## A Video Guide to Understanding Covid-19 without Freaking Out

It’s a complicated time, and we’re all emotionally worn out.

Here at emptywheel we’ve covered the current pandemic’s scientific side in some depth. (see Jim White’s look at the origin of the virus, Rayne has done several very good updates on the science, politics, and misinformation,
and I’ve gone into the mechanisms of the disease and how it compares to other pandemics )

But we haven’t done as much for the overtaxed, overwhelmed reader who just wants some pretty pictures and gentle talking heads to make Covid-19 make sense. Even those of you who voraciously keep up with Marcy’s intricate political  and media analyses might like to give the emotional roller coaster a break, and still feel like you have some frickin’ idea what is going on.

##### The Modeling

Nothing is more calming yet informative than 3Blue1Brown’s soothing and surprisingly clear explanation of epidemic models. This 3Blue1Brown explainer uses SIR, a mathematical modeling system for epidemics. While simplified, it can give you a sense for how more complicated models work, and why policies like social distancing and contact tracing are important and effective.

SIR stands for:
S = the number of susceptible individuals
I = the number of infected individuals
R = the number of removed individuals (removed here means no longer infectious, and includes both immune and deceased.)

3Blue1Brown is also one of the most pleasant-to-watch Youtubers of all time. Even when you don’t have any clue about the math he’s describing, it all comes together and you feel smarter by the end. “It’s the mental equivalent of ice-skating,” my daughter says, “You’re a little bit worried about falling over, but it’s nice.”

The smartypants at minutephysics and Aatish Bhatia teamed up to visualize the progress of Covid-19 cases around the world. They use a visualization with a logarithmic map of total cases versus new cases to clearly show both how similar the track of the disease is, and what it looks like for a geographical area to get a handle on the spread. This video explains how it works, and here is the site where you can watch the model play with current data.
##### But why did this happen?

The why us and why now question is lurking in the back of everyone’s mind, and SciShow comes through on it. SciShow has a long and storied history of well-researched and approachable science education, and their video tackling the zoonotic source of Covid-19 (and other viruses) in bats keeps in the tradition. Bats have evolved different approaches to having a mammalian immune system, which makes them better at handling some of the viruses and worse at handling other pathogens we can overcome easily — this is why their viruses can be so rough on us. We have a lot to learn from them, but we should probably stop disturbing their habitats if we don’t want to keep catching novel viruses from them.

##### The Medicine

If you’ve heard a lot of terms and you don’t know what they mean, Dr. Hope’s Sick Notes goes through 26 of them with clear and non-technical definitions. Dr. Hope is an NHS doctor who teaches and works in an English emergency department as well as a YouTuber. (His ongoing Covid-19 vlog is great, but more stress inducing than the videos featured here.) He gives easy explanations of complicated concepts with handwritten flashcards, a nice soft focus, and some comforting quiet background music. At the end he hands it over to Dr. Sonia, an anesthesiologist at the same hospital, defining some of the more hardcore technical terms we’ve been hearing in the media, but with equal calming friendliness.

Dr. Sonia appears in our next video as well, as an avid AFOL (Adult Fan of Lego). Dr. Hope and Dr. Sonia discuss how the ICU and ventilation really work, demonstrating with a detailed Lego model built by Dr. Sonia in her day off. It goes over all of the scary terms and procedures and why and how they’re used, but with Lego, so it’s fine. My daughter confirmed this too.

There’s a lot of questions about immunity, herd immunity, and the potential for re-infection, and a lot of misunderstanding about what any of those terms mean. Dr. Seema Yasmin breaks it down on a spectrum from life-long immunity to HIV (The worst). Where and how Covid-19 might fit into this is yet to be found, but she lays down the situation and puts it in context.

##### And Finally, Something of Less Value

Watching night shows, comedy news, and Youtubers adapt to filming inside their houses has been some hits and a lot of misses, but there’s a few amazing hits. These aren’t so much information about Covid-19 as a few gems life in quarantine has generated. Relax, it’s what everyone’s therapist is suggesting we do.

Stephen Colbert interviewing fellow Daily Show alumnus John Oliver is somehow both unbearable and ten minutes of comedy gold. I wish all late night interviews could be like this, but I also think that would kill me.

Kate McKinnon takes to a spare bedroom to reprise her role as Barbara DeDrew, trying to get you to adopt a cat, any cat, all the cats, from Whiskers R We.

Last but not least: what would you say to yourself, if you could travel back to January?

Um, am I doing this right?

My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon. Thanks to H.alhajji for the featured image.

## Shi Zhengli Provides Proof SARS CoV-2 Was Not An Accidental Release From Wuhan Institute of Virology

On Saturday, I took a deep dive into the origin of SARS CoV-2, the virus that is the cause of the deadly COVID-19 pandemic. That post was the result of several long days of deep reading and thinking. Somehow, I missed that Scientific American had put out an update on Friday of their profile of Dr. Shi Zhengli, the scientist responsible for much of what the world knows about bat coronaviruses, including isolating the bat coronavirus from Yunnan Province that is the closest relative to SARS CoV-2 that has been seen in a laboratory. Even worse, commenter Zinsky linked to the Scientific American article in one of the earliest comments on my post.

I finally got around to reading the article today. As you might imagine, this editor’s note at the top really got my attention:

Editor’s Note (4/24/20): This article was originally published online on March 11. It has been updated for inclusion in the June 2020 issue of Scientific American and to address rumors that SARS-CoV-2 emerged from Shi Zhengli’s lab in China.

I strongly urge you to read the entire article. It provides an effective look into work that Shi had been doing prior to the outbreak and then takes us along with her as she gets the news on December 30 that a novel coronavirus had been detected in two patients in Wuhan with atypical pneumonia. On instruction from the lab director, Shi left the conference she was attending in Shanghai and rushed back to Wuhan to concentrate all of her attention on the new virus.

It is important to keep in mind that Shi’s career up to the SARS CoV-2 outbreak was aimed at just such an event. In fact, she and her team had warned us. From the Scientific American article:

With growing human populations increasingly encroaching on wildlife habitats, with unprecedented changes in land use, with wildlife and livestock transported across countries and their products around the world, and with sharp increases in both domestic and international travel, pandemics of new diseases are a mathematical near certainty. This had been keeping Shi and many other researchers awake at night long before the mysterious samples landed at the Wuhan Institute of Virology on that ominous evening last December.

More than a year ago Shi’s team published two comprehensive reviews about coronaviruses in Viruses and Nature Reviews Microbiology. Drawing evidence from her own studies—many of which were published in top academic journals—and from others, Shi and her co-authors warned of the risk of future outbreaks of bat-borne coronaviruses.

With that as background, her actions in digging into the new virus make perfect sense for how a respected scientist engaged in work with dangerous viruses would seek the source of the outbreak.

