Well that was quick – WHO has backed off from statement of asymptomatic rarely transfer.

Support for wearing a mask coming from hairstylist who was symptomatic with a mask – https://www.centredaily.com/news/coronavirus/article243395651.html

“A hairstylist at the Great Clips at 1864 S. Glenstone Ave. served 84 clients while symptomatic. The hairstylist infected a coworker, who worked with 56 clients.

Health officials said the hairstylists and all clients wore face masks during appointments, likely preventing spread of the disease. They credited Great Clips’ policies, including distancing salon chairs and staggering appointments.

The health department also offered testing to all potentially exposed to COVID-19 and remained in contact throughout the incubation period. All 46 people tested returned negative results, officials said. Additionally, everyone potentially exposed was quarantined and the health department called them twice a day to monitor symptoms, a spokeswoman told McClatchy News.”

Once again mechanical solutions not prohibitively expensive are available to mitigate virus spreads – https://www.news-medical.net/news/20200609/Deep-UV-LED-inactivation-of-SARS-CoV-2-fast-and-effective.aspx

“Recently, a DUV-LED instrument was reported to inactivate microbes of all kinds, at about 250-300 nm.”

“the plaque assay showed that even short periods of DUV-LED irradiation were capable of rapidly inactivating the virus. After one second of radiation exposure, the titer of infectious virus declined by 88%, and by 99.9% after a 10-second exposure.”

“UV irradiation devices, those providing UV-C are the most efficacious in sterilizing the irradiated objects, by producing photodamage in the DNA of the microbes. The UV light produces pyrimidine dimers in the DNA that disrupt the vital processes such as replication of DNA, transcription, and translation, that are required for microbial activity.

These effects eventually lead to microbial inactivation.”

Brazil leading the death pack…1272…US under 1K 999

NY is not even top 5 at 41 deaths. IL leading at 94 deaths. Confirmations are rising in CA, TX, FL in the 4 digits

County view nothing sticking out other than the usual suspects CA, MI, and AZ

Google data 6 days ago still show much of the workforce at home. Retail is still down. It does indicate a little more driving is occurring.

Japan still hasn’t gotten daily death below 10 on 7 day MA. Switzerland is observing a big spike in deaths. Brazil and Mexico not looking good.

We have rebuilt the database and are building the views from a new datasource. Some are completed below

The big news making the round is WHO stating that asymptomatic rarely spread the disease. I think it is easier to state they don’t spread the disease as much as one that is symptomatic as there is not much sneezing and coughing etc… However an individual who is asymptomatic that is in a choir group, that goes to bars and restaurants every night and is a big chatter, that works in an enclosed call center with hundreds of people, that commutes in rail and bus and talks a storm up AND ALL THIS WITHOUT A MASK – well I think in that case that person likely to transfer more than a person symptomatic that is staying home…

Interesting AI/Satellite effort to review hospital parking lot traffic to identify potentially when Covid-19 started – based on this analysis back in August 2019 – https://www.cnn.com/2020/06/08/health/satellite-pics-coronavirus-spread/

“Using images from October 2018, the researchers counted 171 cars in the parking lots at one of Wuhan’s largest hospitals, Tianyou Hospital. Satellite data a year later showed 285 vehicles in the same lots, an increase of 67%, and as much as a 90% increase in traffic during the same time period at other Wuhan hospitals.”

Diet solution for Covid proposed by Dr. Millard D.Collins, Interim Chair and Associate Professor of Family & Community Medicine at Meharry Medical College in Nashville, TN. Meharry is the nation’s oldest historically Black academic health science institution – https://thebeet.com/in-light-of-covid-19-this-doctor-tells-his-black-patients-eat-vegan-or-plant-based/

“In a recent interview, no lesser nutritional leading light than T. Colin Campbell found that plant-based eating had a "significant" impact on the ability to create antibodies to a virus, in the case of his study it was against Hepatitis B, but he points out that the commonalities in how the body creates antibodies apply to all viruses. “

He is referring to The China Study – which was published in 2005 – https://en.wikipedia.org/wiki/The_China_Study

This study made headlines for a bit and then faded as we found drugs we can purchase to continue to consume the way we want to consume. In addition many tried to poke holes into the book from evolutionary discussions to pointing out other diseases.

“The fastest-growing demographic among plant-based eating is, in fact, African Americans, according to a study published earlier this year.”

“we can adopt this lifestyle as a means to improve the co-morbid conditions that may already be present–for e.g. heart disease, lung disease, cardiovascular disease, and cancer–thus strengthening ones’ immune system and chances of survival in the event that a person becomes infected.”

“the adoption of a plant-based diet can do wonders to boost the immune system, improve energy, and improve chronic diseases mentioned earlier, thus, it can save lives.”

