The Pox On All Your Houses Pt.3

 A direct continuation of; https://watchitdie.blogspot.com/2020/04/the-pox-on-all-your-houses-pt2.html

The practice of medicine is really a series of Risk/Reward calculations.

Take for example Ibuprofen.

Ibuprofen can cause shortness of breath, wheezing and an erratic heartbeat. All symptoms of ARS.

However the Risk of Ibuprofen causing those symptoms is very low. While the Reward of Ibuprofen relieving inflammation and pain is very high.

So Doctors are happy to use Ibuprofen as a medicine. They're even happy for it to be sold to the type of idiots who panic buy toilet paper to use at home, unsupervised.

At a time when demand is outstripping supply medical professionals may need to accept more Risk in the Risk/Reward calculation than they would normally.

For example by delaying putting a patient on Oxygen Therapy for longer than they would normally.

Another example could be with the use of ventilators.

Rather than talking about ventilators I referred to; "Ventilator Beds." This is a logisitical unit made up of the ventilator and a bed. Along with all the things needed to operate the ventilator. Trained staff for example.

A Ventilator Bed also includes a lot of plastic tubing. Endotracheal Tubes.

In non-invasive ventilation an endotracheal tube runs from the ventilator to the patient. Where it connects to mask which fits tightly over the person's mouth.

If you are doing invasive ventilation then there is an endotracheal tube which goes down the patient's throat into their lungs. This is connected to a mounting which sits over the mouth. Another endotracheal tube then connects that mounting to the ventilator itself.

Between patients all of these plastic tubes need to be changed.

In order to prevent a opportunistic infection from one patient spreading to another. If you're already sick enough with a virus to need a ventilator the last thing you want is a fungal lung infection as well.

Most of the endotracheal tubes on the market these days are single-use. They're intended to be thrown away after one use.

The high number of patients requiring ventilation means that some hospitals are going through far more of these plastic tubes than they would normally. Making it had for them to get fresh supplies. Without this USc35 piece of plastic a US$10,000 ventilator stands completely useless.

Under these circumstances medical professionals may have to run the risk of cross infection by reusing things like endotracheal tubes.

Obviously they would still attempt to minimise that risk by sterilising these tubes between patients. Along with increasing the prophylactic broad spectrum antibotics and antiifungals they give the patients.

I'm not sure how you would go about sterilising them though. It's unlikely plastic would survive steam, autoclave, sterilisation. Without knowing the specific type of plastic involved I can't even comment on how it would detoriate on exposure to alcohol.

I suspect the manufacturers of this type of equipment do know though. They could perhaps help by switching production to reusable versions of their products.

As I've said the medical profession has a deeply engrained culture of excellence. Something which has developed over more than 2,000 years. Dating back to Hippocrates.

The most famous thing the medical profession has inherited from Hippocrates is the Hippocratic Oath; "First do no harm."

Essentially don't carry out a treatment unless you are sure that the Reward far outstrips any Risk.

So asking medical professionals to accept more Risk in a Risk/Reward calculation is going to be difficult. It's something that goes against almost the DNA of the profession.

Probably a lesser factor in medical professionals aversion to risk is the possibility they may get sued for malpractice.

Particularly Doctors have to pay out of their own pockets for malpractice insurance. Every time they get sued, even vexatious cases, those insurance premiums go up.

So I wonder if it would be possible for the government or state to act as the insurer for medical professionals treating COVID-19 patients. In instances where they have been forced to accept more risk than they would normally be comfortable with.

One thing which shows the medical profession's culture of excellence is the Mortality & Morbidity (M&M) Conference. If a patient dies unexpectedly a M&M Conference is convened. Even when there are no ambulance chasing lawyers or suggestions of malpractice involved.

An M&M Conference sees all the Doctors in a department, sometimes even in the hospital gathering together. They look at every aspect of the deceased patient's medical history along with the care they recieved. Not so much to indentify what went wrong as much as to identify what could have been done better.

I envison lawsuits resulting from COVID-19 patients going before an M&M Conference. If that concludes that the medical professionals merely accepted more risk than they would normally the government/state acts as the insurer in the case. The usual insurer cannot use the case to calculate future insurance premiums.

If the M&M Conference concludes that actual malpractice had been a factor the government/state no longer has a responsibility. If a medical professional has enaged in serious malpractice it's unlikely they're going to have to worry about paying insurance premiums in the future.

I know this sounds like a good idea. However it also sounds to me like an extremely complex legio-financial instrument to create in a short space of time.

It would be made easier if the Fever Clinic strategy was fully adopted. Meaning that COVID-19 cases are treated only by designated medical professionals in designated sites.

