How to (Not) Hydroxychloroquine COVID-19

The medical journal The Lancet published a study Friday which showed anti-malarial drug hydroxychloroquine (HCQ) — the same drug repeatedly pushed by Trump — does not work as intended against the virus which causes COVID-19.

Hydroxychloroquine’s precursor drug, chloroquine, has shown mild antiviral action in vitro against the Borna disease virus (an orthobornavirus), the minute virus of mice MVMp (a parvovirus), and the avian leukosis virus (a retrovirus) as well as the coronavirus which causes SARS. It has also shown promise against Hepatitis A (a hepatovirus).

But both hydroxychloroquine and chloroquine posed inherent risks to patients as they increased the risk of heart arrhythmia.

Ideally, HCQ’s antiviral effect would prevent the coronavirus SARS-CoV-2 from replicating, allowing the body to attack and remove the virus before it could attack human cells and spread through the body, resulting in earlier recovery from the infection.

Patients who received both HCQ, or its precursor chloroquine, with or without an additional antibiotic, did not recover faster than the cohort which didn’t receive chloroquine.

Further, the patients receiving the drug therapies were more likely to die than those who didn’t.

This study is the latest showing HCQ or chloroquine both didn’t work and increased patient mortality. Previous negative studies included:

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection – A Randomized Clinical Trial
Mayla Gabriela Silva Borba, MD; Fernando Fonseca Almeida Val, PhD; Vanderson Souza Sampaio, PhD; et al
JAMA Network Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765499

Of particular note:

Findings In this phase IIb randomized clinical trial of 81 patients with COVID-19, an unplanned interim analysis recommended by an independent data safety and monitoring board found that a higher dosage of chloroquine diphosphate for 10 days was associated with more toxic effects and lethality, particularly affecting QTc interval prolongation. The limited sample size did not allow the study to show any benefit overall regarding treatment efficacy.

Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
Joseph Magagnoli, Siddharth Narendran, et al
Pre-print; posted April 23, 2020. medRxiv 2020.04.16.20065920; doi: https://doi.org/10.1101/2020.04.16.20065920
https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2

Of particular note:

CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

We still don’t know why Trump is pushing this drug. It’s no longer under a patent and now a generic medication; it’s cheap to produce. If there’s money to be made by promotion of this medication it’s not clear how Trump profits.

We still can’t be certain he’s taking it himself though he claims he is; the letter from his doctor does not clearly state that Trump has been prescribed HCQ and at what dosage for what period of time nor has there been any information provided with regard to the nature of monitoring Trump receives while taking HCQ.

We don’t know why Trump would claim to take HCQ on the advice of some unknown person alleging to be a doctor. We’ve no further information about the letter, the letter’s author, whether a letter even existed since Trump has a proven propensity for making up shit.

All we can be sure of at this point is that more patients with COVID-19 may have died, potentially because of HCQ’s promotion by Trump, than may have died had he refrained from practicing medicine without a license by pushing HCQ.

In the case of the study of HCQ at Veterans Health Administration medical centers, former service persons who’ve already paid a price for our freedoms have been used in human experimentation in what might have been an attempt to validate Trump’s claims about HCQ — and some of them died for it.

It seems odd VA doctors used it out of the clear blue when the Food and Drug Administration hadn’t formally approved this drug for COVID-19 patients. (It’s probably just a coincidence the Center for Disease Control lifted its guidance on off-label use of HCQ two weeks before the VA study was published, right?)

It’d be nice to know if Trump’s three golf buddies at Mar-a-Lago — one of then a doctor — had anything to do with the use of HCQ and chloroquine at VA hospitals on COVID-19 patients.

There’s simply no good reason for Trump’s plugging this particular drug therapy except to harm and kill Americans.

Where’s the Beef? Republicans Don’t Understand Critical Infrastructure and Supply Chains

Over five weeks of a mostly-national shutdown, we never figured out how to protect essential workers.

By April 9, at least 9,000 health care workers — people trained in the proper use of personal protective equipment — had the virus and at least 27 health care workers had died. More than half had no known exposure to COVID outside of their work.

During the period of the shutdown, outbreaks occurred throughout the meatpacking industry, leading to shutdowns in a number of factories.

As a result, we’ve got meat shortages even as farmers have nowhere to sell their livestock. There were reports that a fifth of Wendy’s restaurants have run out of beef.

Stephens analyst James Rutherford said that a study of online menus for every Wendy’s location nationwide revealed that 1,043 restaurants — or 18% of its national footprint — have listed beef items as out of stock. More than 100 locations are still selling Wendy’s chili, which contains beef.

The shortages vary by state. Hundreds of Ohio, Michigan, Tennessee and New York restaurants are out of beef, while other states’ menus do not indicate any supply chain issues.

A Tectonix GEO analysis shows one reason why: people from one of the heavily affected areas traveled throughout the country. That suggests one possible way COVID has spread to a bunch of relatively remote factories was truckers serving the industry. I’ve heard inspectors also likely spread the virus between factories.

There were COVID clusters in a number of other professions that remained open during the shut-down: cops, prison guards, public transport workers, grocery store workers.

We never figured out how to protect these critical workers when it was relatively easy, when they and other essential workers made up most of the people on public transportation, when they were the only people relying on child care. That’s partly because we never managed to get the PPE and test and tracking systems in place to keep them safe.

And as a result, as the meat industry shows, our failure to protect critical workers has led to strains in a key part of our food supply chain, impacting consumers and suppliers up and down that supply chain.

Coronavirus has even threatened parts of our economy more directly responsible for keeping people alive. Before we shut down, for example, our Air Traffic Control was buckling, as the virus spread among workers in the close spaces of control towers.

If we were a sane nation, focused on the public good rather than bottom line dollars, we would have spent the five weeks of national shut-down figuring out how to protect critical workers and implementing those systems wherever workplaces had not shut down. We would have used that time to test the system and build up stocks of PPE and test kits needed to replicate the system in other, less essential work places. We would have perfected systems for keeping workers safe in the time of COVID, so we could learn how to do it while it was relatively easy, giving us something to replicate when the economy reopened.

We’re not a sane nation. We’re largely not focused on the public good.

And as a result, during the entire five weeks of the shutdown, we watched in fascination at what happens when you continue to work without implementing adequate measures to limit the spread of COVID without taking the obvious lessons from it. Again, we watched that happen at a time when it would have been easier to protect critical workers, because they were interacting with a limited number of other people. As the economy reopens, it will get harder to protect such workers, because there will be more people using public transportation and in grocery stores and relying on child care, increasing the likelihood that a single case can spread to more people, each potentially leading to the shut-down of an entire workplace three weeks later.