She and her team jumped into work on the train trip back to Wuhan from the conference in Shanghai:

On the train back to Wuhan on December 30 last year, Shi and her colleagues discussed ways to immediately start testing the patients’ samples. In the following weeks—the most intense and the most stressful time of her life—China’s bat woman felt she was fighting a battle in her worst nightmare, even though it was one she had been preparing for over the past 16 years. Using a technique called polymerase chain reaction, which can detect a virus by amplifying its genetic material, the team found that samples from five of seven patients had genetic sequences present in all coronaviruses.

But here’s where the character of a person who has been dedicated to science her entire career comes out:

Shi instructed her group to repeat the tests and, at the same time, sent the samples to another facility to sequence the full viral genomes. Meanwhile she frantically went through her own lab’s records from the past few years to check for any mishandling of experimental materials, especially during disposal. Shi breathed a sigh of relief when the results came back: none of the sequences matched those of the viruses her team had sampled from bat caves. “That really took a load off my mind,” she says. “I had not slept a wink for days.”

Yes, months before the rumors of an accidental release from her lab started circulating, one of Shi’s very first steps was to make sure that the sequence of the virus found in patients from the wet market did not align with the sequences of any of the viruses isolated from bats that she had in her lab. She had already warned the world of the danger posed by some coronaviruses jumping from bats to humans. [Note: even though we talk about SARS CoV-2 and the bat virus RaTG13 being “closely related”, they still differ by enough that it is clear that SARS CoV-2 came from a different source than either the virus circulating in that bat population at the time it was isolated or the virus as it exists now in the lab.]

Even more importantly, she checked lab safety records and did not sleep until she could eliminate the nightmare of her lab being responsible for the outbreak.

The article goes on to detail the steps taken to confirm SARS CoV-2 as the agent for the outbreak and the use of sequencing of multiple isolates from different patients over time to indicate that it’s very likely that there was only a single introduction of the virus into humans.

Clearly, the rumors of a leak from her lab have bothered Shi, but she will not allow them to stop her:

Despite the disturbance, Shi is determined to continue her work. “The mission must go on,” she says. “What we have uncovered is just the tip of an iceberg.” She is planning to lead a national project to systematically sample viruses in bat caves, with much wider scope and intensity than previous attempts.

/snip/

“Bat-borne coronaviruses will cause more outbreaks,” Shi says with a tone of brooding certainty. “We must find them before they find us.”

Epilogue

In my post on Saturday, I posited that if we are to believe that the outbreak was the product of an accidental release from Wuhan Institute of Virology, we would have to claim that China has removed from the record any evidence of workers from the lab, or the family or other close contacts, being infected or dying.

Now, after the details that Shi has provided, we would have to believe that a scientist with a long history of top-notch peer reviewed research would be involved in such a lie and would further fabricate the story that none of the previous isolates in her lab match the outbreak.

A scientist of this caliber would know that such a lie would eventually be uncovered. That Shi intends to continue her work unabated is very strong evidence that she is being truthful and can rightfully proceed with a clear conscience.

Those considerations prompted me to return to the “evidence” that was presented to suggest an accidental release. Recall that in my post Saturday, I was perplexed by what looked like the outlines of an information operation. First, the specificity, out of the blue, of the question from John Roberts of Fox about an intern at the lab being infected. I still haven’t heard any others make this same suggestion, so that still stands out as suspicious.

But then I went back and looked at the Josh Rogin column from the same day, where Rogin concentrated on two State Department cables from 2018 about Wuhan Institute of Virology. Here’s the setting Rogin provided for the cables:

In January 2018, the U.S. Embassy in Beijing took the unusual step of repeatedly sending U.S. science diplomats to the Wuhan Institute of Virology (WIV), which had in 2015 become China’s first laboratory to achieve the highest level of international bioresearch safety (known as BSL-4). WIV issued a news release in English about the last of these visits, which occurred on March 27, 2018. The U.S. delegation was led by Jamison Fouss, the consul general in Wuhan, and Rick Switzer, the embassy’s counselor of environment, science, technology and health. Last week, WIV erased that statement from its website, though it remains archived on the Internet.

What the U.S. officials learned during their visits concerned them so much that they dispatched two diplomatic cables categorized as Sensitive But Unclassified back to Washington. The cables warned about safety and management weaknesses at the WIV lab and proposed more attention and help. The first cable, which I obtained, also warns that the lab’s work on bat coronaviruses and their potential human transmission represented a risk of a new SARS-like pandemic.

And yet, even though Rogin says he got a copy of the first cable, this is the only money quote he chose to put into his column:

“During interactions with scientists at the WIV laboratory, they noted the new lab has a serious shortage of appropriately trained technicians and investigators needed to safely operate this high-containment laboratory,” states the Jan. 19, 2018, cable, which was drafted by two officials from the embassy’s environment, science and health sections who met with the WIV scientists. (The State Department declined to comment on this and other details of the story.)

Rogin then adds what I think is the most important part:

The Chinese researchers at WIV were receiving assistance from the Galveston National Laboratory at the University of Texas Medical Branch and other U.S. organizations, but the Chinese requested additional help. The cables argued that the United States should give the Wuhan lab further support, mainly because its research on bat coronaviruses was important but also dangerous.

Really? The scariest language that Rogin could lift from the cable warned of a “shortage of appropriately trained technicians and investigators needed to safely operate”, but then he grudgingly had to note that this was in fact tied to a request from the lab for more outside assistance in getting that training. When we couple that thought with the failure, so far, of Rogin or anyone else to have actually published the full cables, I am more convinced than ever that the whole cable story is part of a coordinated information operation where Roberts asked the specific question and then Rogin took information that had been twisted inside-out from a cable asking for help with training at the lab to try to turn it into a potential whistle-blowing event.

One more bit. I did some digging. Rick Switzer, the “embassy’s counselor of environment, science, technology and health” is not a scientist:

Rogin says the cable he saw was written by “two officials  from the embassy’s environment, science and health sections who met with the WIV scientists”. One would hope that there was at least one actual scientist among those two officials.

## Research Misinfo/Disinfo: Ain’t No Sunshine Kill COVID-19 Gone

[Check the byline, thanks! /Rayne]

I thought this series would end after three posts but clearly the misinfo/disinfo related to research studies on COVID-19 continues.

This time Department of Homeland Security is one of the problem children.

By now you know about Trump’s wrong-headed comments about light and disinfectants used in and on humans’ bodies to eliminate SARS-CoV-19. You’ve also heard he gaslighted the public by claiming he was being sarcastic during Thursday’s briefing about light and disinfectants, followed by even more dog-ate-my-homework excuses.

You may have heard speculation that bleach as a COVID-19 therapy specifically may have been the result of communications with Trump by some crackpot who sells this re-labeled chlorine dioxide product as a miracle cure-all.

What you probably haven’t seen is the DHS’s “study” which may also have spurred Trump’s idiotic remarks about light or sunlight. Yahoo News reported about the “study” a week ago, sharing a link to the DHS document it received outlining DHS’s findings.

It’s not a paper. It’s a goddamned slide presentation of which stability of SARS-CoV-19 on surfaces was only a portion.

