a lockdown was imposed in March with little warning, sat under the shade of a bridge waiting for food to arrive. The Delhi government has set up soup kitchens, yet workers like Nihal Singh go hungry as the throngs at these centers have increased in recent days.

“Instead of coronavirus, the hunger will kill us,” said Mr. Singh, who was hoping to eat his first meal in a day. Migrants waiting in food lines have fought each other over a plate of rice and lentils. Mr. Singh said he was ashamed to beg for food but had no other option.

“The lockdown has trampled on our dignity,” he said.

Refugees and people living in conflict zones are likely to be hit the hardest.

The curfews and restrictions on movement are already devastating the meager incomes of displaced people in Uganda and Ethiopia, the delivery of seeds and farming tools in South Sudan and the distribution of food aid in the Central African Republic. Containment measures in Niger, which hosts almost 60,000 refugees fleeing conflict in Mali, have led to surges in the pricing of food, according to the International Rescue Committee.

The effects of the restrictions “may cause more suffering than the disease itself,” said Kurt Tjossem, regional vice president for East Africa at the International Rescue Committee.

Ahmad Bayoush, a construction worker who had been displaced to Idlib Province in northern Syria, said he and many others had signed up to receive food from aid groups, but that it had yet to arrive.

“I am expecting real hunger if it continues like this in the north,” he said.

The pandemic is also slowing efforts to deal with the historic locust plague that has been ravaging the East and Horn of Africa. The outbreak is the worst the region has seen in decades and comes on the heels of a year marked by extreme droughts and floods. But the arrival of billions of new swarms could further deepen food insecurity, said Cyril Ferrand, head of the Food and Agriculture Organization’s resilience team in eastern Africa.

ravel bans and airport closures, Mr. Ferrand said, are interrupting the supply of pesticides that could help limit the locust population and save pastureland and crops.

As many go hungry, there is concern in a number of countries that food shortages will lead to social discord. In Colombia, residents of the coastal state of La Guajira have begun blocking roads to call attention to their need for food. In South Africa, rioters have broken into neighborhood food kiosks and faced off with the police.

And even charitable food giveaways can expose people to the virus when throngs appear, as happened in Nairobi’s shantytown of Kibera earlier this month.

"People called each other and came rushing,” said Valentine Akinyi, who works at the district government office where the food was distributed. “People have lost jobs. It showed you how hungry they are.”

To assuage the impact of this crisis, some governments are fixing prices on food items, delivering free food and putting in place plans to send money transfers to the poorest households.

Yet communities across the world are also taking matters into their own hands. Some are raising money through crowdfunding platforms, while others have begun programs to buy meals for needy families.

On a recent afternoon, Ms. Jaffar and a group of volunteers made their way through Kibera, bringing items like sugar, flour, rice and sanitary pads to dozens of families. A native of the area herself, Ms. Jaffar said she started the food drive after hearing so many stories from families who said they and their children were going to sleep hungry.

The food drive has so far reached 500 families. But with all the calls for assistance she’s getting, she said, “that’s a drop in the ocean.”

[END REPORT]

********

Covid Crisis: American suppliers and grocers battle meat shortages

There is a relatively recent precedent for the unexpected shortages, as the following WSJ report explains. The meat suppliers were able to roll with the punches because the increased demand was over time. 

As to this time -- from the report: “We haven’t seen a situation in our lifetime where the industry has contracted as quickly as we have seen in the last month,” said Will Sawyer, a CoBank economist who researches meat production.

Will the suppliers be able to roll with the punches this time? They're trying, that's for sure. 

Grocers Hunt for Meat as Coronavirus Hobbles Beef and Pork Plants

Surging consumer demand also tightens supplies; supermarkets brace for shortages

By Jacob Bunge, Sarah Nassauer and Jaewon Kang
April 23, 2020 6:10 pm ET

The Wall Street Journal 

[See the WSJ website for graphs]

U.S. grocers are struggling to secure meat, looking for new suppliers and selling different cuts, as the coronavirus pandemic cuts into domestic production and raises fears of shortages.

Covid-19 outbreaks among employees have closed about a dozen U.S. meatpacking facilities this month, including three Tyson Foods Inc. plants this week. Other plants have slowed production as workers stay home for various reasons.