Of course diet AND exercise is suggested to be able to fight off comorbidities – https://www.bicycling.com/health-nutrition/a32781832/exercise-physical-activity-protects-against-atherosclerosis-plaque/

Even if you have plaque in your arteries IF you exercise you will live longer than those that don’t exercise and don’t have plaque.

Study the article refers to since I like source documents – https://www.newswise.com/articles/exercise-levels-can-help-doctors-predict-risk-of-heart-disease-and-death-among-older-adults

“among patients who had significant atherosclerosis (CAC scores greater than 400), there was a stepwise decrease in mortality risk with increasing levels of reported physical activity. The patients with high CAC scores who reported high physical activity had a measured mortality rate which was similar to that of patients who had low CAC scores but reported only low physical activity over the years of follow-up.”

Chile jumped up into second place in terms of daily death reporting at 627

CA and TX both showing a spike in confirmation yesterday. So far not translating to deaths yet. NY back in the lead at only 43 deaths.

County view we see Cuyahoga Ohio seeing an increase in deaths. Providence Rhode Island is having a spike in confirmations.

Brazil, Mexico, Peru, and Chile are still rising on the 7 day MA death chart. Germany is seeing a resurgence to. India, Russaim Saudi Arabia, and Iran are somewhat flattening. US is in a clear trend down.

Our DB is still down as our source has deprecated the DB. We are migrating now.

Coincidentally Brazil has stopped reporting – https://www.reuters.com/article/us-health-coronavirus-brazil-idUSKBN23D0PW

Interesting take on antigen – https://www.dailymail.co.uk/news/article-8396195/Professor-says-10-people-coronavirus-develop-antibodies.html

“Professor says only 10% of coronavirus patients develop antibodies meaning it may never be possible to measure true scale of pandemic”

“…not everyone who has had the virus will produce detectable antibodies, and may have used a different immune response in order to attack the virus. For example, T cells are one of the first lines of defence and act before antibodies are even needed”

“Surveillance testing suggests that 8.5 per cent of people in England have already had the coronavirus, based on measuring antibodies. But scientists say the true figure is likely to be far higher. “

“If you have a good T cell response, it will protect you against the flu, the cold, or the coronavirus. This immune response declines dramatically over the age of 50 – which fits the people who get ill more quickly with the coronavirus.

‘Antibodies are a clear sign of many other infections. With this coronavirus, it doesn’t appear to be quite as clear.’”

IF true this has a lot of impact. Fatality rates would likely drop dramatically from the low numbers already used for antigen testing. It would also mean the likelihood of mitigation is as likely as stopping the common the cold from occurring.

Another game changing discussion – https://www.post-gazette.com/news/health/2020/06/07/Cholesterol-COVID-19-deaths-study-scripps-research-institute-underlying-conditions/stories/202006040179?q1g

“a study by the Scripps Research Institute has shown that high cholesterol levels in lung tissue may be the key culprit in COVID-19 deaths, especially for those with such underlying chronic conditions as hypertension, diabetes and cardiovascular disease”

“Using super resolution imaging, the Scripps team — led by Scott Hansen, an associate professor in Scripps’ Department of Molecular Medicine — documented a chain-reaction process that begins with high cholesterol levels and ends with a cytokine storm that fills the lungs with fluid.”

Cells use cholesterol for many purposes, including mounting an immune response against SARS-CoV-2, the virus that causes COVID-19.

But COVID-19’s potentially lethal process begins with a high number of low-density lipoproteins or LDL — often referred to as bad cholesterol — circulating in the blood, accumulating in tissue, and signaling cells of their presence.

The cells react by altering their membranes to make entry points and position receptors for cholesterol to enter.

But that process simultaneously makes available twice the number of locations for the virus optimally to dock with ACE2, which is the enzyme on the cell membrane that serves as an entry point for the virus to be drawn into the cell.

Excess cholesterol also helps the virus to bind with ACE2, providing an easy access portal into the cell.

The problem is that the high virus count inside the cell spawns development of many cytokines — the proteins (peptides) that generate an inflammatory immune response against the SARS-CoV-2 virus inside and outside the cell.

The role that high cholesterol plays in that process, if confirmed, would clarify why obesity, hypertension, respiratory and cardiovascular diseases, and diabetes represent such high risk factors for COVID-19 severity and mortality.

“As cholesterol increases with age and inflammation [e.g. smoking and diabetes], the cell surface is coated with viral entry points and optimally assembled viral entry proteins,” the study says.

It’s well established that cholesterol levels generally increase with age — a point that runs parallel with the age-related severity and mortality rate from COVID-19.

“Understanding why young people are resistant in this class of [corona] viruses could help both healthy and chronically ill adults avoid severe symptoms of COVID19,” the study says. “Understanding these differences is critical for safeguarding the vulnerable and guiding effective policy and treatments.”

Based on cholesterol levels, age and inflammation levels, the study says, “we build a cholesterol dependent model for COVID19 lethality in elderly and the chronically ill.”