By failing to solve the problem of how you protect workers, those rushing to reopen the economy have set this country up for key failures in our rickety supply chain. Some of those failures will be nuisances, with factories idled because they’re missing a key part or shortages of non-essential items in stores. Some of the failures could lead to further health consequences. Some failures may happen in industries where workers are a lot harder to replace quickly. Those failures will make it harder for businesses that are open, as any outbreak will add to already inflated costs of operating, to say nothing of the blow to confidence such failures will bring.

It turns out, a lot of Republicans don’t understand how our economy works (though the same misunderstandings lay behind their opposition to bailing out the auto industry in 2008). They don’t understand that if critical parts of our fragile system break down, other parts begin to break down, potentially setting off a chain reaction.

And as a result, they’re rushing back to reopen the economy without first having done the basic things needed to operate businesses safely.

Yes, we need to take steps reopen the economy for the sake of the economy and our collective sanity. Which is why it was so important for the Federal government to put the pieces in place that would facilitate reopening the economy during the shut down. Only, the Trump Administration did not do that. It squandered the sacrifice made by the 33 million Americans who lost a job in that period. Now, not having put those pieces in place, the Trump Administration is pushing to reopen the world’s largest economy relying on little more than homemade masks to keep it running.

Long Overdue Policies that Look Obvious in the Age of Pandemic

I’m not usually a fan of George Packer. But I keep coming back to this column, We Are Living in a Failed State. The coronavirus didn’t break America. It revealed what was already broken, which is something I might have written. It argued that this pandemic, to which the US responded like a corrupt poor country, was actually the third crisis of this century, and our responses to the previous two — 9/11 and the Iraq War, and the Wall Street crisis — simply brought this country to the place where Trump could loot it.

Like a wanton boy throwing matches in a parched field, Trump began to immolate what was left of national civic life. He never even pretended to be president of the whole country, but pitted us against one another along lines of race, sex, religion, citizenship, education, region, and—every day of his presidency—political party. His main tool of governance was to lie. A third of the country locked itself in a hall of mirrors that it believed to be reality; a third drove itself mad with the effort to hold on to the idea of knowable truth; and a third gave up even trying.

Trump acquired a federal government crippled by years of right-wing ideological assault, politicization by both parties, and steady defunding. He set about finishing off the job and destroying the professional civil service. He drove out some of the most talented and experienced career officials, left essential positions unfilled, and installed loyalists as commissars over the cowed survivors, with one purpose: to serve his own interests. His major legislative accomplishment, one of the largest tax cuts in history, sent hundreds of billions of dollars to corporations and the rich. The beneficiaries flocked to patronize his resorts and line his reelection pockets. If lying was his means for using power, corruption was his end.

Packer ends with a call for renewed solidarity.

But he might as well also call for a fix to all the failures of the past twenty years. Right now, mind you, Trump is failing, miserably, in part because he believes maximizing the opportunities for looting by his friends is all the policy he needs.

But the sheer scale of the crisis makes policies that long made sense for the United States more urgent and far easier to justify. I plan to keep a running list of those policies.

Medicare for All

No one has figured out how all the people put out of work by the shut-downs will pay for COVID-related health care. Trump has persisted in a plan to kill Obamacare, and some badly affected states never even expanded Medicaid.

Early reports suggested that Trump’s administration has claimed it is willing to pay hospital bill, so long as they pay those bills directly (thereby avoiding establishing a policy, I guess). But with so many people out of work and with hospitals reeling from the shut-down, the far better solution is to make Medicare available to all.

Universal Basic Income

The US government has been backing credit for big industry and tried, but failed, to provide free money for small businesses to keep their employees on staff. Instead, 26 million Americans have applied for unemployment, a sixth of all workers (and a third of all workers in MI, KY, and RI). Meanwhile, the Administration botched even a one-time $1,200 payment.

The government could better ensure that markets don’t crash entirely–and keep states from buckling as they try to serve all these unemployed people–if they simply gave a UBI to all people, as Spain has decided it will do. By keeping it, the US might be able to address the underlying inequality problems that have led to such a disproportionate impact of COVID on communities of color.

Decarceration

Closed spaces, generally, amount for a huge percentage of COVID cases and (in the case of nursing homes) deaths. ACLU just rolled out a paper that argues the models for COVID (which were originally based off other societies’ social patterns, including their prison system) underestimate the total number of deaths because they don’t account for the spread in our prisons.

COVID will remain lethal for long enough that states and the federal government will need to achieve some level of decarceration to prevent the prisons from becoming a source of spread to the wider community (as they have become in the localities with harder hit prisons).

In this case, even before COVID hit, there was bipartisan support to wean ourselves from overincarceration. Prisons will become less lucrative in conservative communities, especially as some states begin to end prison gerrymandering (which gives rural communities representation for prisoners who can’t vote, just like slavery did).

So now is the time to end incarceration for minor crimes, and improve the humanity of incarceration for those who need to be jailed.

Deindustrialization of the Food System

We’ll be lucky if we avoid famine conditions. That’s partly because our food system has the same institutional/retail split our toilet paper supply chain does, meaning the market for half of the food out there disappeared when restaurants and other institutional buyers shut down. That’s partly because bottlenecks in our food supply chain — most notably, thus far, meatpacking plants, but there will be others — have further undermined the market for our plentiful food production. And that’s partly because Trump’s farmer support, thus far, has emphasized direct payments that are effectively a continuation of his earlier bribery of farmers whose markets his trade war screwed, rather than purchasing up surpluses to provide to food banks.

Trump hasn’t shown an ability to get any other needed supplies where they’re needed; it’s unlikely he’ll do better with food.

Meanwhile, food supplies that bypass these commodity markets remain. We need to make this food supply chain more resilient and one way of doing so is to bypass the industrial bottlenecks.

Broadband as a Utility

When schools shut down, it suddenly became acutely visible how many Americans — both rural and urban — don’t have broadband. While some areas have gerry-rigged solutions (like driving wifi-enabled busses to poorer neighborhoods) to get some kids online and learning, that’s not possible everywhere. And even for adults, it takes broadband access to be able to social distance.

Trump is already talking about using infrastructure investments to get America working again. Extending basic broadband as a utility should be part of that.