While talking about Risk/Reward Calculations I should also briefly touch on some of the experimental COVID-19 treatments being suggested.

Particularly the Murdoch Children's Research Institue in Australia's study using the Bacillus Calmette-Guerin (BCG) vaccine as possible treatment for, rather than vaccine against COVID-19.

The BCG vaccine works by injecting a person with live Mycobacterium Bovis. This is very closely related to Mycobacterium Tuberculosis. Which causes Tuberculosis (TB) in humans.

However because Mycobacterium Bovis has evolved to infect cattle it doesn't cause TB in humans.

What it does do is trigger the immune system into fight the virus. In winning this easy fight the immune system develops blueprints for specific antibodies to fight Mycobacterium Tuberculosis.

So if and when the person does get exposed to Mycobacterium Tuberculosis the immune system is there, ready to go to fight it. Meaning that the Mycobacterium Tuberculosis is destroyed before it is able to take hold and the person develops TB.

Obviously the immune system doesn't immediately know how to fight Mycobacterium Bovis. So what it does first is launch a massive response to fight the infection with sort of general purpose antibodies. To stretch the military metaphor this is something like the immune system's Quick Reaction Force (QRF).

Not only does the immune system retain the blueprints for Mycobacterium Tuberculosis. It also retains blueprints for how to quickly deploy a largescale QRF.

That QRF then gets deployed against every infection, bacterial, viral or otherwise, which enters the body. Meaning that those infections also can't take hold and develop into illnesses.

The theory being tested is that this QRF also prevents, or at least reduces, COVID-19 infection.

The Australian study focuses only on frontline healthcare workers treating COVID-19 patients.

As I've said how sick COVID-19 makes you depends of the amount of 2019nCoV virus cells in your body. The Viral Load.

Frontline healthcare workers are treating the roughly 10% of COVID-19 who go on to develop SARS-CoV-2. The people who have got the most sick, the ones with the highest viral load.

Being constantly surrounded by huge amounts of the 2019nCoV virus frontline healthcare workers themselves rapidly develop a high viral load.

I does annoy me when the general public assume that healthcare workers who've become infected and died are typical of COVID-19 patients. So feel they've got to copy the infection control measures that fronline healthcare workers have to take. Such as wearing gloves or masks.

Frontline healthcare workers are an extreme, anomalous, high-risk group for COVID-19. So they have to take special precautions which are utterly meaningless to the general population.

The general population could perhaps show their support by not buying up all their gloves and masks.

Some people have pointed out that it is exactly these infection control measures, Personel Protective Equipment (PPE) etc, which will make the Australian study ineffective. In Australia frontline healthcare workers have access to large amounts of high quality PPE.

This makes it hard to tell whether COVID-19 infection has been prevented by that PPE or by the BCG.

On April 2nd (2/4/20) two French Doctors caused controversy. By suggesting that mirror studies of the Australian study be carried out in Africa. Where frontline healthcare workers have nothing like the PPE available to their Australian counterparts.

They were instantly condemned as racist. Tedros Adhanom, the first African head of the WHO has since said that BCG studies wouldn't be used in Africa. Which, along with the naming issue, has further fuelled speculation that he's more of an Affirmative Action hire.

Not expanding BCG studies to Africa and elsewhere strikes me as foolish. Particularly if the BCG is being donated for free.

In any study you want to test against as many variables against a control group. So here; no BCG, BCG with PPE and BCG without PPE.

What would be unethical would be to create the BCG without PPE group. As would deliberately infecting people with COVID-19.

However as the BCG without PPE group already exists in many African nations. Or is about to. It would be reckless not to collect that data.

It's the same as the issue of when to start Oxygen Therapy for SARS-CoV-2 patients. Which I mentioned in my previous post.

The overwhelming majority of medical professionals will treat their patients according to existing guidelines. However some those with the resources will try treating earlier. While those short of resources will be forced to treat later.

With these variations in treatment happening anyway it's important that data on the results is shared. Not just to improve our understanding of SARS-CoV-2 but of ARS and SARS more generally.

The BCG has been used as a vaccine against Tuberculosis (TB) since 1921. Its risks are well understood, including for imunocompromised (HIV/AIDS) patients.

The only added Risk using it to treat COVID-19 is that it won't work.

Even then though you still has the big Reward that people recieving the vaccine will be immune from contracting TB.

If someone's already sick with SARS-CoV-2 the last thing you want is for them to also catch a serious bacterial lung infection like TB at the same time.

It is also particularly important that the BCG is tested widely. It is known that its effectiveness decreases the closer you are to the equator. Although no-one really knows why.