No peer-reviewed study has been published by DHS in any of the articles since Trump’s ridiculously inappropriate comments last evening.

News outlets have been all over Trump’s remarks, which as Marcy said elicited justifiable uproar. But outlets are doing a pissy job covering the sources of Trump’s practice of medicine without a license at the podium.

Newsweek offers a great example:

Fortunately, CNN got it right:

If DHS’s science and technology advisor Bill Bryan isn’t qualified to make declarative statements relying on research, who is?

Who did the research and where’s their data and output?

Why did the American public have to hear what DHS learned filtered through Trump who has proven himself to be incapable of understanding science let alone demonstrate respect for it?

We need to see the work because there are other studies which do not appear to agree with DHS’s presentation.

This widely cited piece tested the viability of SARS-CoV-2 on different surfaces after exposure to aerosolized virus. The temperature of the study was comparable to a nice spring day — 21-23 degrees Celsius or 69-73 degrees Fahrenheit — with 40% relative humidity.

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

SARS-CoV-2 is quite stable in conditions one might find in an air-conditioned indoor setting according to this study. This much agrees with what DHS presented.

This study looked at viability of the virus over time at different increasing temperatures and exposure to ultraviolet light — like solar radiation.

Stability of SARS-CoV-2 in different environmental conditions
Alex W.H. Chin, Julie T.S. Chu, Mahen R.A. Perera, Kenrie P.Y. Hui, Hui-Ling Yen, Michael C.W. Chan, Malik Peiris, Leo L.M. Poon
https://www.medrxiv.org/content/10.1101/2020.03.15.20036673v2.full.pdf

Here’s a table from the study addressing viability of SARS-CoV-2 at different temperatures:

You can see the virus is viable at 37 degrees C — that’s coincidentally 98.6F, the old average temperature for humans. The virus is stable at that temp for as long as a day. It’s not stable for long at 56C (132.8F) and not at all at 70C (158F) but then neither are humans.

Unsurprisingly, disinfectants disinfect according to the study’s results shown in the table above. Only one little burp with hand soap solution — one of three attempts showed some viability.

This study looked at the differences in number of outbreaks over time in a particular region of China, as the season changed and both temperature and amount of sunlight increased.

No Association of COVID-19 transmission with temperature or UV radiation in Chinese cities
Ye Yao, Jinhua Pan, Zhixi Liu, Xia Meng, Weidong Wang, Haidong Kan, Weibing Wang
Published online April 8, 2020.
European Respiratory Journal 2020, 2000517; DOI: 10.1183/13993003.00517-2020
https://erj.ersjournals.com/content/early/2020/04/01/13993003.00517-2020

These researchers hypothesized that COVID-19 transmission may decrease or even disappear when the temperature and UV radiation increase in the summer.

They collected the confirmed case numbers of 224 cities from China’s National Health Commission, the daily mean temperature and relative humidity collected from the China Meteorological Data Sharing Service System, and daily erythemally-weighted daily dose of UV radiation data extracted from the Dutch-Finnish Ozone Monitoring Instrument aboard NASA’s Aurora satellite. After adjustment for relative humidity and UV, they found temperature held no significant associations with cumulative incidence rate, and that UV was not significantly associated with cumulative incidence rate after adjustment for temperature and relative humidity.

These studies — though some are pre-print and in peer review — do not agree with what DHS’s Bill Bryan or the DHS presentation published a week ago said.

And none of them match what Trump said, whatsoever.

Media outlets really need to have a science reporter covering Trump’s briefings rather than the usual White House correspondents — people who are already highly versed in COVID-19 research and are able to put Trump on the spot.

Or the media needs to give up covering Trump’s briefings live if they can’t do real time pushback and demand better of the guy occupying the White House. Carrying his unfiltered bullshit will get somebody killed and damage businesses which are doing their best to operate under the strain of pandemic conditions.

~ ~ ~

We know now from the Washington Post that Trump’s unacceptable remarks on light and disinfectant therapy for treatment of COVID-19 may have been inspired by a briefing about a DHS study:

Trump’s commentary seemed to be inspired by a presentation from a Department of Homeland Security official about a promising but still inconclusive government study exploring the possibility of heat, humidity and light to kill the virus, as well as the effectiveness of disinfectants in killing it on surfaces such as tables, countertops and office workspaces.

Emphasis mine. An in-fucking-conclusive study, the same one on which Bill Bryan gave a presentation. Why was it offered at all? To provide happy talk for the daily propaganda program?

William Bryan, the department’s acting undersecretary for science and technology, first shared the study with members of the White House coronavirus task force on Wednesday and returned Thursday. He said his department had studied the virus in an air chamber and never said chemicals or UV light had been studied on humans nor suggested they be used in humans, according to several administration officials.

Why did he come back? Did some asshat on the White House coronavirus task force think Bryan could finesse this inconclusive report?

Others on the task force, including Birx, White House chief of staff Mark Meadows, as well as McEnany and others in the communications and press shops, were concerned that the Department of Homeland Security study had not been thoroughly vetted. “It was not ready at all to go to the president,” the senior official said. “There was no guideline. There was no data. There was nothing.”

Oh. Now we have sources named. At least one of these people and/or Dr. Fauci are most likely to have said this “study” was not ready to go to Trump. If these three and Dr. Fauci didn’t think it was ready, how did it end up getting in front of Trump?

Still, Vice President Pence and his team wanted Bryan to present the information to the president and to the public, eager to have something positive to share. They hoped the study would help encourage people to spend more time outdoors and to disinfect their homes, aides said.

Oh great — Mr. HIV-outbreak-of Indiana Pence with a history of ignoring public health officials’ advice to the public’s detriment, probably ignored the opinions of task force members who felt the DHS “study” was not ready for Trump’s propaganda show.

This time Pence’s bad decision-making resulted in an onslaught of calls to poison control center numbers and at least 20 people in New York alone who ingested bleach or disinfectant.

No word yet as to whether someone has fried themselves crispy outdoors in an effort to get rid of SARS-CoV-2 using ultraviolet light having relied on the misinfo/disinfo served up by the idiocracy in the White House.

## Digging Through The Science—And The Noise—On What Is Known About The Origin Of SARS CoV-2

Update: In a new post we find that Shi Zhingli of Wuhan Institute of Virology has provided convincing evidence to Scientific American that SARS CoV-2 is the result of a natural jump to humans from an animal host and was not accidentally released from her lab, which had no isolates of any viruses that match closely enough to be the outbreak virus.

Although it seems that all of this has been going on forever at this point, it’s important to realize that the COVID-19 pandemic outbreak probably began less than six months ago. In the context of how we develop an understanding of a disease like this one, and the virus that causes it, SARS CoV-2, that means that we really have only just begun our analysis. Nevertheless, because of the ongoing disastrous impact on global public health as well as the global economy, it is imperative that we learn as much as we can as fast as we can.