Update: Arne Duncan describes what needs to happen for existing efforts to expand broadband access to be really effective.

Industrial Policy

Two months after we first identified shortages in necessary medical supply, we’ve barely managed to switch production to those necessary objects, even as entire factories were otherwise shut down. We’ve got shortages of not just testing kits, but the underlying supplies. We’ve got drug shortages too (and had them, even before the President started pitching miracle cures).

It’s long past time to admit that we do have an industrial policy — but right now, it’s focused on building the troubled F-35, not ensuring that the United States has the ability to build the things we need domestically, even if we interact openly with the rest of the world. This story uses the failed lithium battery investments Obama made, largely in Michigan, to talk about how we came to be unable to supply our own medical equipment.

We have an industrial policy. We just need to be willing to match that policy to our society’s real needs, not exporting warmongering.

On Mountains, Mountain Climbing, and COVID-19

Memorial to climbers who have died on Mount Everest at the Pheriche Aid Post (h/t akunamatata via flikr; CC BY-ND 2.0)

The language of mountains and mountain climbing is all over the COVID-19 coverage, from the talk of “reaching the peak” of infections to the euphoria of those who proclaim that in various areas, we are “hitting the plateau.” But as a mountain-climbing friend once told me “Climbing the mountain is the easy part — it’s the descent that’ll kill you.”

This is not just a cliche, or a (non-)urban legend, but backed up by the experience of those who know the mountains best:

Kami Rita Sherpa knows Mount Everest better than anyone else: He’s summited the world’s tallest peak 24 times, more than any person in history. . . .

Sherpa said problems arise not from those lines [of climbers waiting at altitude to pass along single-file sections of the climb], but when people accidentally push past what their body can support. Some research suggests that Everest climbers can develop a kind of “summit fever,” racing to the top to prove they can, even when their bodies are showing signs of giving out.

“At that altitude, it takes everything to put one foot in front of the other,” Everest climber and exercise psychologist Shaunna Burke recently told Business Insider. “If you haven’t judged how much gas you have left in the tank, then you can’t make it down. That’s why some climbers sit down and don’t get back up.”

Sherpa echoed this.

“When returning, their body is out of energy, and many people die due to this cause,” he said.

It’s not just one or two climbers’ opinion, either. In 2006, Paul Firth and his colleagues published “Mortality on Mount Everest, 1921-2006: descriptive study” in the British Medical Journal, which looked at every documented death on Mount Everest and sought to understand what commonalities might be found among the fatalities. They first distinguished between deaths below 8000 meters as climbers and their guides traversed areas prone to avalanches, crevasses, and other features of the mountain, and the deaths that took place above 8000 meters, where the mountain is generally more stable but fatigue and altitude sickness are the greatest dangers. On the lower part of the mountain, guides were more likely to be the ones who died, which the authors surmise is because the guides make multiple trips up and down the climbing route, setting ropes and bringing supplies up to the higher camp, before they guide the climbers along the route they found and made more safe. When it came to the deaths above 8000 meters, however, things reversed, and they noticed some shocking numbers:

Table 3 presents data on the mountaineers who died after reaching 8000 m. Fifty three (56%) died during the descent, 16 (17%) after turning back below the summit, and nine (10%) during the ascent. The stage of the summit bid was unknown for 12 mountaineers (13%), and four (5%) died before leaving the final camp.

Look at those top three figures again: 10% died while making the push for the summit, and 73% died while descending. For every death going up, there were 7 going down.

Maybe these climbers who died on the way back down pushed too hard going up, and had nothing left for the descent. Maybe they became disoriented because of lack of oxygen and quit thinking clearly. Maybe they were so excited at having made it to the top that they got sloppy as they turned around and headed down the mountain.

Whatever the cause, the study was clear: descending from the peak is more deadly that making the climb up. As our veteran climber cited above put it:

Burke said that although all climbers want to reach the summit, that objective alone can be a problematic.

“The summit is only halfway,” she said. “Your ultimate goal should be to make it back to camp alive.”

I look at the images of the folks protesting the “stay-at-home” orders issued to fight the COVID-19 epidemic, and their cheers of things like “We made it! We stopped the disease! Now let’s open things up again and get back to work!” I read the tweets to “liberate” this or that state, cheering on those who think the task is done. Then I think of the mountain climbers cheering at having reached the top of the mountain, who don’t realize how dangerous things can be on the way back down. That’s what worries me about all the talk of opening back up right now.

Yes, some places may have reached the peak of new infections, the peak of ICU bed usage, and the peak number of intubated patients. But here’s the thing: we are still on the mountain. Getting to the top is great, but the goal is to make it back to camp alive.

I don’t want to minimize the accomplishment of the climb, whether speaking of those who scale mountains or those who have been struggling to keep ahead of the increasing numbers of those hit by COVID-19. But relatively speaking, climbing the mountain is the easy part. It’s the descent that’s much more likely to kill. Face it, people: This journey has a long way to go, with plenty of opportunities for negligence and for misplaced cheering which will give life to a virus that deals out death.

This is no time for getting complacent or sloppy. Stay home, stay safe, save lives.

Trump Puts his Rasputin Guy, Michael Caputo, at Department of Health and Human Services During a Pandemic

As Politico reported yesterday, in a bid to marginalize Alex Azar (who has been largely silenced in the middle of a pandemic since Rod Rosenstein’s sister Nancy Messonier told the truth in public), Trump has made Michael Caputo the spokesperson at Department of Health and Human Services.

The move is interesting for several reasons. It suggests the White House believes the way to control a Senate-confirmed cabinet member is to hire a spokesperson for that person, not to replace him or work out problems with him.

The move is designed to assert more White House control over Health and Human Services Secretary Alex Azar, whom officials believe has been behind recent critical reports about President Donald Trump’s handling of the coronavirus pandemic, according to two officials with knowledge of the move.

That, in turn, suggests that in the middle of a pandemic, Trump’s White House is treating HHS as a PR shop, not a functional agency.

But the far more interesting aspect of this hire is that, as recently as February 3, Bill Barr’s DOJ claimed in FOIA exemptions on Caputo’s FBI interview report that it was conducting an ongoing investigation into something Caputo did during the 2016 election — possibly with Roger Stone — called Project Rasputin. What Project Rasputin was is redacted in the 302. But whatever it was is closely enough connected with his and Stone’s willingness to take a meeting with a Russian selling dirt on Hillary Clinton that Caputo told Mueller’s team that, “‘Project Rasputin’ was mutually exclusive from anything having to do with” the guy selling that dirt.