““People with a really poor diet with high cholesterol over a long period of time are sitting ducks for the virus.”

Giovanna Rappocciolo, an assistant professor in the University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, has studied cholesterol’s impact on the human immunodeficiency virus and found the Scripps study to be plausible.

She said the Scripps study, however, is “rough around the edges” — a situation that could be remedied through the peer-review process.

But the study also is important, she said, in noting that COVID-19 potentially could be treated by manipulating cholesterol levels, with drugs already available.

For now, she said, “using available drugs directed to reduce cell cholesterol levels could represent an important line of inquiry.”

“Generally speaking, this is a very interesting and valid study that needs some more work,” said Ms. Rappocciolo, who holds a Ph.D in immunology. “It opens up a new field of study to try to exploit these pathways to stop the infection of cells.”

I find it interesting the first response to solving this is using a drug – versus just changing your diet. Did you know CHOLESTERAL IS ONLY FOUND IN ANIMAL PRODUCTS? A way to tell if something is vegan look to see if there is 0 cholesterol. This is very enlightening to figure out why young people are so much better – cholesterol is a perfect rationale for this.

Yesterday and today we now want to not be a male balding, Type A, High cholestral diet if our goal is to not die from Covid.

Lots of interesting reads…

https://time.com/5848949/covid-19-asymptomatic-spread/ – Nearly Half of Coronavirus Spread May Be Traced to People Without Any Symptoms…

“In a study published June 3 in the Annals of Internal Medicine, researchers at the Scripps Research Translational Institute reviewed data from 16 different groups of COVID-19 patients from around the world to get a better idea of how many cases of coronavirus can likely be traced to people who spread the virus without ever knowing they were infected. Their conclusion: at minimum, 30%, and more likely 40% to 45%.”

“Five of these studies included follow up testing of the participants; they showed that only a small fraction of people who were asymptomatic when they tested positive the first time then went on to develop symptoms. That allowed the researchers to distinguish between people who are pre-symptomatic—those who test positive but eventually go on to develop symptoms—and those who are truly asymptomatic, and test positive for COVID-19 but never develop obvious symptoms. Among the more than 2300 people sampled in the Vo population, none of the 41% who had no symptoms when they tested positive ever developed symptoms over a 14 day period.”

Scary part

““People who are getting infection without symptoms are actually doing a lot of damage to their bodies and they don’t know it,” says Topol. Another small study in South Korea that studied 10 asymptomatic people from a group of 139 COVID-19 patients supports these findings.”

“Are people infected but not showing symptoms because their immune systems are better at controlling the virus, or because the virus they harbor is somehow less potent? Or are these people asymptomatic because they have immunity to other, more prevalent coronaviruses that are responsible for the common cold and therefore already might already have a level of protection against SARS-CoV-2 as well?

Another question that the data raise involves how long asymptomatic people are infectious. In Topol’s analysis, the cases from U.S. aircraft carrier U.S.S. Theodore Roosevelt suggests that they may be able to spread the virus for longer than the presumed 14 days, which would have wide-ranging implications for public health policies focused on reopening cities and states safely—and further support the need for wearing masks in public settings.”

Here is my hypothesis I came up while swimming laps – HOW AND WHERE you get infected is causing the difference. IF you get infected lets say by bringing the virus into your body via a cut or ingestion instead of the lung you are getting infected in a way your body can handle it. IF you get in the lung and the viral load is large you become very symptomatic. Unlike SARS and MERS this virus is not so fatal this allows it to spread as host are surviving. Because of this there is likely no way around the spread. Our ventilation system designs need to be reworked to mitigate lung exposure to covid-19. Given the evitable spread, nursing homes need better designs to protect the elderly. As much as one gets a cold I suspect as much as one could get covid but for the most part be okay.

Blood type driving the differences? – https://www.medrxiv.org/content/10.1101/2020.05.31.20114991v1

Unlike the retracted Lancet study you will notice tons of names on this report…

“The association signal at 9q34 was located at the ABO blood group locus and a blood-group-specific analysis showed higher risk for A-positive individuals (OR=1.45, 95% CI, 1.20 to 1.75, P=1.48×10-4) and a protective effect for blood group O (OR=0.65, 95% CI, 0.53 to 0.79, P=1.06×10-5). Conclusions. We herein report the first robust genetic susceptibility loci for the development of respiratory failure in Covid-19. Identified variants may help guide targeted exploration of severe Covid-19 pathophysiology.”

“with higher risk for A-positive individuals (meta-analysis result OR=1.45, 95% CI, 1.20 to 1.75, P=1.48×10-4)

and a protective effect for blood group O (meta-analysis result: OR=0.65, 95% CI, 0.53 to

0.79, P=1.06×10-5; see Supplementary Table 5 for details)”

Men have higher chances of covid – https://science.sciencemag.org/content/368/6495/1038

“Epidemiological data from around the world have confirmed the early reports of male vulnerability. In Lombardy in Italy, for example, men comprised 82% of 1591 patients admitted to intensive care units (ICUs) from 20 February to 18 March, according to a JAMA paper. And male mortality exceeded that of women in every adult age group in another JAMA study of 5700 New York City patients hospitalized with COVID-19.”