In this post, I want to take a deep dive into what virologists and epidemiologists have pieced together on the emergence of SARS CoV-2. The problem is that what might initially appear to be straightforward scientific and public health questions eventually get muddled by accusations of disinformation, accusations of hiding data and offerings of potential leaks of intelligence that also have a chance to be disinformation. These noisy battles relate to basic facts that have a direct bearing on our understanding of the virus’ origin.

As a result, it needs to be stated from the outset that because some of the needed basic information may be hidden or some of what we think we know might be wrong. Therefore, this analysis will be unable to come to a definite conclusion. With any luck, the discussion will help us to have a framework within which we can proceed as more facts become verified.

Overview Derived From SARS CoV-2 Genetic Sequence

I want to start with the science.  The very helpful graphic below is lifted from this paper in Current Biology. It is in three sections. The section on the left illustrates what we know from the genetic sequence of the virus when that is compared to other known viruses. What it shows is that the closest overall relative to SARS CoV-2, with a sequence identity of 96%, is RaTG13, another coronovirus isolated from a bat:

Let’s move to this Nature Medicine article from March 17 and this Cell article from April 16 for the narrative on diving into the distinguishing features of SARS CoV-2 from its genetic sequence.

From the Nature Medicine article, we get a description of the features of SARS CoV-2 that distinguish it from other known viruses (these features are what the center and right panels of the graphic address):

Our comparison of alpha- and betacoronaviruses identifies two notable genomic features of SARS-CoV-2: (i) on the basis of structural studies and biochemical experiments, SARS-CoV-2 appears to be optimized for binding to the human receptor ACE2; and (ii) the spike protein of SARS-CoV-2 has a functional polybasic (furin) cleavage site at the S1–S2 boundary through the insertion of 12 nucleotides, which additionally led to the predicted acquisition of three O-linked glycans around the site.

To translate some of the terms and clarify a bit, there are four genera of coronaviruses, with alpha and beta infecting mammals and delta and gamma infecting birds. The genome is the genetic sequence of the virus. I would usually say the DNA sequence, but coronaviruses are RNA viruses. There has been much discussion of ACE2 on this blog in the comments, so for now let’s just say ACE stands for angiotensin converting enzyme and ACE2 is present on the surface of many cell types found in many different tissues within the body. So what stands out here is that the structure of the virus spike protein, as determined from its genetic sequence and tests in the lab, allows it to bind exceptionally well to ACE2 when compared to other coronaviruses.

The middle panel of the graphic shows us that although the overall sequence of SARS CoV-2 is very closely aligned to the bat virus, when we narrow it down to only compare the region where the spike protein binds to ACE2, it is a perfect match of that part of a pangolin virus, while it is very different from the bat virus. For the important stretch of the spike protein (these amino acids are not next to each other when the gene sequence is read from start to finish, but once the protein is assembled from amino acids, the amino acids are close to each other from the way the protein assumes its three dimensional structure), the gene encodes a string of five amino acids in the protein that matches exactly with the pangolin virus sequence but in only the first of the five positions on the bat virus sequence.

But that final panel and the second half of the Nature Medicine snippet goes further in what is different about this virus. The gene for the spike protein encodes two subunits, S1 and S2. Remarkably, SARS CoV-2 has acquired a site where the two subunits can be separated using a enzyme called furin that is found in mammalian cells. The right panel shows us that neither the bat sequence nor the pangolin sequence has a furin cleavage site.

The Cell paper tells us that a furin cleavage site has not been seen in the betacoronaviruses closely related to SARS CoV-2. It has been seen in other human coronaviruses, though. Of further significance is that a furin cleavage site also appears in the more pathogenic bird flu viruses.

Not A Lab Construct

From the Nature Medicine article, we get one of the most convincing arguments I’ve seen against the virus being created in a lab:

While the analyses above suggest that SARS-CoV-2 may bind human ACE2 with high affinity, computational analyses predict that the interaction is not ideal and that the RBD sequence is different from those shown in SARS-CoV to be optimal for receptor binding. Thus, the high-affinity binding of the SARS-CoV-2 spike protein to human ACE2 is most likely the result of natural selection on a human or human-like ACE2 that permits another optimal binding solution to arise. This is strong evidence that SARS-CoV-2 is not the product of purposeful manipulation.

So, in other words, if someone in the lab wanted to set out to make a virus with the best possible ACE2 binding site, this is not the sequence the computer or the literature would have given them. That suggests that this very good binding sequence is a product of natural evolution instead. The Nature Medicine article also further noted that the genetic sequence of SARS CoV-2 differs too much from that of any other known coronavirus sequence for one of the known viruses to have been used as a starting point in engineering this stronger pathogen.

The Species Jump

Perhaps the most important step in the emergence of SARS CoV-2 is the jump from its initial host species to humans. This could have happened directly, or as in the case of MERS CoV, which went from bats to camels to humans, with an intermediate host. Note that MERS still has not adapted to efficient human to human transmission, and so when we see it, it’s usually from multiple camel to human events.

The problem here is that we don’t have proof of the host from which humans were first infected with SARS CoV-2. In other words, no virus isolated from an animal so far is related closely enough at the sequence level to SARS CoV-2 that we can say this is where humans were first infected, as we can tell from the MERS jumps from camels to humans. As we will discuss below, and as you are well aware, early suspicion on the origin of human infection centered on the wet market in Wuhan. Remarkably, authors of the Cell paper visited the market and took these pictures in October 2014 because they were concerned that wet markets in general, and this one in particular, represent a particularly large risk for bringing humans into contact with less commonly encountered hosts of potentially deadly viruses:

The caption properly notes that many early cases are linked to the market, but we don’t yet have proof of where and how the first human infection(s) took place. In discussing the jump and subsequent outbreak, the Cell authors continue:

The emergence and rapid spread of COVID-19 signifies a perfect epidemiological storm. A respiratory pathogen of relatively high virulence from a virus family that has an unusual knack of jumping species boundaries, that emerged in a major population center and travel hub shortly before the biggest travel period of the year: the Chinese Spring Festival.

/snip/

While our past experience with coronaviruses suggests that evolution in animal hosts, both reservoirs and intermediates, is needed to explain the emergence of SARS-CoV-2 in humans, it cannot be excluded that the virus acquired some of its key mutations during a period of “cryptic” spread in humans prior to its first detection in December 2019. Specifically, it is possible that the virus emerged earlier in human populations than envisaged (perhaps not even in Wuhan) but was not detected because asymptomatic infections, those with mild respiratory symptoms, and even sporadic cases of pneumonia were not visible to the standard systems used for surveillance and pathogen identification. During this period of cryptic transmission, the virus could have gradually acquired the key mutations, perhaps including the RBD and furin cleavage site insertions, that enabled it to adapt fully to humans. It wasn’t until a cluster of pneumonia cases occurred that we were able to detect COVID-19 via the routine surveillance system. Obviously, retrospective serological or metagenomic studies of respiratory infection will go a long way to determining whether this scenario is correct, although such early cases may never be detected.

