Rapid COVID-19 Spread with Mild or No Symptoms, More on Hydroxychloroquine (lecture 39)
Welcome to another MedCram covid-19 update. We are looking at a total of almost 200,000 cases that are confirmed worldwide. Total deaths 7948; total recovered 81,000. If we look at Italy, we have 31,506 cases and 2,500 deaths. If we compare that to, for instance, South Korea, which has done extensive testing, and has despite that only about 1/4 of the cases, and only eighty-four deaths. Interesting numbers. The United States has 6362 confirmed, with 180 deaths and 17 total that have recovered.
There was an interesting paper that was published in Science that I will show you later, and I also put a link in the description below. Basically what it shows is that at a single point where this virus started, and we expanded out, there was a point where the travel ban went into effect in China. That was on January 23rd.
What they did is they use Bayesian statistics to try to figure out how many people went undiagnosed, and which people were diagnosed in terms of before and after the travel ban. Using Bayesian statistics, they found that 86% of covid-19 patients prior to January 23rd went undiagnosed.
In other words, here is the proportion of patients here at 86%, by the time we get to January 23rd in our timeline going across the bottom. These people here did not get tested for covid-19, so they didn’t know that they had it. The authors note that those who don’t get diagnosed often had mild, limited or no symptoms at all. So in other words, if these people had severe symptoms they probably would have gone to the hospital, and they probably would have gotten tested, but they didn’t get tested, so many of them were walking around with mild or no symptoms, going to work, going to school, going to restaurant.,etc.
Furthermore, the author’s mathematical model predicts that these undocumented cases, where the source of approximately 79 percent of all reported cases in China. Had these people known that they had covid-19 and not spread it, let’s say that they were in isolation, because they knew they had the virus according to the model, the number of cases in China would have dropped by 79 percent, and the number of cases in Wuhan would have dropped by 66%.
So this is the article that was published in Science, which is about as good as you get in terms of peer-reviewed journals. So you can go ahead and look at the graphs in the link in the description below. But I wanted to point out some things in their conclusion. “Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-cov2.
Just think about that. The two things here that they’re looking at, identification – that can only come from increased testing, and isolation – that’s what we have to do as citizens.
The key is understanding that a very large majority of the patients who had been infected at the time of the travel ban didn’t know that they had been infected with the coronavirus. Because of the fact that they didn’t isolate themselves, they were unfortunately, unwittingly able to infect far more people.
This is interesting. Their model predicts that the undocumented infections were less contagious, 55% as contagious as documented infections. But since there were a lot more of this undocumented infection group, this group of people contributed most to the spread of covid-19 in China.
The 2009 H1N1 pandemic influenza virus also caused many mild cases quickly spread globally and eventually became endemic.
Presently, there are four endemic coronavirus strains currently circulating in human populations, and they’re listed there. If the novel coronavirus follows a pattern of 2009 H1N1 pandemic influenza, it will also spread globally and become a fifth endemic coronavirus within the human population.
These findings explain the rapid geographic spread of SARS-cov-2 and indicate containment of the virus will be particularly challenging, and that’s what we’re finding out at this point. What I get out of this article is basically the best way to flatten the curve is to isolate. Otherwise, you might be having a similar situation to what is going on in Italy at this time.
I want to revisit the entire zinc and chloroquine, hydroxychloroquine issue because that seems to be picking up rapid speed here in the last couple of days. So the first thing is, of course, here’s this very busy picture enough to say that when the coronavirus infects the cell, it’s going to dump in to your cell a messenger RNA that’s going to be translated using ribosomes. Those ribosomes, the first thing they’re going to do is translate that RNA molecule into a protein called RNA-dependent-RNA polymerase, or replicase, and it is this enzyme that it’s been shown that is inhibited by high intracellular concentrations of zinc.
As it turns out, chloroquine is a zinc ionophore as is hydroxychloroquine. Zinc ionophore is just basically a protein or a gate that allows zinc to come into the cells. We don’t know if that is the actual way that it is working in this case, but it does seem to lead credence to the mechanism of action that zinc does inhibit replicase, and that hydroxychloroquine and chloroquine increase intracellular concentrations of zinc. For more on hydroxychloroquine and chloroquine and dosing and mechanism and recent articles, please go to Update 35, which will give you a lot of the background information.
What I wanted to show you today was some recent reports, but not actual publications as yet. There was an article that was published in today’s edition of a French publication called The Connection. French researcher posted a successful covid-19 drug trial. I don’t know if this has been peer-reviewed or even published in a journal, but it is a newspaper article that talks about a renowned research professor in Marseille, France by the name of Professor Raoult, and there is a video in French on YouTube, which I will put the link to, and this is what is reported.
There is a medication, of course, chloroquine and hydroxychloroquine, which is marketed as Plaquenil. What they say here is that they took 24 patients who are among the first patients to become infected in southeast France. The patients were given 600 micrograms per day for 10 days. They were closely monitored. What they found was that they were able to ascertain that patients who had not received Plaquenil, which is the drug, were still contagious after six days. But of those that had received Plaquenil after six days, only 25% were still contagious.
A caution here: because we don’t actually have the peer-reviewed data, this was only 24 patients. But this is an interesting finding as it may represent the first glimpse into some of the trials that will be coming out in the next few months. I’m sure the professor was very excited to get this word out.
Here is a similar news on another French news site, coronavirus, hydroxychloroquine would be effective according to Professor Raoult, and we don’t have the actual paper published as yet, but this is the highlights from the press conference that again I will link to in the description. It says here that the professor presented the first results of the clinical tests with hydroxychloroquine, and the results are even more promising with hydroxychloroquine and Azithromycin, an antibiotic effective against viruses.
Azithromycin, for those who don’t know, is an antibiotic; it’s the active ingredient in what you may know as Z-packs that you might get if you went to the urgent care, or your primary care doctor, or the emergency room, and had an infection. That’s interesting that azithromycin might have an effect against viruses. It’s an interesting point and one that has to be looked into to see why that was the case.
There are some indications that Azithromycin may have anti-inflammatory properties. One of the other concerns that I would have personally is the fact that hydroxychloroquine may have QT prolongation issues, and we know that those are issues also that are present with Azithromycin. QT prolongation is a consequence of a number of medications which can lead to fatal cardiac arrhythmias if not monitored correctly. Apparently, the government was impressed enough to extend this test to other hospitals to test its effectiveness on a much larger scale.
And if we go back to the table of countries here, we know that South Korea has used this medication early with extensive testing. We can see here that the mortality, or the number of deaths divided by the number of confirmed cases, is quite small. In fact, it’s about 1%. This makes one wonder if chloroquine is part of that calculus.
Well, that’s it for today. Further updates will talk about this idea of re-infection and immunity. Thanks for joining us.