Of course, on precisely the same day that Bill Barr’s DOJ released materials indicating it was still investigating something called Project Rasputin that Caputo had been involved in, Barr replaced then DC US Attorney Jesse Liu, who had permitted the Roger Stone investigation and prosecution to proceed unmolested by the kind of unprecedented interference that Barr would engage in just days later. Which raises questions about whether Trump doesn’t care that his own DOJ was still investigating something Caputo did in 2016, or whether Barr saw to it that investigation ended, making Caputo hirable for the first time in Trump’s Administration.

When I asked Caputo what Project Rasputin was, he simply responded by tweeting a picture of the charlatan advisor to a czar, a picture he has since deleted (along with a bunch of other Tweets he purged before taking this position).

Ah well. I’m glad that Trump’s desperation to stop Azar from telling the truth about how the President ignored sound medical advice in favor of conspiracy theories will provide yet another pressing reason to ask Reggie Walton to fully declassify the 302s describing this project.

Research Misinfo/Disinfo: Off-Label COVID-19 Therapy Has No Proof

[Check the byline, thanks! /~Rayne]

Funny enough, this COVID-19 post originally came about because of one of my family members.

They sent me a link to an op-ed from the Detroit News — the more conservative of the two major Detroit-based papers in this state — in which the author took Michigan’s Gov. Gretchen Whitmer to task because the state’s Department of Licensing and Regulatory Affairs clamped down on off-label prescriptions of an antimalarial drug.

“Any thoughts on the mandate against hydroxychloroquine?” they asked along with the link.

“Oh no,” I replied, “the author is going to regret writing that op-ed.”

They really had no idea what they were writing about. But then Trump doesn’t either.

~ ~ ~

We’re desperate. Trump and his minions don’t want to admit it, carrying on with Trump’s daily self-fluffing at the podium in front of his narcissistic supply, I mean, select White House press pool as if everything is under control.

We the public know it’s not. On Wednesday March 25, actor and activist George Takei pointed out a person died of COVID-19 in New York City every six minutes the previous day. The numbers have only grown worse.

We are that measurably desperate.

We’re grabbing at any kind of research, peer-reviewed and not, to find a way to shut down this fire hose of death because the other realistic alternative is at least 18 months of alternating levels of social distancing until a vaccine for COVID-19 has made it through multiple trials.

In a previous post I did homework and laid out some of the off-label approaches which have been taken in other equally desperate countries — like the antiviral remdesivir and the rheumatoid arthritis medication tocilizumab. These are in studies and haven’t been approved for use against COVID-19. We can only hope that other countries’ desperate, compassionate use of drugs off-label will add to the body of knowledge we have about effective treatments between now and the vaccine to come.

Our desperation makes us sloppy. We forget that what looks too good to be true often is just that.

Like the combined drug cocktail hydroxychloroquine and azithromycin.

~ ~ ~

Back on March 13 while writing about drug therapies in research, I wrote:

A number of existing drugs have been revisited for repurposing against COVID-19 instead of their original intended purpose. Antiviral remdesivir and antimalarial chloroquine are among them.

Chinese researchers posted a paper about in vitro results, not peer reviewed (at least I didn’t see that it was).

There’s a paper about chloroquine alone; in vitro studies suggest it may work against COVID-19. Chinese researchers have a number of in vivo studies in progress, but no data has been released.

Chloroquine by itself as an effective therapy would be a miracle in that it’s an old drug now off patent and available as a generic, super cheap to produce. Can’t imagine Big Pharma would like this. But we won’t even face this conflict if we don’t get data from in vivo studies.

Data. We needed data from peer-reviewed in vivo studies before any pronouncement could be made about the antimalarial medication as a therapy for COVID-19.

Published March 2 in Science Direct, a commentary by researchers at Aix Marseille University said essentially the same thing after examining an announcement by Chinese researchers that chloroquine phosphate was better than a control in treating SARS-CoV-2 (COVID-19) pneumonia — an announcement which had no supporting data:

In conclusion, the option of using chloroquine in the treatment of SARS-CoV-2 should be examined with attention in light of the recent promising announcements, but also of the potential detrimental effect of the drug observed in previous attempts to treat acute viral diseases. We urge Chinese scientists to report the interim trial results currently running in China as soon as they are available. This should be preferentially done in a peer-reviewed publication with detailed information to allow the international scientific community to analyse the results, to confirm in prospective trials the efficacy of the proposed treatment and to guide future clinical practice.

(Emphasis mine.)

These researchers are literally begging the Chinese researchers to provide data as soon as possible, after noting that while hydroxychloroquine’s precursor chloroquine appeared effective as an antiviral in vitro against different viruses, it has shown no benefit in animal models. (They also noted in a study of its efficacy against chikungunya virus, chloroquine actual “enhanced” viral replication in animal models. Not good.)

A study was published around the March 24 but reports said it was unfavorable for the antimalarial. (I haven’t been able to get my hands on the study; the link from each news source citing it has failed.) The size of the group studied was very small — only 30 patients with a control group of 15.

And yet sandwiched in time between the first Chinese study and this most recent one was another one submitted for publication on March 17:

Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of
COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of
Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
https://www.mediterranee-infection.com/wp content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

The researchers from Aix Marseille University made no mention of this study though it must have been underway in their own backyard, so to speak.

No one noticed this — the dog that didn’t bark.

Meanwhile, on March 19, Trump talked about hydroxychloroquine from the podium during a briefing before a White House press pool. He not only mentioned it in glowing terms but he tweeted about it. Mike Pence also promoted the antimalarial two days later.

On March 24 an Arizona man died and his wife was hospitalized after taking hydroxychloroquine’s precursor, chloroquine — used to maintain their fish tank — having heard Trump talk about it so positively. The couple poisoned themselves; Trump scored two casualties with his misinformation.

~ ~ ~

A critical threat to U.S. health security is its monoculture — specifically, its complete investment in English excluding other languages. Back when we worried about Zika virus posing a threat to Americans traveling to South America and when Zika arrived in Florida, we were combing through research from other countries. The Chinese fortunately published much of their work in both Mandarin and English, but Brazil had a considerable amount in Portuguese. Their work was ignored in favor of less credible work which appeared in English.

This same dynamic is at work with regard to potential drug therapies — hydroxychloroquine in particular.

The study Gautret et al. (2020) was published in French and English, you’ll note. Many people picked up on it because it was so accessible.