Grocery executives at retailers including Walmart Inc. and Costco Wholesale Corp. worry supplies of some products could run short just as demand is surging.

“I have not seen beef sales and all protein behave this way since the Atkins Diet days,” when shoppers bought up meat as part of the low-carb diet, said Jeff Lyons, senior vice president of fresh food for Costco. The warehouse chain is considering new suppliers to shore up its meat supplies, he said.

Tyson, the biggest U.S. meat company by sales, on Thursday temporarily closed a Washington state beef plant, after closing two Midwestern pork plants on Wednesday that produce millions of pounds of meat, together slaughtering nearly 35,000 hogs daily. Smithfield Foods Inc., Cargill Inc., JBS USA Holdings Inc. and Hormel Foods Corp. have closed plants over the past month, leading to significant declines in overall U.S. meat production.

Last week U.S. beef production fell 24% compared with a month earlier, with pork off 20% and poultry down 10%, according to estimates from CoBank, an agricultural lender.

Some meat orders are arriving incomplete as suppliers pull back on variety and major plants remain closed, grocery executives said. Ground beef supplies are declining, a regional grocery executive said, and wholesale prices are creeping up after a fall that occurred when closed dining rooms clipped restaurant demand.

Meat inventories are likely to become tight within two weeks because of the recent processing-plant closures, and temporary shortages are possible, said Pat LaFrieda, chief executive of his namesake meat wholesaler, based in New Jersey. The company typically supplies food to Shake Shack Inc. and other restaurants, but now is selling most of its inventory to grocers, he said.

The spread of Covid-19, the disease caused by the new coronavirus, among U.S. meat-plant workers has thrown the $213 billion industry into disarray. Meat companies are trucking poultry and livestock to be processed at other plants, and bringing in welders to install shields between processing-line work stations. On farms, some pigs now are being euthanized because slaughterhouses have closed, farmers said. In Iowa, Gov. Kim Reynolds this week dispatched as many as 1,000 National Guard members to help deliver Covid-19 tests to meat plants.

“We haven’t seen a situation in our lifetime where the industry has contracted as quickly as we have seen in the last month,” said Will Sawyer, a CoBank economist who researches meat production.

At Costco, Mr. Lyons is focused on supplies of pork and chicken, which the chain requires to be raised and processed to certain specifications. Those industries inherently have less room for closures or surges in sales in their supply chains because animals are bred in precise quantities to meet expected demand, he said. Costco is meeting demand now, he said, but is considering working with new suppliers to fill orders if needed, with some of its U.S. suppliers’ plants expected to be down for about two weeks, Mr. Lyons said.

For chicken, where Costco specializes in boneless, skinless breasts that are 99% fat-free, the company is working with plants to temporarily supply those products for additional days each week, Mr. Lyons said.

Walmart is buying more products ordinarily destined for restaurants, working to help convert plants used for food service to retail, as well as narrowing meat assortment to focus on the fastest-selling items such as basic steak cuts to simplify the supply chain, said a person familiar with the situation. Sales of vacuum-seal bags are also rising at Walmart, a sign shoppers are buying food they intend to preserve, this person said.

Todd Allen, director of meat and seafood at the Raley’s grocery chain in West Sacramento, Calif., said the company is receiving about 80% of its chicken orders while its meat sales have increased about 67% since March. It recently removed purchase limits on chicken items and has been able to keep more inventory in its warehouses to meet the demand, but it is paying higher wholesale prices for some products, including 30% more for beef shoulders and around 80% higher for inside leg parts.

“If we have to lose money to be competitive, we do,” he said.

A few closed plants reopened this week. Cargill’s Hazleton, Pa., plant closed on April 7 after nearby Covid-19 cases spiked. Over the past two weeks the company installed plastic PVC sheeting between stations on the processing line, set up plans to check employees’ temperatures in the middle of shifts, and laid out one-way entrances and exits for cars and workers.

Early this week, about 60% of day-shift employees had returned to work and 70% for the night shift had done so, above expectations, Cargill said.