“Another retrospective study, still unpublished, controlled for age and other medical conditions and got similar results: Of 58 patients with prostate cancer who contracted the coronavirus, the 22 taking ADT were significantly less likely to be hospitalized and to need supplemental oxygen, says William Oh, a prostate cancer physician-scientist at the Icahn School of Medicine at Mount Sinai. “Our conclusion supports the hypotheses that androgen signaling might increase the risk of severe outcomes from COVID-19 and that androgen deprivation may limit those severe outcomes,” Oh says.

Two small studies have reported that men with male pattern baldness are overrepresented among hospitalized COVID-19 patients. This type of baldness is associated with high levels of dihydrotestosterone (DHT), a key metabolite of testosterone, in the scalp. An April study of 41 Spanish men hospitalized for COVID-19 found that 71% had male pattern baldness; the background rate in white men is estimated at 31% to 53%. A second study published last month found that 79% of 122 men in three Madrid hospitals with COVID-19 had male pattern baldness.”

So from the two above don’t be blood type A balding man….

More Gilead Science pumping – https://www.fiercepharma.com/pharma/remdesivir-stockpiling-could-help-push-covid-drug-into-profitable-territory-for-gilead

“Analysts at SVB Leerink predicted Gilead will announce its pricing plans for remdesivir soon and start selling it commercially in the second half of the year, they wrote in a note to investors Wednesday. The analysts estimate the price will be $5,000 per course in the U.S., $4,000 in Europe and $2,000 elsewhere.

At those prices, remdesivir should bring in $1.9 billion in sales this year, peak at $7.6 billion in 2022 and then fall off from there, SVB Leerink said. The operating profit margin on the drug will peak at 19% in 2021, and governments should start scooping up the drug for stockpiling late that year, the analysts added.

Remdesivir’s contribution pushed SVB Leerink’s estimate for Gilead’s total sales in 2021 up 28% to $30 billion. The firm also boosted its earnings-per-share estimate by 10% for next year to $7.74.”

I guess no thinking vaccine is coming.

Database is not updating today….

Lancet has retracted the study that caused a storm on mass media and proved once again confirmation bias clouds us if we don’t focus on being objective- https://www.thelancet.com/lancet/article/s0140673620313246?

Simple journalism would have uncovered the issue and the simple biases being made – however much of the media is deadest on making someone look like a fool at all cost. Medication like most decisions is a simple risk/reward metric and as I have been noting the risk category for HCQ is extremely low factoring cost and the millions that have already taken HCQ. The rewards may be nothing (placebo) to actually being effective in thwarting covid as many have shown.

Another case indicating viral load and air management as key in spreading of covid – https://www.scmp.com/news/hong-kong/health-environment/article/3087709/coronavirus-kitchen-fans-could-be-behind-latest

“Yuen said he believed the extraction fan in the kitchen could be why the virus spread among the three flats numbered 12.”

In this case the suspect is the kitchen fans spreading covid. The data is limited here and hopefully they can be as thorough if not more than the restaurant and building study I have noted before.

I have read theaters are opening up. The good thing theaters have a ton of air volume space and many are instituting a reduce size of people which should help in viral load reduction. In the end these institutions (retailers/venues) need to implement something to clean the air or at least demonstrate the air is already being cleaned e.g. as on an airplane. The last thing they want is to get a tracing that goes back to them.

If you think containing/managing/curing covid-19 is hard – its not even remotely close to the challenge presented by GHG – https://www.france24.com/en/20200605-atmospheric-co2-levels-hit-new-record-high-despite-covid-19-lockdowns

“Measurements of carbon dioxide, the chief human-caused greenhouse gas, averaged 417.1 parts per million at Mauna Loa, Hawaii, for the month of May, when carbon levels in the air peak, the National Oceanic and Atmospheric Administration said. That’s 2.4 parts per million higher than a year ago.

Even though emissions of carbon dioxide from the burning of fossil fuels dropped by as much as 17% in April, it was a brief decline. Carbon dioxide can stay in the air for centuries, so the short-term reductions of new carbon pollution for a few months didn’t have much of a big picture effect, said NOAA senior scientist Pieter Tans.”

We literally shut the world economy down and we don’t even get much for it. Going green has many other benefits which does not need to be connected to reducing GHG. The GHG goal may be too much for society – adaption seems to be inevitable.