So, the sequence information comes to a dead end here until the details of the epidemiology are reconstructed. As the authors note, it likely will prove impossible to sample many of the most important animals and humans that would clarify the route and timing. It is further worth noting that the bat from which the RaTG13 sequence is derived was found in Yunnan province, a very long way from Wuhan.

Epidemiology

It appears that as of this writing, the earliest known infection may have been a shrimp seller in the wet market who first developed symptoms on November 17. Also, this Lancet article provides further details on some of the early studies showing a high concentration of cases affiliated with the market in December. The Lancet graphic suggests a case on December 1 not affiliated with the market and the start of the market cluster on the tenth, with 27 of the 41 early patients considered here being associated with the wet market. If that were indeed the earliest case, we might think we’ve seen the index case. But if the South China Post article is to be believed, the shrimp seller fell ill on November 17 and, according to the article, one to five people a day from that day forward had the disease. If we believe that information, then the virus appears to have already been circulating before the middle of November.

It is when we start getting into this information that accusations of hiding information are thrown about. Were there earlier cases that China suppressed or that simply went undetected? We have no way of knowing at this point.

A further point that comes from the Cell paper is that SARS CoV-2 has been circulating long enough that minor variations in the gene sequence are arising that don’t affect pathogenicity but allow for tracing of various lineages of the virus in its spread around the globe. They also note that the lineages allow them to go back in time over the evolution of those sequences and the diversity diminishes a lot as they get back to the early isolates from Wuhan. This is further confirmation for Wuhan being essential in the earliest part of the outbreak.

Accidental Release

It is here that the noise gets really loud. If we accept the really strong evidence that SARS CoV-2 was not deliberately made in a laboratory, there remains the possibility that the virus could have escaped from a laboratory that studies potential pandemic agents.

As long ago as 2004, Rutgers scientist Richard Ebright spoke out against the massive amount of funding that was funneled into research on bioweapons after the 2001 anthrax attacks. From the New York Times:

Dr. Ebright disagrees with much of the security community about how best to protect the nation from attacks with biological weapons.

The government and many security experts say one crucial step is to build more high-security laboratories, where scientists can explore the threats posed not only by deadly natural germs, but also by designer pathogens — genetically modified superbugs that could outdo natural viruses and bacteria in their killing power. To this end, the Bush administration has earmarked hundreds of millions of dollars to erect such laboratories in Boston; Galveston, Tex.; and Frederick, Md., among other places, increasing eightfold the overall space devoted to the high-technology buildings.

Dr. Ebright, on the other hand, views the plans as a recipe for catastrophe. The laboratories, called biosafety level 4, or BSL-4, are costly, unnecessary and dangerous, he says.

”I’m concerned about them from the standpoint of science, safety, security, public health and economics,” he added in an interview. ”They lose on all counts.”

Ebright continues:

The labs, Dr. Ebright says, are a perilous overreaction to an inflated threat and will do more harm than good.

Although the threat of biological warfare is real, the weapons used by terrorists are unlikely to be the next-generation agents that the high-security labs are intended to study, he says. Yet by increasing the availability of such pathogens, Dr. Ebright argues, the labs will ”bring that threat to fruition.”

”It’s arming our opponents,” he said.

In addition, he says, the laboratories could leak. They could put deadly pathogens into irresponsible hands and they will divert money from other worthy endeavors like public health and the frontiers of biology. Moreover, their many hundreds of new employees would become a pool of deadly expertise that could turn malevolent, unleashing lethal germs on an unsuspecting public.

Note the “leak” bit. The article goes on:

But Dr. Ebright noted that the deadly SARS virus recently escaped from BSL-4 and BSL-3 labs in Taiwan, Singapore and Beijing, in each case setting off minor epidemics that killed or sickened people.

This 2014 paper from the Center for Arms Control goes into detail on two separate escapes of SARS from the same laboratory in Beijing,  along with four other documented cases of releases of possibly pandemic pathogens if you care to read further. Suffice it to say that Ebright was right that with the proliferation of these new labs, there would be leaks. So far, they’ve all been accidental instead of the type feared by Ebright where someone from inside a laboratory deliberately releases a pathogen.

With regard to the SARS CoV-2 outbreak, rumors from nearly the very beginning swirled about a lab in Wuhan. There is in fact a level 4 containment lab in Wuhan and there is also a level 2 lab as well, that I believe is very close to the wet market.

Should there have been an accidental release from either of these labs, at this point we would have to postulate that China has specifically quashed all information relating to this event and kept the laboratory personnel and any close family or other contacts who may have been infected out of the databases of patients.

But that hasn’t stopped the noise. Some aspects of the noise even begin to look to me like an information operation of sorts. Of course, since we don’t know the originator of the operation, we don’t know if it is actual intelligence being leaked or if it is disinformation being sown to add to the chaos.

At any rate, this April 2 column from David Ignatius put the idea of an accidental leak from a Wuhan lab into the Washington Post. Those who follow intelligence community news know that Ignatius is often thought of as a mouthpiece for information the CIA wants disseminated. Are they his source here? Was some other information operative his source?

Then things really heated up on April 15. Here is John Roberts of Fox News asking Trump a question during the April 15 “press conference”:

Wow. That’s an incredibly specific question. It assumes a female intern at the lab who infected a boyfriend and then she (or did he, not clear to me from Roberts’ phrasing) went to the market. Even though this was April 15, I’ve seen no further pushing of this specific version of the story.

But Trump’s response is a bit concerning. Note that he says they’re “hearing that story a lot”, but then makes a really big deal of the word “sources”. Given Trump’s history of spilling classified intelligence, and the constant warnings to him about such leaks compromising “sources and methods”, I almost wonder if that’s a genuine response of his lizard brain to all those warnings. We simply have no way of knowing that or knowing if perhaps those “sources” happen to lie outside the intelligence community and among circle of wingnuts who have the ears of Trump and Fox News and he’s really proud of them but doesn’t want to divulge them.

That same day, Josh Rogin put out a Washington Post column pushing the leak from a lab story, this time tying it directly to the State Department cables in 2018 about lax biosecurity protocols at the level 4 containment lab in Wuhan that Roberts mentioned. But Rogin didn’t include the specifics about the intern.

I’ve heard nothing further on the intern question, but the general idea of an escape from a Wuhan lab still gets tossed around. Ignatius returned to the idea of an accidental release on April 23. He even talked to Ebright:

“Science is not going to shift this from a ‘could have been’ to a ‘probably was,’ ” messaged Richard H. Ebright, a leading biosafety expert at Rutgers. “The question whether the outbreak virus entered humans through an accidental infection of a lab worker . . . can be answered only through a forensic investigation, not through scientific speculation.” Ebright told me the Chinese government should launch a forensic investigation by reviewing “facilities, samples, records, and personnel.”

Given Ebright’s history of predicting just such an accidental release, I find it very reassuring that he isn’t ready to say that’s what happened. As he rightfully points out, we can only know what happened when detailed information is assembled on the epidemiology of the earliest cases. Only Chinese medical investigators can know whether any laboratory personnel, and especially whether any family or other close contacts of them appear on the timeline of the early infections. It is also crucial to know where any such infections, if they exist, fall on the timeline in relation to cases affiliated with the wet market.