Write to Jacob Bunge at jacob.bunge@wsj.com, Sarah Nassauer at sarah.nassauer@wsj.com and Jaewon Kang at jaewon.kang@wsj.com

[END REPORT]

*********

Oh God. Now there'll be a run on nicotine patches and cigarettes.UPDATED 11:15 pm ET

UPDATE  
It didn't take a crystal ball to foresee this development. From The New York Post, 5:45 pm ET today:

Fearing a run on nicotine gum and patches, France has banned the online sale of the products — a move spurred by reports of a lower-than-expected number of smokers among those hospitalized with the coronavirus.
In addition to the online ban, French authorities are limiting people who purchase the smoking cessation products at pharmacies to one month’s supply only, BBC.com reported.[...]

END UPDATE

"Whilst the study design is far from perfect - and the authors are clear about its limitations - the evidence for a protective effect of smoking (or nicotine) against COVID-19 is bizarrely strong... actually far stronger than for any drug trialed at this stage... . It is a claim that has been emerging around the world. " -- Daily Mail

"The renowned French neurobiologist Jean-Pierre Changeux, who reviewed the study, suggested the nicotine might stop the virus from reaching cells in the body preventing its spread. Nicotine may also lessen the overreaction of the body’s immune system that has been found in the most severe cases of Covid-19 infection." -- The Guardian

I'll bet they're rolling on the floor with laughter at the Big Five cigarette companies. Predictably, the finding that nicotine could protect against COVID-19 has set off a brawl in the scientific community, with some scientists rubbishing the findings. But this group of French researchers isn't waiting around to see who wins:

Was Hockney RIGHT? French researchers to give nicotine patches to coronavirus patients and frontline workers after lower rates of infection were found among smokers

• A French study found that only 4.4% of 350 coronavirus patients hospitalized were regular smokers and 5.3% of 130 homebound patients smoked
• This pales in comparison with at least 25% of the French population that smokes 
• Researchers theorized nicotine could prevent the virus from infecting cells or that nicotine was preventing the immune system from overreacting to the virus 
• To test this theory, hospitalized coronavirus patients, intensive care patients and frontline workers [will wear] nicotine patches

By MARY KEKATOS SENIOR HEALTH REPORTER FOR DAILYMAIL.COM
PUBLISHED: 18:11 EDT, 22 April 2020 | UPDATED: 07:50 EDT, 23 April 2020
The Daily Mail [U.K.]

[Note:  The Mail seemed determined to beat The Guardian's report on the same news so their report included mention of other studies/scientific opinions connected with nicotine and the coronavirus. This makes for an interesting if long and complicated report.  To help with readability I've omitted all the charts, graphs, etc. included in the report; see the Mail's website for such data and text insets.]

The French study, performed at Pitié Salpêtrière, part of the Hôpitaux de Paris, used data from 480 patients who tested positive for the virus.

Three hundred and fifty were hospitalized and the remainder recovered at home.

Results showed that of the patients hospitalized, with a median age of 65, only 4.4 percent were regular smokers. But among those at home, with a median age of 44, 5.3 percent smoked.

By comparison, among the general population, 40 percent of those between ages 44 and 53 smoke, and around 11 percent of those aged 65 to 75 smoke.

The researchers determined that far fewer smokers appear to have contracted the virus or, if they have, their symptoms are less serious.

'Our cross-sectional study strongly suggests that those who smoke every day are much less likely to develop a symptomatic or severe infection with Sars-CoV-2 compared with the general population,' the study reads.

'The effect is significant. It divides the risk by five for ambulatory patients and by four for those admitted to hospital. We rarely see this in medicine.'

The team says it is not advocating that anyone start smoking because cigarettes have fatal health risks.

However, French neurobiologist Jean-Pierre Changeux, who reviewed the study, told The Guardian that nicotine may be hindering the virus from entering the body's cells.

In addition, the authors theorize nicotine could abate the immune system's overreaction to the virus, which leads to serious complications in some patients.

The researchers will verify the study's results by giving nicotine patches to hospital patients, those in intensive care and frontline workers.

This is not the first study to suggest that nicotine may ward off the coronavirus.

A French study from the Université Pierre et Marie Curie found that just 8.5 percent of 11,000 hospitalized coronavirus patients were smokers compared to 25.4 percent of the country's population.