Brazil tops again at 1473 US 1036 Mexico 816

New York back as the leader for the states at 115

Washington county in Arkansas showing to be a new hotspot from our maps. Quick google search https://www.arkansasonline.com/news/2020/jun/02/northwest-arkans-driving-covid-increase/

“Benton and Washington counties accounted for more than two out of every five new coronavirus cases in Arkansas since Sunday, according to figures released in the governor’s pandemic update Monday.”

“The largest daily increase so far, outside of the prison population, was 261 on Thursday. Only three of the 190 new cases reported Monday are in prisons.”

“What role poultry plants play in the outbreak is unknown because not enough testing has been done, Smith said. More than 100 new cases last week were found among poultry workers across the state, according to the Arkansas Department of Health.

The spike in cases among poultry workers prompted protests last week, including demonstrators at four plants Friday owned by Cargill, George’s and Tyson Foods. The protests were organized by poultry workers rights group Venceremos.”

LOL – “role of poultry plants play in the outbreak unknown” – well the data tells you it would seem food processing facilities, prisons, and nursing homes ARE big culprits….one doesn’t need a double blind test and/or hire an outside consultant to analyze the data to tell you that. We should quickly come up with ways to mitigate the viruses in those environments – and the crazy thing is we have the technology to do it. Fresh air hvac, UV lighting, mask, etc…

Unfortunately in a week it would seem Brazil will surpass UK in deaths

Brazil and Mexico no flattening out for them. India continues to rise. Russia looks to flattening out.

To temper HCQ we have the following study – https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home

“This randomized trial did not demonstrate a significant benefit of hydroxychloroquine as postexposure prophylaxis for Covid-19. Whether preexposure prophylaxis would be effective in high-risk populations is a separate question, with trials ongoing. In order to end the pandemic, a reduction in community transmission is needed.”

“Nausea, loose stools, and abdominal discomfort were the most common side effects. There were no serious intervention-related adverse reactions or cardiac arrhythmias.”

However this is just HCQ and does not include the Zinc combination being recommended. In addition they note in their study they did not have access to testing. Another positive is the acknowledgement the side effects are minimal unlike the Lancet study.

WHO has backtracked their response to Lancet study – https://www.statnews.com/2020/06/03/who-resuming-hydroxychloroquine-study-for-covid-19/

WHO resumes hydroxychloroquine study for Covid-19, after reviewing safety concerns

Conspiracy theorist on the origin of virus going to love this – like a James Bond plot with a touch of reality as it was noted as an accidental release not a nefarious reason but why create such a virus?- https://www.walesonline.co.uk/news/world-news/coronavirus-origin-lab-mig-wuhan-18360326

Gilead details on remdesivir – https://www.axios.com/remdesivir-sales-predictions-gilead-coronavirus-adeb5473-9f7e-429b-a0a5-343903a9305a.html

“Gilead’s intravenous coronavirus drug remdesivir could fetch $6.7 billion in revenue in 2021 with a 19% profit margin, assuming the company prices each treatment at $5,000, according to new forecasts from Geoffrey Porges, a highly read pharmaceutical analyst at Wall Street firm SVB Leerink.”

“…That price would also be above what independent researchers suggest is a fair price.”

So lets compare HCQ=$19X14(days)=$266 vs. $5000 19X…which is much better than the initial cost of 10K that many noted – assuming they go with that price…not sure what that “fair” price even means. They should note how they compute a fair price – I suspect it is based on a rate of return they believe is “fair” which then would be probably an industry average return on risk adjusted basis based on investments to discover the drug and produce it.

US below 1K deaths in the middle of the week – this is a big step! Unfortunately Brazil 1349 and Mexico 1092….

Leader in the US is NJ….NY not even in top 5 in terms of daily death

Memorial day weekend impact probably coming in now given some incubation time period. There is an uptick in Tennessee and Texas in terms of confirmation. This is dropping the fatality rates in these states.

County view AZ is showing more areas on the high end

Brazil #3 in deaths

No more flattening for Brazil and Mexico. Germany has a rise.

Staying on the positive train….

10 million tested in Wuhan https://apnews.com/70fd3d4ecbb5882ca0ddd50f4f7532ca

“It identified just 300 positive cases, all of whom had no symptoms. The city found no infections among 1,174 close contacts of the people who tested positive, suggesting they were not spreading it easily to others.”

“virtually everyone above the age of 5 in the city of 11 million people has been tested, said Li Lanjuan, a member of a National Health Commission expert team.

“The city of Wuhan is safe,” she said at a news conference with city officials.”

“The industrial city on the Yangtze River in central China spent 900 million yuan (about $125 million) on the tests, the official Xinhua News Agency said, citing a Wuhan official.”

Amazing results – the percentage is amazingly low plus just because you have it even close contacts are not getting it now – likely a result of awareness and preventative actions. This also means that social distancing and lockdown are not needed IF the ones closest to you are not getting it. Perhaps simple cultural habits and awareness is all that is needed to limit the virus.