My gut feeling is that the evidence still very strongly points to the virus originating through the wet market, but I also think the index case there likely goes back even earlier than the November 17 case discussed above, since there are suggestions there were other cases appearing daily by then. Also, it’s hard to imagine that if the official intelligence community had a story as specific as the intern story and had evidence to back it up, that Trump wouldn’t be trumpeting it on a daily basis to deflect the criticism being heaped on his response to the outbreak.

Stay tuned. I suspect the story will take several more turns before we ever reach any level of certainty.

## 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.

## COVID-19 Tick-Tock Redux — Gridlocked Edition

[Check the byline, thanks! /~Rayne]

On March 25 I published a post in which I counted out the anticipated time required from a surge of new COVID-19 exposures to the date when the exposed persons would likely be recovered, dead, or free of SARS-CoV-2 virus.

At that time the last big public event at which people would have gathered closely and ignored social distancing was St. Patrick’s Day on March 17. Several states issued shelter-in-place/Stay Home orders after the last of the green beer was served, among them Michigan on March 23.

See Marcy’s post for a list of other states’ lockdown orders.

Of course Trump’s malignant narcissism, megalomania, and oppositional defiant disorder kicked in several times during his near-daily coronavirus briefing cum re-election campaign rally. He has champed at restraints on business, in part because Trump organization businesses have been shut down and cut into whatever their revenue streams may be, and in part because his good-old-boy network has been prodding him about the market and their businesses’ lack of revenue.

Which in turn has been used by the right-wing and white nationalists to foment unease and dissension among the Tea Party-ish types.

Like these embarrassments to my state.

While the DeVos family denies having any ties to the Michigan Freedom Fund and the Michigan Conservative Coalition which organized the “Operation Gridlock” protest for this Wednesday in Lansing, somebody surely funded the groups behind these racist feckwits.

And somebody organized these mouthbreathing zombies in Ohio so they would protest in Ohio’s capital city Columbus at the same time.

Photo: Joshua A. Bickel/Columbus Dispatch

And somebody organized these sheep-dip-for-brains in Kentucky as well, also protesting in Kentucky’s capital city.

Sure feels like Tea Party 2.0, just missing the tea bags.

But it’s possible there’s some other entity behind this neatly coordinated multi-state tantrum. Let’s not forget that in 2016 a foreign influence operation persuaded Floridians to hold rally-like pro-Trump events via Facebook.

Somebody knows exactly who the easily motivated Trumpists are who would jump in their car on relatively short notice. It’s just not clear yet whether this was homegrown or if there was help from abroad. Such effort could explain the number of Trump flags and other pro-Trump paraphernalia present at these protests. It would also explain the presence of the far right Proud Boys.

Whatever the case, these whiny morons protesting the lockdowns in their respective states as incursions against their freedoms have likely spread COVID-19 amongst themselves due to their lack of adequate social distancing.

That photo of the mouthbreathers in Columbus fogging up the glass is a perfect example of the aerosolized exhalation humans give off and other humans breath in when there is poor air circulation and a lack of distance between humans. It’s highly possible this photo captured the moment of exposure between individuals. I do hope some well-masked journalist asked these people their names so they could follow up with them:

— in 5 days time when infection has likely set in and earliest symptoms begin;
— in 10-14 days when mild cases will have symptoms and severe to critical cases will seek medical treatment or hospitalization; and again
— in 21-28 days when the exposed have been hospitalized, treated, begun to recover, or died leaving their loved ones behind to answer questions.

We’ll be watching the calendar for the wave of new cases which will likely start this weekend.

Thanks to these thoughtless morons demanding their freedom to buy lawn fertilizer and visit their hair colorist right the fuck now, the rest of us could be looking at lockdown extended to Memorial Day.

Yes, it will be nearly the end of May until the secondary exposures and infections die out after the primary wave of new exposures recover or fade.

It was bad enough that we will likely have a small wave of new cases because of resistance from evangelical and fundamentalist Christian churches which insisted on holding services for Easter. Those exposures would result in new cases from a primary exposure requiring recovery through the first week of May.

Freedom for the rest of us is sadly dependent on waiting out the illness and death of the persuadable and stupid.

## 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

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.

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.

## Capitalism fails the Covid-19 Crisis

We have shut down large parts of our economy and our social lives to cope with the Covid-19 crisis. This experience might teach us a lot about ourselves and about our economic system. Here are some things that seem important to me.

1. The point of capitalism is to protect capitalists. We see this fact after every financial crisis. The bailouts go to capitalists and their corporations, and therefore indirectly to the shareholders, who are largely in the top 10% in wealth. That was so after the Great Crash of 2008 when the financial institutions that caused the disaster were bailed out with massive help from Congress and the Fed. Other massive aid went to the automobile industry and airlines. There was next to nothing for any of the millions of us damaged by the cheats and frauds of the financial sector.

This time the money cannon was first aimed at the financial institutions. Fed programs to save the financial system include the following:
a. Cutting bank capital requirements.
b. A quantitative easing program, under which the Fed will purchase an unlimited amount of Treasuries and Agent debt, commercial real estate backed by Fannie and Freddie, and pretty much anything else as needed to preserve liquidity and insure orderly markets. Whatever that means.
c. A program, called a facility, to buy newly-issued long term corporate debt.
d. A similar facility to buy existing corporate debt.
e. A facility to buy asset-backed securities, like packages of student loans. and collateralized business loans.
f. Money Market Mutual Fund Liquidity Facility that we hope will stabilize the money market funds so many people use.
g. A facility to buy certain tax-free commercial paper, so states and localities an continue to fund certain public and private projects.
h. The Fed is also considering a plan to lend directly to small businesses.

Congress quickly got in on the act and fired its money cannon at the corporate sector. The bill enabled the Fed to make cheap loans totaling up to \$4.5 trillion, as the lobbyists for the rich patted them on the wallet. Another truck-load of money is going to hospitals, including the hundreds owned by private equity and publicly-held corporations.

Oh, and a few extra dollars for the unemployed for a few weeks eventually unless the repulsive spawn of Antonin Scalia can stop it; and small checks to some families, distributed whenever Treasury Secretary Mnuchin gets around to it.

The details behind this are equally astounding, as you can see from Dave Dayen’s newsletter, Unsanitized, which you should read every day.

2. Capitalism doesn’t fix problems. If it wasn’t already obvious, this crisis proves that capitalism makes crises like the pandemic worse. Our supply chains broke down. We are unable to produce the needed medical supplies and equipment. We failed to produce tests for this virus.

Our hospital system was driven by the profit motive to minimize surge capacity in beds, supplies and equipment; it was easily overwhelmed. What we actually mean by “flattening the curve” is that we spread out the cases requiring medical intervention so we don’t exceed our capacity to provide care. After the Great Crash we called it “foaming the runway”.