And it also found, albeit in a small study, that people who had milder coronavirus infections and didn't need to be admitted to hospital had lower smoking rates, too.

Just 5.3 per cent of the 139 outpatients in the study were classed as active smokers - still a fifth of the proportion of smokers in the general public.

The paper focused on statistics but pointed to past research which suggested nicotine may alter receptors inside the body called ACE-2 receptors, which the coronavirus relies on as its gateway into the body.

Any protective effect, the researchers suggested, may therefore work for people with any level of infection, not just those with severe illness.

They wrote: 'The [smoking rates] did not differ between outpatients and inpatients, suggesting that the protective effect of smoking covered the whole population of symptomatic (both non-severe and severe) patients.

However, the US Food and Drug Administration (FDA) has said that cigarettes can increase the risk of contracting the disease.

'People who smoke cigarettes may be at increased risk of infection with the virus that causes COVID-19, and may have worse outcomes from COVID-19,' the agency told Bloomberg News.

The FDA has previously warned about 'worse outcomes' for coronavirus among smokers but did not specify what that meant.

Does smoking PROTECT against coronavirus? That was the amazing claim from David Hockney but multiple scientific studies now suggest he might be on to something

When world-famous artist David Hockney wrote a letter to the Daily Mail saying he believes smoking could protect people against the coronavirus many scoffed.

Mr Hockney wrote: 'Could it not be that smokers have developed an immune system to this virus? With all these figures coming out, it’s beginning to look like that to me.'

Understandably the claim was brushed off as laughable and 'rubbish' by many.

But is it?

A leading infectious disease expert at University College London, Professor Francois Balloux, said there is 'bizarrely strong' evidence it could be true.

And data from multiple Chinese studies shows that COVID-19 hospital patients contained a smaller proportion of smokers than the general population (6.5 per cent compared to 26.6 per cent), suggesting they were less likely to end up in hospital.

Another study, by America's Centers for Disease Control of over 7,000 people who tested positive for coronavirus, found that just 1.3 per cent of them were smokers - against the 14 per cent of all Americans that the CDC says smoke.

The study also found that the smokers stood no greater chance of ending up in hospital or an ICU.

The reasons for this are unclear.

Evidence coming out of scientific studies is conflicting and some say doctors are just too busy to be accurately noting down everyone's smoking habits.

Some researchers suggest smoking could reverse one of the ways in which COVID-19 damages the lungs while others argue the lung damage caused by smoke makes the organs more susceptible to failure.

Governments in both the UK and US urge people to stop smoking to protect themselves from the virus, but scientists admit there is no clear proof cigarettes can worsen the disease.

In his letter, Mr Hockney wrote: 'I used to joke that being a smoker in Malibu was the equivalent of being a non-smoker in Pasadena. They used to have very bad pollution there.

'Could it not be that smokers have developed an immune system to this virus? With all these figures coming out, it’s beginning to look like that to me.'

The British artist, now 82 and living in France, adds 'I'm serious' and has in the past revealed he's smoked for more than 60 years but still considers himself healthy.

Around 1.1 billion people around the world smoke cigarettes in spite of evidence they cause lung cancer, heart disease and numerous other life-threatening illnesses.

Whether they make people more likely to end up in hospital or die if they catch COVID-19, however, is unclear.

A study published earlier this month by scientists in New York and Athens claims the opposite.

It looked at 13 Chinese studies that had registered smoking as a precondition and found that the number of smokers across the whole sample of 5,300 patients was 6.5 per cent. An astonishingly small number in country where half of all men still smoke.

'This preliminary analysis does not support the argument that current smoking is a risk factor for hospitalization for COVID-19,' it reads.

'Instead, these consistent observations, which are further emphasized by the low prevalence of current smoking among COVID-19 patients in the US (1.3 per cent), raises the hypothesis that nicotine may have beneficial effects on COVID-19.'

The paper has not been reviewed by other scientists and admits that it is based on limited data, but says that nicotine and the coronavirus both interact with the same receptors on cells inside the lungs.

It was done by Dr Konstantinos Farsalinos and Dr Anastasia Barbouni, from the University of West Attica in Athens, and Dr Raymond Niaura of New York University.