What wasn’t picked up readily was the problems with an affiliated researcher. Many reported problems have been documented online where the world can read them, in of all places, Wikipedia.

But that’s Wikipedia France — a different address than we use in the U.S., published in French.

See: https://fr.wikipedia.org/wiki/Didier_Raoult

Use Google Translate and read the section on COVID-19. The translation isn’t entirely smooth but it does well enough for the average English speaker to figure out Raoult is a character.

He also has a history of sexual harassment and possible abuse according to a number of accusers, also documented in this Wikipedia entry.

(I’ve scraped that entry and translated it out of concerns it might change over time. You can read the portion of the French Wikipedia entry on Raoult and COVID-19 at this link. You can compare it against the Wikipedia page’s editing history though you’ll need to reverse translate it.)

It could be said in the MeToo age that many accused abusers are competent at their professions and are simply jerks when it comes to managing their attitude toward co-workers. But in Raoult’s case the accusations are smoke and where there’s smoke there’s an ethical fire.

It seems Raoult’s research has had a problem with data which looks artificial in at least two other studies, noted during peer review.

He’d previously been banned from publishing in microbiology journals.

Complaints about a hostile work environment in his lab do not offer reassurance about the credibility of his work. Were subordinates pressured for results?

It also seems odd this one study from France has been relied on so heavily by others, when the underlying drug is manufactured by a French manufacturer (though not the only company which does).

None of this passes the smell test.

Gautret et al. also didn’t pass the sniff test with the journal in which it was published though it did not retract the study:

The April 3, 2020, notice, from the International Journal of Antimicrobial Agents, states that the March 20 article, “Hydroxychloroquine and azithromycin as a treatment of Covid-19: results of an open-label non-randomized clinical trial”

does not meet the [International Society of Antimicrobial Chemotherapy’s] expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.

The notice, which is from the ISAC and not the journal itself, is a bit ambiguous. The society says it “shares the concerns” about the paper, but it doesn’t appear to be taking additional action.

It’s unclear what took the journal nearly a month to make this statement of doubt. Because it hasn’t been retracted references are still made to Gautret et al. (2020).

~ ~ ~

Studies to date on hydroxychloroquine or its precursor chloroquine have been small or flawed; the merits of these antimalarials were thin to begin with.

Zumla, A., Chan, J., Azhar, E. et al. Coronaviruses — drug discovery and therapeutic options. Nat Rev Drug Discov 15, 327–347 (2016).
Published: 12 February 2016
https://doi.org/10.1038/nrd.2015.37
https://rdcu.be/b3uhd

An excerpt from this review of drug therapies notes chloroquine had limited promise against SARS-CoV-1:

…Chloroquine is an anti-malarial drug that sequesters protons into lysosomes to increase the intracellular pH. It has broad-spectrum antiviral activities against numerous CoVs (SARS-CoV, MERS-CoV, HCoV-229E and HCoV-OC43) and other RNA viruses in vitro 123, 210, 211, 212, 213, 214. However, it did not substantially reduce viral replication in SARS-CoV-infected mice, possibly because the cell surface pathway was not simultaneously blocked. …

This study of antiviral remdesivir with antimalarial chloroquine was in vitro, not in vivo:

Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020).
Published: 04 February 2020
https://doi.org/10.1038/s41422-020-0282-0

Remdesivir may act alone as antiviral. Conclusion is that these two drugs “should be assessed in human patients suffering from the novel coronavirus disease.” The drugs were assessed but not employed as a protocol.

This next study is again in vitro, not in vivo:

Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 6, 16 (2020).
Published: 18 March 2020
https://doi.org/10.1038/s41421-020-0156-0
https://www.nature.com/articles/s41421-020-0156-0

Its conclusion calls for more testing, while implying hydroxychloroquine’s use would be better as an anti-inflammatory during cytokine storm though this study didn’t examine its anti-inflammatory effects:

…HCQ is a safe and successful anti-inflammatory agent that has been used extensively in autoimmune diseases and can significantly decrease the production of cytokines and, in particular, pro-inflammatory factors. … In combination with its anti-inflammatory function, we predict that the drug has a good potential to combat the disease. This possibility awaits confirmation by clinical trials. We need to point out, although HCQ is less toxic than CQ, prolonged and overdose usage can still cause poisoning. And the relatively low SI of HCQ requires careful designing and conducting of clinical trials to achieve efficient and safe control of the SARS-CoV-2 infection.

Hydroxychloroquine is toxic and it needs carefully designed clinical trials — this prediction of its “good potential” is happy talk until there’s data to prove its effectiveness for its intended purpose.

A pre-proof study about the two-drug hydroxychloroquine and azithromycin cocktail published on March 30 is small but makes a more declarative statement right in its title:

Molina JM, Delaugerre C, Goff JL, Mela-Lima B, Ponscarme D,
Goldwirt L, de Castro N, No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the
Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19
Infection
, Medecine et Maladies Infectieuses (2020),
doi: https://doi.org/10.1016/j.medmal.2020.03.006
https://www.sciencedirect.com/science/article/pii/S0399077X20300858

The summary:

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety.

This study was in vivo, using the same dosing regimen reported by Gautret et
al
. study on a cohort of patients similar to the same study. The results were unsatisfactory:

At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381-891) at days 3-7 after treatment initiation.

Nor had the virus been cleared 5-6 days after treatment began in 8 of 10 surviving patients. The study’s authors made a point to compare their findings against the Gautret et al. study:

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.

Hydroxychloroquine doesn’t work against SARS-CoV-19 even when paired with the antibiotic azithromycin, but a larger, randomized clinical trial with appropriate controls is still necessary to beat it through the heads of people pushing this therapy.

~ ~ ~

But out of desperation, hospitals have been using hydroxychloroquine anyhow, only to discover it doesn’t work against COVID-19 — it may even make patients sick.

That last French study above squelched further use of hydroxychloroquine at the St. Louis Hospital in Paris.

Hospitals in Sweden stopped using it after negative effects (open link in Chrome and use Google Translate to read in English) including impaired vision.

On Sunday, Dr. Sanjum S. Sethi, Vascular Medicine and Interventional Cardiology Columbia University Irving Medical Center, shared that ALL patients treated in the ICU for COVID-19 have received hydroxychloroquine:

Dr. Sethi doesn’t say how many patients have been treated with the drug so far — there could be as many as 1,000 patients in ICU at one time based on a newsletter by Surgeon-in-Chief Craig R. Smith, MD for NYP/CUIMC — but it didn’t work for severe-to-critical patients in ICU.