Vaccine trials for Moderna Phase 3 covid-19 vaccine will being with 30K individuals – https://www.forbes.com/sites/brucejapsen/2020/06/02/fauci-modernas-phase-3-covid-19-vaccine-trial-will-include-30000-young-and-old-individuals/amp/?

It will be hard to test as the numbers decline in the US.

HCQ front

The Association of American Physicians & Surgeons (AAPS) filed a lawsuit, AAPS v. FDA, against the Food and Drug Administration to end its arbitrary interference with the use of hydroxychloroquine (HCQ),

https://news.yahoo.com/amphtml/association-american-physicians-surgeons-aaps-182000674.html?

“Two million doses of HCQ are being sent by the Trump Administration to Brazil to help medical workers there safeguard themselves against the spread of the virus. But at the same time the FDA continues to block Americans’ access to this medication.

HCQ has been approved as safe by the FDA for 65 years, and the CDC states on its website that "CDC has no limits on the use of hydroxychloroquine for the prevention of malaria."

More than 150 million doses have been donated to the strategic national stockpile controlled by the federal government, but unjustified FDA restrictions limit its use to only hospitalized patients for whom a clinical study is unavailable. Hospitals are even returning HCQ to the stockpile because they are not able to use it effectively.

"It is shocking that medical workers in Brazil will have access to HCQ as a prophylaxis while Americans are blocked by the FDA from accessing the same medication for the same use," observes AAPS Executive Director Jane Orient, M.D.

"There is no legal or factual basis for the FDA to limit use of HCQ," states AAPS General Counsel Andrew Schlafly. "The FDA’s restrictions on HCQ for Americans are completely indefensible in court."

Many foreign nations, including China, India, South Korea, Costa Rica, United Arab Emirates, and Turkey, use HCQ for early treatment and prevention of COVID-19, AAPS points out.

"Entrenched, politically biased officials at the FDA should not be allowed to interfere with Americans’ right to access medication donated to the federal government for public use," Schlafly says. "By preventing Americans’ use of HCQ as a prophylaxis, the FDA is infringing on First Amendment rights to attend religious services or participate in political events such as political conventions, town halls, and rallies in an important election year."

"FDA Commissioner Stephen Hahn states that the FDA does not interfere with physicians’ ability to prescribe HCQ, and yet at the same time the FDA denies access by millions of Americans to 150 million doses of it in the national stockpile," Schlafly adds. "This irrational hoarding by government is an abuse of power."

The Association of American Physicians and Surgeons (AAPS) has represented physicians of all specialties in all states since 1943. The AAPS motto is omnia pro aegroto, meaning everything for the patient.”

Blood will be on the hands of several – https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling

“the questions swirling around the Lancet paper have left leaders of the halted chloroquine trials weighing whether to restart. “The problem is, we are left with all the damage that has been done,” says White, a co-investigator on a trial of hydroxychloroquine for COVID-19 prevention that was halted at the request of U.K. regulators last week. Headlines proclaiming deadly effects will make it hard to recruit patients to key studies, he says. “The whole world thinks now that these drugs are poisonous.”

“The controversy has been an unfortunate distraction, Hernán adds. “If you do something as inflammatory as this without a solid foundation, you are going to make a lot of people waste time trying to understand what is going on.”

Chaccour says both NEJM and The Lancet should have scrutinized the provenance of Surgisphere’s data more closely before publishing the studies. “Here we are in the middle of a pandemic with hundreds of thousands of deaths, and the two most prestigious medical journals have failed us,” he says.”

Not so positive on the data as the weekend lull is catching up. Brazil tops the death chart at 1262. US 1031

This time it is not NY – in fact NY is not even on the top 5. IL tops at 113.

Cass N. Dakota is popping up in our County view for deaths. A quick google search does highlight nursing home issues. Seems like nursing home

Shelby TN popping up for confirmed cases. A quick google search did confirm county officials are concerned – https://wreg.com/news/memphis-shelby-county-covid-19-joint-task-force-gives-daily-update-11/

“The spike comes a little more than a week after Memorial Day. Randolph said he was not aware of any specific event on that holiday that might have led to an increase, but said more people were out and gathering over the weekend, which might have an impact on numbers. The number of people tested in Shelby County is 78,104, Randolph said. The positivity rate for those tests is 6.8%, while the fatality rate from COVID-19 in the county is 2.1%”

Our global testing source is stagnating in its update so I would hold off on believing any testing metric (non US).

Mexico and Brazil still holding flat. India and Russia still on rise. Egypt is accelerating in deaths – from the trajectory likely to be the next hotspot to be discussed.

Good news on many fronts

Russians claim to have an effective treatment for the coronavirus, which hospitals will start using this month – they certainly have people to test this on (#2 in confirmed cases 500k+) – https://www.cnbc.com/2020/06/01/russia-approves-drug-to-treat-covid-19-hospitals-to-use-in-june.html

“Preliminary trials are said to have shown that it could shorten recovery times for patients with Covid-19.