They suggest that while the virus causes lung damage by depleting the numbers of those receptors - known as ACE-2 receptors - smoking can increase the number of them, reversing the effect.

ACE-2 receptors, which are found on cells in the airways and lungs, have been said to work as the coronavirus's doorway into the body and to 'facilitate' infection.

Therefore having more of them would seem to be a bad thing, but scientists say they have a protective effect in the lungs and low levels are linked to worse damage from viral infection.

A 2008 study in mice found that getting rid of ACE-2 made the animals more likely to suffer severe breathing difficulties when infected with the SARS virus, which is almost identical to COVID-19. ACE-2's function in human lungs is poorly understood.

Dr Farsalinos's study was shared on Twitter by Professor Francois Balloux, director of the genetics institute at University College London.

Professor Balloux described the paper as 'puzzling' and added: 'Whilst the study design is far from perfect - and the authors are clear about its limitations - the evidence for a protective effect of smoking (or nicotine) against COVID-19 is bizarrely strong... actually far stronger than for any drug trialled at this stage...'

It is a claim that has been emerging around the world.

French scientist Professor Jean-François Delfraissy, who is leading a scientific council advising the country's government on COVID-19, said: 'We have something very special with tobacco.

'We have found that the vast majority of serious cases are not smokers, as if (…) tobacco protects against this virus, via nicotine,' French news site Sud Ouest reported.

The study by Dr Farsalinos adds by way of explanation: 'It has been observed that decreased ACE-2 availability contributes to lung injury and acute respiratory distress syndrome development.

'Therefore, higher ACE-2 expression, while seemingly paradoxical, may protect against acute lung injury caused by COVID-19.'

This is a disputed area of science - there are studies which show smoking can both increase and decrease the levels of ACE-2 available on someone's lung cells.

An increase before infection could allow more of the viruses to get into the body in the first place, making someone more vulnerable to the disease.

A paper published by scientists at University College London offers the opposite view to Dr Farsalinos.

It said: 'SARS-CoV-2 has been shown to enter cells through the ACE-2 receptor​.

'Some evidence suggests that gene expression and subsequent receptor levels are elevated in the airway and oral [cells] of current smokers​, thus putting smokers at higher risk of contracting SARS-CoV-2.

'Other studies, however, show that nicotine downregulates the ACE-2 receptor.'

Professor Jamie Brown, an addiction researcher at UCL and one of the authors who wrote that paper, told MailOnline the link is 'very difficult to understand'.

'Everything we know about other respiratory viruses and comorbidities [health problems] suggests smokers will suffer worse outcomes,' he said.

Only recently - a paper published this year claimed to be the first - have scientists started to record that smoking increases ACE-2 levels in the airways.

It had previously been reported to reduce levels, something that researchers have linked to worse lung damage in coronavirus infections.

While higher levels of the receptor may offer some protection in theory, they also offer more doorways through which the virus can enter the body.

The study in the European Respiratory Journal said: 'While the up-regulation of ACE-2 may be useful in protecting the host against acute lung injury, chronically, this may predispose individuals to increased risk of coronavirus infections, which uses this receptor to gain entrance into epithelial cells.'

Professor Brown added that, considering how smoking influences other lung infections, he would be 'very surprised' if it didn't make COVID-19 worse.

One paper suggested that a reason children appear not to be badly affected, in general, by the coronavirus could be that they have more ACE-2 receptors than adults, but it added there is 'a lack of evidence to show that ACE-2 expression varies with age'.

Dr Farsalinos and his colleagues' study even suggested that withdrawal symptoms from not being able to smoke in hospital could make cigarette users' symptoms worse.

It added: 'Hospitalization for COVID-19 will inevitably result in abrupt withdrawal of nicotine and its beneficial effect linked to this hypothesis in smokers or users of other nicotine products.

'This could, at least partly, explain the association between smoking and COVID-19 severity among hospitalized patients.'

The theory of smokers having some level of protection from the virus stems from raw hospital data which suggested only small proportions of seriously-ill patients smoke.

Hospitals in China, the US, Germany and France have had hundreds of thousands of coronavirus patients but admitted disproportionately small numbers of smokers.