Flattening the curve should have bought time to restock our medical supplies and equipment, and get a decent testing program up and running. That didn’t happen. Trump insisted that markets driven by the profit motive allocate half of the available supplies, and he distributed the rest following what looks like political logic for his own benefit. As Josh Marshall explains, it makes sense to use the existing distribution chains, but it makes no sense whatsoever to allow the private sector to set up auctions where states and the federal government bid against each other for the necessary equipment. The “market” didn’t supply the needed supplies and equipment. There aren’t enough test kits, and there is no testing program. Following neoliberal theory, government cannot or will not solve these problems.

Capitalism didn’t fix anything. Instead, capitalists demanded government bailouts.

3. What Rugged Individual? Our economy runs on the exploitation of millions of people whose work, according to the “market”, is worth little more income than necessary to keep them alive. Suddenly even the most aggressive neoliberals are forced to acknowledge that all of us depend on these people, who feed us, provide us with deliveries, pick up our garbage, clean our streets, cook for us, clean our houses, pick our produce, kill animals and cut them up for our dinners, haul the trailers that bring us our food, and tend to our elderly. Not to mention the RNs, the LPNs, the LPAs, the medical technicians who operate ventilators and testing equipment, the phlebotomists, the lab techs, the pharmacy assistants, the all-important janitors and cleaners, the EMTs; and the clerks who manage the insurance businesses that pay the medical people.

Suddenly we hear about these people. Suddenly they are our frontline troops, our new heroes. Suddenly we hear stories about medical workers being applauded on their way to work. We notice the people putting toilet paper on the shelves. We think about the people putting food on our tables, delivery people, Lyft drivers, UPS drivers. It suddenly seems perfectly obvious that we are dependent of these people in a way that we are not dependent on the financial thugs at Goldman Sachs and JPMorgan Chase and Private Equity firms.

And for a light touch, get a load of this short CNBC clip.

The crisis exposes the lie of the American myth of the rugged individual, amplified into the neoliberal foolishness of Homo Economicus. No one stands alone. The Don’t Tread On Me crowd insisting on making their semi-annual trip to church for Easter worship whinge on about liberty, ignoring the risk to others. They won’t all get Covid-19, but some will, and they contribute to the surge at hospitals, the depletion of medical supplies and equipment, and the exposure to health care workers.

In fact it’s the people who keep us going as a nation who follow the real American Dream: they cooperate to solve problems. In this case cooperative problem-solving is undermined by leaders put into office by allegedly Conservative Rugged Individuals; not just the elected officials, but Senators, Representatives, political appointees, and judges. If the sickening SCOTUS Chief Justice catches Covid-19 in Wisconsin, the health care workers there will work together to take care of him even though he made them choose between dangerous exposure at the polls and losing their right to vote.

All of us depend on each other for the things we cannot provide for ourselves. We also depend on each other for creating and enriching our humanity. We lose a critical piece of ourselves when we can’t hang out with other humans, chat with the check-out lady at the drug store, get advice on TVs from the guy at Best Buy, argue about the NBA championship series at work, discuss the meaning of the Parable of the Laborers In The Vineyard with our Bible Study groups, share a meal or a laugh or a hug.

I hope we remember this dependence when the lockdowns end.

## US “Job Creators” Negate The Humanity Of Workers

Yesterday, I retweeted this list of stimulus packages from around the world and added a rant on how it means that when the US economy reopens (see Marcy here on why it’s not Trump’s call to make, despite his claims), the US will be left in the dust because so many workers who were laid off during the shutdown will have lost everything and likely will face a long delay in finding re-employment.

As you can see from the list, much of the world is taking care of workers to see that they are able to meet their basic needs of shelter and food until social distancing begins to be lifted. (I won’t even go into the fact that the rest of the world also assures universal health coverage as well, so as not to upset my blood pressure even further).

The sad reality of these numbers is that in the US, workers simply aren’t acknowledged as human. They are merely tools the “job creators” use to enrich themselves. This Washington Post article from yesterday drives that point home in disgusting detail. Here’s a screencap of the headline and subhead:

That subhead, coupled with the comparison of different countries’ approaches for stimulus packages, perfectly sums up the complete negation of humanity for US workers. In the civilized portions of the world, governments are stepping in directly to make sure workers continue getting paid at a rate that is fairly close to their usual wages. In the US, direct payments to the public at large are essentially taboo, so token \$1200 payments have been approved and we can rest assured that the Trump administration will drag their feet and fuck this up enough to make sure most workers won’t see this money for a very long time if ever. So, enter the plan to funnel money to workers through the SBA and the “job creators” who are so sacred to the distorted US view of how to structure the economy. But even here, “job creators” just can’t grasp the idea that workers are humans who need food and shelter during the time that, through no fault of their own, they can’t work. The idea of paying workers to do nothing simply never can be entertained, even if it literally means life or death.

Here’s how the Post article opens:

Bob Giaimo, founder of the Silver Diner restaurant chain, is hoping to receive emergency funding in the coming days through a federal loan program. But he doesn’t want to spend the money right away.

Small-business owners are supposed to use the loans immediately to keep employees on their payrolls during the coronavirus crisis, but at the moment there is little for Giaimo’s workers to do. His restaurants in Virginia, Maryland and the District will be closed for sit-down service until local officials allow them to reopen.

“Getting the loan is hard enough. Using it is harder,” said Giaimo, who is lobbying his members of Congress for more flexible loan terms.

No, Bob, using those SBA funds is not hard. The whole fucking point of this program, right there as the Post says, is “to keep employees on their payrolls during the coronavirus crisis”. It doesn’t matter that they have nothing to do. What matters is that they need to buy groceries and pay rent.

Let’s get back to Bob, because he’s such a gem of a “job creator”.

For Giaimo, part owner of Silver Diner, which runs 19 restaurants, the mandated timing of the spending is a problem.

In his 30 years in business, he says he’s never laid off an employee, until now. After the coronavirus hit, local authorities ordered restaurants to close for sit-down service, forcing Giaimo to temporarily lay off 1,600 of 1,800 workers, he said. Most of them are now collecting unemployment, he said. (Some regional restaurant chains qualify for the loans even if they employ more than 500 people.)

/snip/

He applied through a local bank for a \$9.5 million emergency loan and is awaiting approval. But rehiring his workers immediately would be impractical, he said.

“There’s no job for them,” he said. “We would use all the loan proceeds while we’re closed, and we’d be out of funds to reopen.”

But poor Bob. Even though his business doesn’t really fit the definition for small, he’s found a loophole to still apply for a \$9.5 million forgivable loan that is specifically designed to keep employees of actual small businesses on the payroll. But, you see, he cut 89% of his employees off the payroll to join the flood of those seeking paltry state unemployment benefits. And Bob has needs now:

Giaimo wants the rules to change so that the companies can qualify for loan forgiveness if they wait to rehire workers until they are legally allowed to reopen. Meanwhile, he’d like to use part of the loan to pay the workers he has retained and to pay suppliers of food and other goods, but he says paying suppliers isn’t an allowed use of the funds under current regulations.