The final stage of Avifavir clinical trials involving 330 patients, are ongoing.

Russia’s Ministry of Health on Saturday temporarily approved the use of the drug as a coronavirus treatment”

“According to data received from an earlier clinical trial of the drug, 65% of the 40 patients tested negative for coronavirus after five days of treatment, which was two times higher than in the standard therapy group, RDIF and ChemRar said last month.”

Paper on HCQ released May 27th -perhaps another confirmation bias paper – https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa093/5847586

“Dr. Harvey A. Risch, Department of Chronic Disease Epidemiology, Yale

School of Public Health, P.O. Box 208034, New Haven, CT”

“Funding: None”

“Hydroxychloroquine+azithromycin has been used as standard-of-care in more than

300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac

arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is

<20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These

medications need to be widely available and promoted immediately for physicians to prescribe.”

“the key to returning society toward normal functioning and to preventing huge loss

of life, especially among older individuals, people with comorbidities, African Americans and

Hispanics and Latinos, is a safe, effective and proactive outpatient treatment that prevents hospitalization in the first place.”

“Numerous reviews of HCQ efficacy and adverse events

have been and continue to be published. To my knowledge, all of these reviews have omitted the

two critical aspects of reasoning about these drugs: use of HCQ combined with AZ or with

doxycycline, and use in the outpatient setting.”

“first study of HCQ+AZ (24) was controlled but not randomized or

blinded, and involved 42 patients in Marseilles, France. This study showed a 50-fold benefit of

HCQ+AZ vs standard-of-care, with P-value=.0007. In the study, six patients progressed,

stopped medication use and left the trial before the day-6 planned outcome measure of swab sampled nasopharyngeal viral clearance.”

“Examination of

the database for adverse events reported from the beginning of the database in 1968 through

2019 and into the beginning of 2020, shows for hydroxychloroquine 1064 adverse event reports

including 200 deaths for the total of cardiac causes that could be both specifically and broadly

classified as rhythm-related. Of these, 57 events including 10 deaths were attributed to Torsades

de Pointes and long QT-interval syndrome combined. This concerns the entirety of HCQ use

over more than 50 years of data, likely millions of uses and of longer-term use than the 5 days

recommended for Covid-19 treatment.

“All but one of the scientists on the Scientists to Stop Covid-19

panel are laboratory or clinical scientists; only one is an epidemiologist. Their recommendation

for remdesivir use as early as possible was made without either FDA approval or RCT evidence

of efficacy in the outpatient context. This recommendation therefore appears to be an

extrapolation from animal and laboratory data and from use in severely ill hospitalized patients.

However, a history of epidemiology shows numerous instances of failed extrapolation from

animals to humans. “Animal research on almost any topic of epidemiologic interest is so

heterogeneous and inadequately synthesized that it is possible to selectively assemble a body of

evidence from the animal and in-vitro studies that support almost any epidemiologic result.””

“it is not my point to say that remdesivir has little evidence to

support its potential outpatient utility, only efficacy considerations that have not been addressed

and that could lead to lack of efficacy under general use, but that HCQ+AZ has been directly

studied in actual early high-risk outpatient use with all of its temporal considerations and found

empirically to have sufficient epidemiologic evidence for its effective and safe employment that

way, and that requiring delay of such general use until availability of additional RCT evidence is

untenable because of the ongoing and projected continuing mortality. No studies of Covid-19

outpatient HCQ+AZ use have shown higher mortality with such use than without, cardiac arrhythmias included, thus there is no empirical downside to this combined medication use”

“Substantial fractions of physicians treating Covid-19 patients in

Europe and elsewhere report use of HCQ+AZ: 72% in Spain, 49% in Italy, 41% in Brazil, 39%

in Mexico, 28% in France, 23% in the US, 17% in Germany, 16% in Canada, 13% in the UK

(45), much of the non-US use in outpatients. HCQ+AZ has been standard-of-care treatment at

the four New York University hospitals, where a recent study showed that adding zinc sulfate to

this regimen significantly cut both intubation and mortality risks by almost half”

“I conclude that HCQ+AZ and HCQ+doxycycline,

preferably with zinc (47) can be this outpatient treatment, at least until we find or add something

better, whether that could be remdesivir or something else. It is our obligation not to stand by,

just “carefully watching,” as the old and infirm and inner city of us are killed by this disease and

our economy is destroyed by it and we have nothing to offer except high-mortality hospital treatment. We have a solution, imperfect, to attempt to deal with the disease. We have to let

physicians employing good clinical judgement use it and informed patients choose it. There is a

small chance that it may not work. But the urgency demands that we at least start to take that

risk and evaluate what happens, and if our situation does not improve we can stop it, but we will

know that we did everything that we could instead of sitting by and letting hundreds of thousands

die because we did not have the courage to act according to our rational calculations.”