According to the campaign group, Foundation for a Smoke-Free World, early data showed that in Germany six per cent to 21 per cent; and in France six per cent compared to 27 per cent.

Data from the Centers for Disease Control and Prevention (CDC) in the US showed that of around 7,000 COVID-19 patients, former smokers were more likely to be hospitalised or taken into intensive care than current smokers.

Just 22 of the hospital patients and five of those in intensive care admitted to being smokers, while 45 in hospital and 33 in ICU said they were former smokers.

Public Health England has not published any information about the people diagnosed or hospitalised with coronavirus in the UK.

Why then, scientists have asked, do smokers make up such a small proportion of patients when there are significantly more of them in the countries?

Experts have knocked this theory down and say reporting of who smokes and who doesn't has not been accurate enough.

UCL's Professor Brown told MailOnline: 'It's difficult to assess how well smoking status has been recorded in an emerging epidemic and a lot of these people have been too sick to answer or have not replied totally honestly.'

He added: 'We know generally smokers tend to come from lower income groups which have poorer access to healthcare... so may be more likely to die in the community.'

Professor Paul Hunter, a former NHS doctor and now medicine lecturer at the University of East Anglia, agreed that recording was likely to blame.

He told MailOnline: 'One interpretation is that smokers are less likely to end up in hospital.

'But actually it's more of an indication that when you've got doctors who are unbelievably busy they don't complete all of the questioning they would normally do.'

Professor Hunter added that the notion smoking could protect people from COVID-19 was 'rubbish', but admitted the ACE-2 receptor link deserved further study.

Early data from America's Centers for Disease Control and Prevention (CDC) showed that just 1.3 per cent of people diagnosed with COVID-19 were classified as smokers.

From a sample of 7,162 of the nation's earliest patients, just 96 were 'current smokers'. Just 22 out of 1,037 patients in hospital were smokers, along with five out of 457 in intensive care, according to the data.

This contrasts sharply with the CDC's statistics that show 14 per cent of all Americans regularly smoke cigarettes.

It is not clear whether there is a link between smoking and a lower risk of catching or falling ill with coronavirus, or whether recording of who smokes and who doesn't isn't up to scratch.

University College London's Professor Jamie Brown, a tobacco and public health expert, said he expects it to be the latter.

He told MailOnline: 'It's really difficult to assess how well smoking status has been recorded in an emerging epidemic and a lot of these people have been too sick to answer or may not have replied totally honestly.

'We know, generally, smokers tend to come from lower income groups which have poorer access to healthcare and may be more likely to die in the commmunity.'

A researcher at Cold Spring Harbor Laboratory in New York, Jason Sheltzer, picked apart Dr Farsalinos paper on Twitter with similar logic, calling the study 'severely flawed'.

He said that the measures for what defined a smoker varied across the world and across the multiple other studies that were referenced in the paper. One of them, he said, only classified very heavy smokers and not those with lighter habits.

A deeper dive into data, Mr Sheltzer wrote, revealed that smoking actually appeared to be linked to a higher risk of severe infection.

He said: 'In order to further investigate, I emailed the authors of some of the studies on COVID-19 in China. One doctor replied that their smoking frequency was so low because some patients were literally too sick to answer the question.

'So... it’s clear that in these studies, the definition of a smoker is neither consistent nor consistently applied. You can’t throw them all on a graph and call it a meta-analysis.'

He added: 'In short, I think that this analysis is severely flawed. They’re comparing statistics that shouldn’t be compared.

'I don’t think that there’s any convincing evidence that smoking protects against coronavirus.'

Government bodies are adamant that people should not consider the prospect of smoking being protective against the illness, which can be deadly, especially for people who already have health problems.

Both Public Health England and the Centers for Disease Control and Prevention (CDC) have urged people to stop smoking to protect their health.

British Health Secretary Matt Hancock last month said: 'It is abundantly clear from the research into previous coronaviruses that smoking makes the impact of a coronavirus worse.'

And his chief medical adviser, Professor Chris Whitty, added: 'If you are going to give up smoking, this is a very good moment to do it.'

[END REPORT]

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Myriad companies are retooling to make essential medical supplies. It's an astounding project.

"Medical equipment can indeed be hard to manufacture in a hurry, particularly by firms that have never made it before."