One theory is that the closer you are to the equator the more sunlight you get. Creating the warm conditions that bacterium really thrive in.

This means that people living closer to the equator will likely have been infected with some strain of Mycobacterium before they recieve the BCG. Learning and remembering how to rapidly deploy an immune QRF.

Meaning that when they do recieve the BCG the immune system's QRF defeats it without having to develop the specific antibodies needed to fight TB.

Once again proving the lesson that health 'experts' seem to have forgotten in the face of COVID-19;

There are actually some infections that you want people to get.
Another potential experimental treatment being discussed for COVID-19 is Chloroquine/Hydroxychloroquine.

Interest in this really began with the big Pharmaceutical company Bayer donating quanities of Hydroxychloroquine tablets to the US government for free. With US President Trump singing the drug's praises at his daily press briefings other large Pharmaceutical companies following suit.

Hydroxychloroquine is intended to treat Malaria. A parasitic infection.

As the Malaria parasite attacks the body's red blood cells it actually creates an environment which is toxic to it. In order to survive it needs to build its own, almost, PPE.  

Hydroxychloroquine stops the creation of that PPE. Effectively hoisting the parasite by its own petard.

As a side-effect Hydroxychloroquine ever so slightly alters the PH balance in the body's cells.

2019nCoV works by spearing itself into healthy cells. It seems to prefer those in the lungs. It then uses the healthy cells to replicate it's RNA to create many more 2019nCoV cells.

The slight change in that PH balance created by Hydroxychloroquine makes it more difficult for 2019nCoV to get its RNA into the healthy cell. Preventing, or at least slowing, the replication of 2019nCoV. Keeping the viral load down.

So it's well established that Hydroxychloroquine will have some effect in treating COVID-19, along with any other Coronavirus. However that can also be said about a host of other specialised anti-viral drugs. The question is over how much effect it will have.

As a potential COVID-19 treatment Hydroxychloroquine actually has two things going for it.

Firstly it is an extremely old drug. Developed in 1934. Meaning that there is very little that is not known about its effects on the human body. Therefore the Risk of using it properly, in a medical setting, is known to be negliable.

The other advantage is that it is extremely cheap. That though is largely because Hydroxychloroquine has been something of a victim of its own success.

The only strains of Malaria parasite that exist in the World now are the ones which are resistant to Hydroxychloroquine. The strains that aren't have long been destroyed by Hydroxychloroquine.

As a result there isn't really a market for Hydroxychloroquine anymore.

Although I gather that since President Trump has been shouting about it the commodity price has shot up from around US$100 per kg to US$1000 per kg.

The pharmaceutical companies which are donating Hydroxychloroquine are also in a race to develop a vaccine for 2019nCoV. This lockdown, stay-at-home, social distancing is largely driven by their fear.

Their fear that 90% of the population will become immune to 2019nCoV. Having contracted it and recovered after experiencing either mild symptoms or no symptoms at all.

Meaning that no-one will be prepared to pay them for the privilege of being infected with 2019nCoV.

The Influenza vaccine of course just seems to be a very expensive way of making sure you catch flu twice. Once when you get the vaccine. Then when the vaccine doesn't work and you get the flu anyway.

I'm sure that frontline healthcare workers know all about the Hepatitis B vaccine. How you have to book a week off work to recover from the 'mild' symptoms it causes.

Those pharmaceutical companies other big fear is that the US will invoke the Defence Production Act of 1950. That will prevent them from obtaining a patent for any 2019nCoV vaccine. Forcing them to provide it at a loss rather than a profit.

Donating Hydroxychloroquine seems to be the little bit of charity now which ensures massive profits later in the year. I'm sure the tenfold increase in the commodity price is helping to soften the blow for them in the meantime.

Hydroxychloroquine certainly makes for an interesting talking point.

As the name suggests it is derived from Qunine. The bark of Rubiaceae tree. Making it a form of herbal medicine. Although one which actual medicine has made a lot more potent.

As a treatment for Malaria Hydroxychloroquine has really been replaced by Artemisinin. 

This is dervived from Arteminisia Annua. A type of wormword which is commonly used in traditional Chinese medicine. The traditional Chinese medicine that Chinese Premier Xi has been so aggressively promoting.

In fact the Nobel Prize winning paper that introduced Artemisinin to the world was entitled; "Traditional Chinese Medicine's Gift to the World."

President Trump has been insisting on calling COVID-19; "The Chinese Virus."

I think a lot of people really wish he wouldn't. It certainly doesn't inspire confidence.

But then neither does supposed health 'experts' forgetting the lesson that the pharmaceutical companies clearly haven't.

21:20 on 9/4/20 (UK date).