Which means the Chinese researchers’ suggestion that hydroxychloroquine’s anti-inflammatory qualities may help with cytokine storms didn’t pan out.

~ ~ ~

Meanwhile, Trump continues to tout hydroxychloroquine, as does his best buddy in Brazil, Jair Bolsonaro.

Brazil, like other tropical countries has ongoing incidence of malaria. It’s endemic along the Amazon River and treated with chloroquine or hydroxychloroquine. The drug has also been used prophylatically.

And yet Brazil is experiencing a growth in COVID-19 cases even along the Amazon River, suggesting hydroxychloroquine or its precursor are not effective in the early stages of the disease, failing to fend off infection and contagious pre-symptomatic progression to mild, severe, and critical cases.

Further assessment is difficult because like Trump, Bolsonaro has undermined reporting and efforts to limit contagion.

Brazil’s Minister of Health Luiz Henrique Mandetta nearly lost his job late last week when he refused to authorize a protocol prescribing hydroxychloroquine for COVID-19 patients. A few doctors continued to press him on this after he survived a heated cabinet meeting in which this pharmaceutical was discussed.

Two days later a small study was published; chloroquine as therapy for COVID-19 patients had been halted early after more than 25% of the subjects died:

Borba M, Almeida Val F, Sousa Sampaio Vanderson, CloroCovid-19 Team, et al. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)
Published: April 11, 2020
medRxiv 2020.04.07.20056424; doi: https://doi.org/10.1101/2020.04.07.20056424
https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1

~ ~ ~

The bottom line is that we are still without an effective pharmaceutical antiviral therapy, no matter what Trump says.

What he’s said from the podium has only encouraged risk-taking pushing past the limits of ethics guiding the practice of medicine and human experimentation. The Texas City nursing home administration who has dispensed hydroxychloroquine without advanced informed consent is a perfect example of ethics collapsing under Trump’s equally unethical practice of medicine and pharmaceutical lobbying from the presidential podium.

Though we know more now than we did at the beginning of March about hydrochloroquine as a tool for treating COVID-19 — and we know that no study to date has suggested the drug will be effective for a majority of COVID-19 patients — we still do not know why Trump is so invested in this generic medication.

Who told Trump this drug was an effective treatment for COVID-19?

Has someone continued to reinforce this fallacy though Dr. Fauci has yet to reverse his own professional opinion about hydroxychloroquine?

Who likewise sold Bolsonaro on this drug? It likely wasn’t Fox News though the network may have irresponsibly reinforced Trump’s lobbying for hydroxychloroquine.

Why are talking heads on Fox News still promoting this drug with impunity — like Laura Ingraham who is not a medical professional?

Why are other right-leaning pundits continuing to press for this drug though they do not have medical background, and while other experts continue to express doubts about hydroxychloroquine?

None of this makes sense; we lack information. As I said before, we need data from peer-reviewed in vivo studies before any pronouncement can be made about the antimalarial medication as a therapy for COVID-19.

And we need to know more about Trump’s reasons for promoting this drug while ignoring the risks hydroxychloroquine poses.

Masked Up, Ready to Go (Nowhere)

[Check the byline, thanks! /~Rayne]

You’ve probably heard the U.S. Center for Disease Control is expected to reverse its position on the public wearing masks a little over a month after this meltdown on February 29:

The CDC’s reversal on policy is a result of several things, though one of the biggest issues is a push to get everyone ready to go back to their workplaces at the end of April. There’s resistance to going any longer than that, based on U.S. for Care’s Andy Slavitt on Twitter last night, attributing this deadline to governors (but I think we know it’s not the governors who are pressing for an end to Stay Home orders).

I have no idea how parents with kids out of school will handle this; we need some sort of an exemption for parents to continue to work at home if they have children who would have been in school into June but whose schools have now closed for the rest of the school year.

I also think it’s too soon to lift the Stay-Home orders given how goddamned sloppy states like Florida have been in executing them. Spring breakers were still congregating this past week in some southern states which means these stupid fools who were exposed will travel home, get sick in 2-3 weeks, infect others during that time and a mini-wave of successive infections will follow that.

Anyhow…the CDC has acknowledged the larger role respiratory droplets play in infection. Many anecdotes from community acquired infections support this. From CDC:

“COVID-19 is thought to spread mainly through close contact from person-to-person in respiratory droplets from someone who is infected. People who are infected often have symptoms of illness. Some people without symptoms may be able to spread virus.”

There are two studies about viability of the virus causing COVID-19 on surfaces; the researchers also noted the hang time of aerosolized virus and its viability. This study is cited most often:

van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
March 17, 2020. doi: 10.1056/NEJMc2004973
https://www.nejm.org/doi/full/10.1056/NEJMc2004973

The active virus could hang in the air for as long as 3 hours according to this study, from which we can infer the exhalations of infected persons carrying the virus will also hang about.

This study found the respiratory material from infected patients could cover objects and surfaces all over a room:

Ong SWX, Tan YK, Chia PY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient.
JAMA. Published online March 04, 2020. doi:10.1001/jama.2020.3227
https://jamanetwork.com/journals/jama/fullarticle/2762692

While not about the virus underlying COVID-19, this paper discusses the exhaled infectious material and how far it spreads — nice graphics included, a nice read:

Bourouiba L. Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19.
JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4756
https://jamanetwork.com/journals/jama/fullarticle/2763852

Science writer Ed Yong at The Atlantic tries to summarizes everything in his article, Everyone Thinks They’re Right About Masks: How the coronavirus travels through the air has become one of the most divisive debates in this pandemic.

Yong notes as I have that countries which use masks more regularly — like Japan — have had lower rates of COVID-19. But these countries also were more aggressive about dealing with containment much earlier.

Need more perspectives? Molecular biologist Sui Huang of Institute for Systems Biology in Washington state has an overview in support of mask wearing at Medium; science writer Ferris Jabr has a pro-mask article at WIRED.

This DIY Cloth Face Mask page at Instructables has not only information to sew your own mask but discussion about wearing masks and filters in them. The page is changing fairly often because of feedback — it didn’t have filter information in February.

It’s important to think about masks not just as protection for yourself. It’s possible some of us have already had asymptomatic cases and may even be contagious as I type this. Wearing a mask can protect others.