An April 19 report from The Economist chronicles a globe-spanning effort by all kinds of companies to switch within hours to manufacturing and distributing supplies that are desperately needed by medical facilities during the pandemic. The obstacles such companies are overcoming at breakneck speed is an inspiring example of what people can do when they put their minds to it. Here are some passages from the report:

[...]

“If you’re not asking what more you can do,” [Flavio] Volpe says, “we’re all going to fall short.”

For Mr Volpe, that means responding to the surge in demand for essential medical supplies caused by the pandemic. He is president of APMA, the trade association for Canada’s auto-parts suppliers. So far 77 member firms are converting some capacity to making medical equipment. A consortium led by one of the biggest, Linamar, is helping to assemble ventilators. Woodbridge, an upholsterer, is turning out masks. Plastics firms are producing face shields; airbag-makers, gowns; others, nose-swabs.

[...]

Typically in markets, surges in demand call forth extra supply. But the supply of medical gear has not been able to expand at the breakneck pace needed to keep up with the virus. 

[...]

Worse, the world economy’s sudden halt has caused bottlenecks. Flexport, a freight forwarder, says that normally half of all air freight cargo (on some routes, up to 80%) travels in the holds of passenger planes that are no longer flying; shipping lines, meanwhile, have cancelled sailings or dropped ports from their itineraries. Vendors’ commercial terms have become tighter too.

[...]

Amid the scramble, lots of higher-minded efforts like Mr Volpe’s are underway to fill the gap. Some are of cottage-industry dimensions: across Britain, for instance, “scrub hubs” have sprouted, with volunteers making basic gowns at home for doctors, nurses and care workers. But to make more sophisticated gear at scale, you need industrial muscle.

[...]

Fashion firms are turning their supply chains to masks and gowns. Sweden’s H&M has sent 50,000 masks each to Italy and Spain, and is planning to deliver 1m protective, single-use aprons to Swedish hospitals in the coming weeks, all from suppliers in China. 

Canada Goose, which makes outdoor apparel, has committed itself to making 60,000 disposable gowns for isolation patients per week from its domestic factories. 

In France, the LVMH factory that normally makes Christian Dior perfumes has been retooled to produce hand-sanitiser.

Makers of cars and planes are starting to turn out ventilators and other equipment—sometimes from scratch, sometimes lending their scale to the existing products of specialist companies. 

On April 14th General Motors began producing critical-care ventilators from Ventec Life Systems, a medical-technology firm, at its car factory in Indiana. Ford, PSA, Valeo and others have also switched from vehicles to ventilators. Israel Aerospace Industries, a defence company, has converted a missile production line to the same.

“With time, we can make anything,” says Mr Volpe at APMA. “Whether you’re making a plastic part that goes into a ventilator or a plastic part that goes into a Jaguar, it’s the same process.” 

The difference lies in speed. Changing an engineering process, from winning a contract to retooling to production, might normally take six months. That is being compressed into a few days. Canada’s health authorities have helped by speeding up approvals, he says, without dropping their standards. There have been some failures.

Medical equipment can indeed be hard to manufacture in a hurry, particularly by firms that have never made it before. In Britain, NHS staff report that some new shipments of droplet-resistant gowns—of which there is a severe shortage, because they weren’t included in the existing pandemic stockpile, designed for airborne flu viruses—have failed quality tests when they arrived, rendering them unusable. After some Chinese-made equipment sent to Europe was rejected as substandard, China is now requiring that its exporters meet importing countries’ standards before their goods leave the factory (though that causes more holdups meanwhile).

Sourcing high-specification materials also can be difficult, although Barbour has had success switching from its famous wax jackets and Ford is adapting fabric meant for airbags. 

Mr Volpe says his biggest bottleneck is materials: some unwoven material for specialised masks is made in volume only in China; the supply of resins used in swabs are threatened by American export restraints.

These problems become even more acute with complicated medical machinery. Britain’s government has overseen a scheme under which aerospace, automobile and engineering companies agreed to make ventilators. However, only one design—adapted from an existing ventilator, from Penlon, a medical-device company—has so far been approved for medical use. Changes to the required specification led the government to cancel an order for thousands of units of a more simple ventilating device, known as “BlueSky”, from a consortium including the Renault and Red Bull Formula 1 groups.