You see, Bob has bills. He needs to pay those bills, like the ones from his suppliers. As for all those workers he laid off? Fuck their bills.

It should be noted, although this point will be totally lost on Bob, that this loan program is already under discussion for expansion, presumably to extend the amount of time workers could continue to be paid as we await the chance to restart activities like dining in restaurants. But it just never enters Bob’s little mind that he could take these funds, which he wouldn’t have to repay, and use them to pay those workers he laid off, even if they can’t work right now.

## Research Misinfo/Disinfo: It’s a Scam

[Check the byline, thanks! /~Rayne]

When certain folks all push the same angle — Trump, Giuliani, Solomon, et al — one may think immediately it’s a scam.

Like the Ukraine quid pro quo scam on which the very same players worked together, singing from the same hymnal.

The scam is more obvious because two of the people involved are promoting a pharmaceutical and they’re not medical doctors — they may be practicing medicine without a license by encouraging the use of a medication which isn’t approved for the use they advocate.

The drug is hydroxychloroquine, an antimalarial drug which has also been approved for a small number of autoimmune disorders like lupus.

Something is clearly not right when so many of the same players are pushing a drug using the power of the presidency to do so.

~ ~ ~

Interregnum: I’ve had to put this post up now, out of order. I had originally intended to write two posts about misinfo/disinfo about research related to COVID-19 and the underlying virus, but push has come to shove with Trump pushing hydroxychloroquine again today, admitting the U.S. has not purchased ventilators or personal protection equipment on a timely basis but instead bought and stockpiled 29 million doses of hydroxychloroquine.

Something is really wrong and it must be addressed immediately, before more people get hurt.

My post about the problematic background of research behind hydroxychloroquine will have to come next. Right now we need to talk about the scam in progress.

~ ~ ~

It took me a while to figure out what the angle might be on a drug which is old and cheap but I think this is the way this works.

Of course you all know Trump wants and NEEDS to stay in office or he’s up the creek without a paddle. This scam isn’t about making money but instead about serving his need not to be investigated and prosecuted for all manner of tax, bank, wire fraud and more beginning ten months from now.

So…Team Trump picks a drug which when administered in safe dose, doesn’t do much constructively for anybody except people they don’t give a shit about like patients with lupus and autoimmune disorders.

Weak sauce studies on hydroxychloroquine to date suggest it’s a 50/50 crap shoot that the critically-ill patients qualifying for compassionate use and receiving this drug will recover. Somebody external to the White House, possibly external to the U.S., maybe even the drug company/ies which makes this, may have made have chosen this drug because they did this math. They have just enough iffy research by iffy researchers to encourage its use.

They end up with just enough people who’ll recover and claim it’s a miracle drug that saved their lives, and the other half are dead or disabled so they won’t appear on camera to say otherwise. Handpicked survivors become testimonials to Trump’s ‘Wile E. Coyote super genius‘ and his prospective worth as our two-term conman-in-chief.

Even Dr. Fauci has said there’s no proof this drug cocktail works; he’s been clearly frustrated with Trump’s handling of COVID-19.

But Team Trump counters Fauci’s doubts by launching a character assassination attack in social media, calling Fauci part of the “deep state” out to get Trump.

At the same time there’s a continuous social media swarm pushing the drug.

Team Trump haven’t fired Fauci because they still need him to save Trump from making bigger mistakes and Fauci has much higher credibility ratings than any of the rest of Team Trump appearing before cameras.

But Trump’s current pandemic response failures are already projected to cost at least 100-240,000 American lives which Team Trump are now calling a goal, or success.

That’s part of the scam, too, the framing of what success will look like, long after Trump blew by the true benchmark of zero American deaths.

All this to boost his approval rating so he can use it for his re-election campaign. That’s the scam.

Just like the quid pro quo for which Trump was impeached — manipulate the situation so that false information boosts Trump’s approval with voters, abusing his power for his own personal gain.

~ ~ ~

What gave me pause wasn’t just the crappy research. Or the problematic French research with which this all began.

It was the fact that Rudy Giuliani, John Solomon, Charlie Kirk and a bunch of other right-wing support players were also doing their bit repeatedly to push this drug cocktail as well as a Russian doctor.

This is the Ukraine scam all over again, only this time the players are going to push a crappy drug and assassinate Dr. Fauci’s character, instead of pushing a false meme about Hunter Biden and assassinating Marie Yovanovitch’s character while she was ambassador to Ukraine.

Dr. Fauci has received death threats now because of this nonsense and his security detail has been increased because of it.

Michigan’s Governor Gretchen Whitmer has also been criticized by right-wingers about hydroxychloroquine. The state’s Department of Licensing and Regulatory Affairs throttled off-label prescriptions of the antimalarial drug because doctors and pharmacists were abusing their licenses by writing scripts for themselves and their families, hoarding the drug while depleting inventories.

But Dr. Fauci and Gov. Whitmer aren’t the only ones affected by this. There are so many stories about lupus and other autoimmune disorder patients who haven’t been able to fill their prescriptions because of a run on hydroxychloroquine because of Team Trump’s unlicensed practice of medicine at the podium — or unregistered lobbying for pharmaceutical company or companies.

Not to mention the strong possibility that although the Food and Drug Administration caved under pressure from Team Trump and now allows “compassionate use” of the drug for COVID-19, the drug could easily kill patients who are already under stress from SARS-CoV-2’s attack on their systems.

Hydroxychloroquine requires additional caution when used on females, geriatric patients, patients with diabetes — this describes a considerable number of COVID-19 patients in critical care! — thyroid disease, malnutrition, liver impairment, or those who drink alcohol to excess — for starters. The drug must be used with caution in persons with cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances.

This is only part a portion of the contraindications and precautions for hydroxychloroquine.

It may also cause permanent eye damage.

Imagine monitoring the patients receiving hydroxychloroquine even more closely when hospitals are overwhelmed and understaffed.

None of the research so far has been performed in vivo in a large, randomized trial. We really do not know what it will do except for what it has done for malaria patients and for autoimmune disorders — hardly the same things as patients in extremis from COVID-19.

Trump’s pushing drugs from the presidential podium must stop because Americans are being hurt for the sake of whatever scam Team Trump is pulling off this time.

We can see part of the potential reasoning Team Trump has used, but who else is benefiting from this? How do pharmaceutical companies fit into this, particularly Novartis which may be the sole source for the stockpile of hydroxychloroquine the federal government acquired. We don’t know the total amount the U.S. holds, how much might have been donated, and how much has been bought.

We don’t know whether this was part of conversations which may have happened at Davos around January 22, when pharmaceutical companies like Novartis were present and when business leaders were already concerned about COVID-19 outbreak in China.

We just don’t have all the facts yet to know every angle of this particular artless deal.

~ ~ ~

Part 3 will address the research behind hydroxychloroquine in relation to COVID-19.