In Asia wearing a mask is also seen as a sign of respect for others’ well-being. Americans have had a skewed perspective about masks and have until now viewed them negatively when worn outside health care settings as a hallmark of illness. We’re going to have to change that.

Because I’m in the at-risk group due to my autoimmune disorder, I have to wear a mask. Family members with heart disease and diabetes likewise need to wear masks. I’ve sewn my own for myself and family members alike. While the first masks I sewed for us were two-layer cotton, I’m now making another batch with non-woven poly fiber — baby wipes and cleaning wipes are just two examples of this fabric in use around us all the time. The non-woven poly inside a reusable fabric mask can reduce the amount of material shed or inhaled by the wearer beyond what two layers of cotton fabric can limit.

If you choose to wear a mask, leave surgical masks and N95 to health care professionals because shortages of these commercial masks are severe and likely won’t be relieved for more than a month. Make your own instead. There are plenty of How-To and DIY instructions out there for sewn and non-sewn masks.

If you do wear a reusable fabric mask, make sure to shut your eyes and hold your breath when taking a used mask off because it will have collected potentially infectious material. Immediately wash it thoroughly in hand soap and water — the soap is all that’s needed to deactivate any virus. Then wash your face and then hands carefully, again with soap and water. Rinse your mask well with water and hang to dry or put the mask in the wash with your other laundry.

If you see somebody at the grocery store picking up milk while wearing a mask, it might be me. I’ll be going nowhere else even with a mask long after April 30 except for the occasional but necessary venture out to pick up groceries.

Three Things: Shit Got Real with Family and COVID-19

[Check the byline, thanks. /~Rayne]

I spent last night crying off and on all evening.

Right now some parent or parents are experiencing the nightmare I have hoped and still hope I won’t have to face.

A chemical engineering student at a state university died Sunday. He was only weeks away from graduating — just like my younger adult child at another state university.

This didn’t fucking have to happen. This bright promise didn’t have to be swept away in this human-made disaster. Don’t tell me this was natural, not when that narcissistic wretch in the White House treated the governor of my state like crap this week after her persistent pleading for federal assistance. Not after he failed from the time he was first told of this potential pandemic threat in December.

This death is on that miserable wretch’s head, and on the head of every GOP senator who looked the other way after Trump abused his power and solicited a quid pro quo. He did it again to our governor after the GOP senate gave him a permission slip instead of removing his unethical, greedy ass from office.

The horror isn’t over, either. There’s no telling how many more parents will face this same nightmare because one man just plain failed to do his job in a big and repeated way, because roughly 20 senators are spineless if not equally incompetent and corrupt.

~ 3 ~

You can guess what preoccupied my time last evening when I wasn’t crying. Text messages and phone calls were flying furiously between my house and my two kids’ homes downstate.

A capital city newspaper reported a 65-year-old man was confirmed with COVID-19. Nothing remarkable about this story on the face of it; so far he’s a living statistic.

But to this family this particular story is important. The man lives three miles from from my older adult child. Some of the folks who work with my older child live in the same neighborhood development. While the company for which my child works will implement screening body temperature at the door today, it’s a couple weeks late and pretty useless for asymptomatic cases. It would have been useless on this man up until he became sick, three days before Michigan’s Stay Home order took effect.

The patient developed symptoms on March 21 and has been sick since then. Before he developed symptoms he had been shopping at Sam’s Club, Costco, Meijer — three of the most popular grocery stores in the area. My child and their spouse shop at the latter two stores.

My younger college-student child had planned to go to Costco yesterday.

You might think, “Whoa, big spacious stores, no big deal,” right? But a study from China found two COVID-19 cases in Wenzhou traced shared one common trait — both patients had shopped in the same mall on two different floors. They had a low-intensity indirect transmission without prolonged contact.

COVID-19 appears nearly as bad as measles in terms of transmission. It’s spread mainly by exhalation of asymptomatic/pre-symptomatic people as well as those with symptoms. A recent frequently-cited study showed the virus can hang in the air, active, for three hours. This weekend’s story about a church choir which observed all the social distancing rules — apart from staying home — illustrates how easily this virus spreads in the air in closed spaces.

The 65-year-old patient said he doesn’t know where he was infected. “I don’t go to a lot of parties or hang around with a lot of different people,” he told the reporter, “I probably caught it from a public place.” But he did go to the grocery stores and he visited a rehabilitation facility in Ann Arbor to drop off supplies for a family member. The rehab facility was likely not a source since no known COVID-19 case arising from the facility was mentioned in the article.

Kudos to this gent for wanting to share his situation with the public. He’s been quite sick; he admitted, “I can’t imagine anyone with a compromised immune system, I can’t imagine them going through this…My lack of taking it seriously, versus wearing a mask or gloves or both probably contributed to me getting this. I kind of regret it now.”

So now we wait and wonder whether anyone who works with my older child has a community acquired infection from their neighbor.

And we wonder and wait to see if my older child along with their spouse has been infected, too.

Just stay the fuck at home. Don’t put yourself in this situation where you, too, must wait and wonder. You don’t need any more stress than that wretch in the White House has forced on us.

~ 2 ~

Speaking of that wretch, after comparing notes with Marcy this past week, I have a theory about the White House’s abuses of power denying or obstructing aid to certain states under emergency declarations.

See if you can spot what I think has happened in the context of a table Marcy prepared; I added a few more columns to it.

It’s not just that “the woman in Michigan” was mean to poor baby Trump. Her state has a very tight senate race and no Trump hotel, golf course, or Trump organization business within its borders.

One thing I didn’t add but makes sense to me about the tribal governments’ federal emergency declaration: Marth McSally’s Senate seat. What do you think?

~ 1 ~

This pandemic crisis has pushed our system past its limits, exposing all the cracks in a hyper-capitalist system. I know I’m probably preaching to the choir in saying that, or at least if you’re a regular here you’re unsurprised to see that I’ve written this.

But how quickly people have been pushed to their personal breaking point hasn’t really been plumbed. I’ve written before over the last few years that nearly 50% of Americans haven’t had $400-600 cash for emergencies, that rent across the country was beyond what minimum wage workers were paid, and health care insurance let alone health care was simply out of reach even with the Affordable Care Act.

The emergency is here, and any time now the dam is going to break. One-time checks from the government will come too late for many. Read this thread by Yashar Ali explaining one person’s crisis:

Some of us can’t afford to help; we know this from the data and anecdotes we’ve seen. But those of us who can very much need to right now. Find a local soup kitchen or food pantry and make a donation of cash because people may already be experiencing food insecurity. Hunt down charitable programs delivering meals to children, elderly, and even groceries for hospital workers. As hard as we’re expecting health care folks to work, they may not have time to shop for themselves.