And clearing one bottleneck may reveal another. Although ventilators, for example, are crucial for treating many covid-19 patients in intensive care, they are not used in isolation. Every ventilator bed requires high-pressure oxygen (which many hospitals cannot provide at scale) as well as other machines to monitor the heart and kidneys. All this takes up more precious space and requires trained staff, of whom many are sick or in precautionary isolation.

Even if sufficient stock is available, distributing it is a challenge. General practitioners, ambulances, mental-health services and care homes all need PPE [personal protective equipment] as well as hospitals. In England, NHS Providers, which represents hospital trusts and other parts of the service, estimates that the supply chain has gone from delivering to around 250 trusts to tens of thousands of separate organisations.

[...]

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Compay Segundo's recipe for vitality in old age

At a fiesta he sang to President Fidel Castro, who took his pulse and joked about his vitality despite his 90-plus years. "Who could have imagined that?" he asked when he found himself at the Vatican City, performing "Chan Chan" before Pope John Paul II. He explained his longevity simply: mutton consommé and a drink of rum.

"He" was a Cuban named Máximo Francisco Repilado Muñoz Telles, known professionally as "Compay Segundo," who became a star all over again in his 80s. He lived to the respectable age of 95 and was performing right up to the end of his life. He was a trova guitarist, singer and composer who inspired generations of Afro-Cuban musicians. And he invented the armónico, a seven-stringed guitar-like instrument, to fill the harmonic jump between the Spanish guitar and the tres.  This brief memoir by a fan goes into some detail to explain how international fame came to him in his old age; it's as much a story about the rise and fall and rise again of Afro-Cuban society in Cuba as about one musician. 

Compay had additional explanations for his vitality: women, cigars, flowers, and -- 

His sunny disposition and sense of humor surely also helped.   

I like "Chan Chan," his most famous composition, but I love his rendition of "Guantanamera." I sing along whenever I'm feeling overwhelmed by reports on Covid-19. 

Here are the lyrics, courtesy of Juan Diego Jerez posting at YouTube:

Guantanamera, guajira guantanamera Guantanamera, guajira guantanamera Yo soy un hombre sincero De donde crece la palma Y antes de morir yo quiero Echar mis versos del alma Guantanamera No me pongan en lo oscuro A morir como un traidor Yo soy bueno y como bueno Moriré de cara al sol Guantanamera Con los pobres de la tierra Quiero yo mi suerte echar El arroyo de la sierra Me complace más que el mar Guantanamera Tiene el leopardo un abrigo En su monte seco y pardo Yo tengo más que el leopardo Porque tengo un buen amigo Guantanamera, guajira guantanamera
Compositores: Jose Diaz / Joseito Fernandez Diaz Letra de Guantanamera © Universal Music Publishing Group

As to the mutton consommé, it's a nutritious dish, that's for sure, but the closest recipe I could find (on the internet) is from Australia and it's for a lamb consommé. What's the difference? Technically mutton refers to meat from a lamb that's more than two years old but I don't think there's a difference here in the USA because all lamb meat sold in grocery stores is called lamb, no matter what its age -- although the mutton meat is darker than the younger lamb, which may or may not make a difference in the flavor of the consommé.   

The chef notes the recipe takes patience to make. Yup, from what I understand of the following instructions (see below). And the recipe starts with lamb stock. Somehow I don't think packaged lamb stock is available even at Whole Foods so you would have to start from scratch. But hey, if you're in Covid lockdown, what else do you have to do with your time?  Just sing along with Compay while you're making stock and learning to chop vegetables brunoise style.  

Ingredients

1 Litre Lamb stock

200 g Mirepoix (100 g Onions, 50 g Celery, 50 g Carrots, cut Brunoise)

1 Bay leaf, crushed

1 g Sea Salt

5 Eg Whites

50 g Ice

Lamb mince

********

Method

Whip the egg whites with salt and mirepoix/mince, then fold through the stock with ice.

Simmer for 1 hour, allowing the lamb protein to bond with the egg whites.

Pass through serviette, or other membrane leaving a clear liquid.

Guantanamera