The U.S. didn’t become a great nation based solely on personal greed but by what Alexis de Toqueville called our “self-interest rightly understood.” The diminishment of investment in our country through a combination of taxes and giving to ensure we all do well is why country is falling, why we now find ourselves in this mortal mess. Take immediate corrective action and help others if you can with cash.

~ 0 ~

Keep in mind as we go forward this is both a shared national crisis, and an intensely personal crisis. The odds are stacked against any of us getting through the next 12 months without losing someone we know, like, love, and without someone within our personal spheres suffering hardship.

This is an open thread. Bring it here, back up the truck and dump it in comments.

Dispatch from the War on COVID-19 [UPDATE-1]

[Check the byline, thanks. Update at the bottom. / ~Rayne]

If you’re a regular here you know I don’t like to share stuff from Fox or affiliates. But local station Fox5NY picked up and republished a video online I haven’t been able to capture elsewhere. It’s extremely important.

She isn’t the only nurse we’ve heard from here in Michigan about the “war zone” in which they now work. I shared a link earlier today in a previous post; I’ll share it as an embed here so you can hear these health care workers back to back.

 

View this post on Instagram

 

Dear Family, Friends and Complete Strangers, Please STAY HOME!! Love, an ER Nurse

A post shared by Mary Macdonald (@marymac019) on

Now, a word to Sen. Lindsey Graham who denigrated nurses because of the possibility they may collect $24 an hour on unemployment.

Senator Graham:

Nurses are degreed professionals who not unlike lawyers must pass a state licensing test and earn continuing education credits on top of their regular job. The ICU nurse has had very specific training as has the ER nurse; both have likely had to add more training to cross over to do the jobs they’ve performed this week.

They are our foot soldiers in the war on COVID-19. We will not have enough of these soldiers because they will get sick from a combination of exposure to high viral loads, especially when they don’t have adequate protection, and from the heightened, sustained stress of this pandemic war.

They do not deserve your disrespect. These professionals will treat every patient as someone worthy of their efforts. They will do their level best to save whomever they can provided they have the resources. The least you can do is treat them with the same respect they’d treat you as a patient. For all you know you will find yourself sick with this virus and you’ll be on the business end of one of these professionals who are in such high demand there won’t be any unemployed nurses in this country for more than a year.

Get over yourself, Graham. And stop taking social cues from that rude, nasty cretin in White House. Your friend McCain would be ashamed of you if he were still alive.

To whoever is bashing Governor Whitmer about her performance, a word:

Just like these health care workers who are pleading for supplies, so has Whitmer pleaded for assistance. Her constituents in the state of Michigan deserve all the services they’ve funded their federal government to provide. They are already getting what the state of Michigan can provide because Whitmer is ensuring this happens.

You cannot hide the fact that the federal reserve for supplies should have been ordering and collecting materials in January after China told WHO that a novel coronavirus posed a pandemic risk. Attacking Whitmer won’t change the fact that it is the federal government, directed ultimately by the president, which was responsible for detecting pandemic risk and responding proactively to it, informing states of the risk as early as possible.

That didn’t happen and now governors like Whitmer are forced to do both the job their states have elected them to do and more, taking responsibilities which belong to federal agencies, while Trump denies states the Honest Services they are entitled to because he has not received some sign of obeisance.

To use an aphorism well-known former Michigander Lee Iacocca enjoyed, “Lead, follow, or get out of the way.” Bashing Governor Whitmer is none of those things. Pick one of the three.

To everyone else: pay heed to what these health care workers are saying. Overall mortality will go up, not just from COVID-19, because first responders will be overwhelmed by both the demands this virus places on our systems, and by illness and death as their own ranks are infected and sickened. Stay home. Keep your distance. Heighten your hygiene practices to reduce risk of infection. Wash your hands. Help your loved ones, friends, community as best you can.

To health care workers and all other first responders: do the best you can. That’s all we can ask of you. If the best you can do is allow someone you cannot save to die in peace, so be it. We should have done more for you before this war began.

And someone should have told us all when that war started instead of lying to us until it was nearly too late.

UPDATE-1 — 7:00 P.M. ET —

I am suitably chastened by this video by a doctor at Emory:

YOU are the frontline, the foot soldiers. What you do during this period of necessary social distancing makes the difference counted in lives. We may have to be patient longer because we didn’t start early enough, but our loved ones, friends, their futures depend on it.

And the lives of health care workers also rely on us. We’ve lost a number of nurses and doctors, people like these women in these videos. We can’t afford to lose more.

Trump’s Death Panel Comes for Detroit [UPDATE-1]

[Update at bottom of post, thanks. /~Rayne]

Ordinarily I wouldn’t step on Marcy’s posts by putting another one up so soon and one so short, but I am both FURIOUS and scared sick about this.

Since last night, Detroit Free Press confirmed yesterday’s rumors about the number of ventilators at one chain of Detroit hospitals — that area hospitals had run out of ventilators and patients were notified on arrival they may not have access to a ventilator if needed.

Without ventilators, those suffering from acute respiratory distress syndrome in critical need may die.

Trump decided to kill Detroiters by withholding essential equipment. He’s chosen not to act in a timely fashion and interfered with the state’s ability to obtain equipment, while trash talking about Michigan’s governor in the process.

Welcome to Trump’s death panel.

Michigan’s Governor Whitmer couldn’t make it any more plain how urgent the situation was, just as Governor Cuomo has.

Trump’s gross negligence isn’t hurting just black Detroiters, either — yeah, I went there, you know damned well Trump doesn’t care about the woman who is our governor or the black people who are the majority in Detroit.

Trump is hurting rural white Michiganders in areas that voted for him in 2016.

If this is how he’s setting out to win swing states, I hate to see what more harm he’ll cause to solidly blue states.

UPDATE — 1:10 P.M. ET —

You need to watch this video produced by an ER nurse in Oakland County, Michigan. The county straddles four congressional districts, two of which recently flipped blue. This is where white flight settled pre-2000, leaving Detroit behind.

They don’t even have acetaminophen to give patients when they put the ventilator tube down their throats — assuming they still have ventilators right now.

Trump’s death panel won’t just kill you. It will make sure you suffer along the way.

 

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