It must be Yale day – another Yale article pointing out another cost effective option ACE inhibitors – https://www.medrxiv.org/content/10.1101/2020.05.17.20104943v1

“there was a nearly 40% lower risk of hospitalization with the use of ACE inhibitors in the Medicare population. This finding merits a clinical trial to evaluate the potential role of ACE inhibitors in reducing the risk of hospitalization among older individuals, who are at an elevated risk of adverse outcomes with the infection.”

Food for thought – so important to read and take in thoughts you don’t necessarily agree with – https://www.aier.org/article/nobel-laureate-michael-levitt-on-the-lockdowns-i-think-it-is-a-huge-mistake/

Michael Levitt is Professor of computer science and structural biology at Stanford Medical School and winner of the 2013 Nobel Prize in chemistry.

“The R-0, which is very popular, is in some ways a faulty number. Let me explain why. The rate of growth doesn’t depend on R-0. It depends on R-0 and the time you are infectious. So if you are twice as long infectious and have half the R-0 you’ll get exactly the same growth rate. This is sort of intuitive, but it’s not explained, and therefore it seems to me that I would say at the present time R-0 became important because of a lot of movies — it was very popular — talked about R-0. Epidemiologists talk about R-0 but, looking at all the mathematics, you have to specify the time infectious at the same time to have any meaning. The other problem is that R-0 decreases — we don’t know why R-0 decreases. It could be social distancing, it could be prior immunity, it could be hidden cases.”

“The reason I felt that social distancing was unimportant is that I had two examples in China to start with and then we had the additional examples. The first one was South Korea (yeah), and Iran, and Italy. The beginning of all the epidemics showing a slowing down, and it was very hard for me to believe that those three countries could practice social-distancing as well as China. China was amazing, especially outside Hubei, in that they had no additional outbreaks. People left Hubei, they were very carefully tracked, had to wear face masks all the time, had to take their temperatures all the time, and there were no further outbreaks.

So this did not happen in either in South Korea or in Italy or in Iran. Now, two months later something else suggests that social distancing might not be important, and that is that the total number of deaths we’re seeing in New York City, in parts of England, in parts of France, in northern Italy — all seem to stop at about the same direction of the population so are they all practicing equally good social distancing? I don’t think so”

“My feeling is that in London, and in New York City, all the people who got infected, all got infected before anybody noticed. There’s no way that the infection grew so quickly in New York City without the infection spreading very quickly. So one of the key things is to stop people, who know that they’re sick, from infecting the others. Here again, China has three very, very important advantages that are not high-tech that don’t involve security tracking of telephones.”

Here is a little bit of confirmation bias with the “SMART” lockdowns I was promoting from the beginning.

“I think we need smart lockdowns. If we were to do this again, we would probably insist on face masks, hand sanitizers, and some kind of payment that did not involve touching right from the very beginning.”

“I see the standout winners as Germany and Sweden. They didn’t practice too much lock down, they got enough people sick to get some herd immunity. The standout losers are countries like Austria, Australia, Israel that actually had very very strict lockdowns but didn’t have many cases. So they have damaged their economies, caused massive social damage, damaged the educational year of their children, but not obtained any herd immunity. “

“There is no doubt in my mind that when we come to look back on this, the damage done by lockdowns will exceed any saving of lives by a huge factor. One very easy way to see this is, and again I am getting into a sensitive territory here, but economists have a very simple way of looking at death. They don’t count people. They come to the conclusion that if you’re 20 and you die that’s a greater loss than if you’re 85 and you die. It’s a hard issue, but in some ways are we valuing the potential future life of the 20 year old? Are we valuing the loss of more senior persons by what’s called daily disability-adjusted life years. Basically if somebody is in their 80s, has Alzheimer’s disease, and then dies from pneumonia (perhaps due to corona) that is less of a loss than if a 15 year old is riding his motorcycle bike and gets run over. This is an important way of looking at death”

“Another factor which has not been considered are all the cancer patients who aren’t being treated, or all the heart cardiology patients who aren’t being treated. I’ve got estimates of tens of thousands of people who are basically going to be dying because of lack of that treatment — and generally again the age group who die of cancer are younger than the age group who die of coronavirus.”

“in Europe there were about 140,000 excess deaths in the last nine weeks. The number of those excess deaths who are younger than 65 is about 10%. So basically 13,000 of 130,000 deaths are actually under 65 years old and if we had simply been able to protect elderly people then the death rate would have been much much less. But the key thing is to have as much infection for as little possible death and also do whatever you can to keep the hospitals full but not overflowing. It’s a difficult calculation and the trouble is that in Sweden there’s no political concerns.

The trouble is is that in Israel and I know as well in the United States, everything is political and therefore nobody could say something like this. They would say, “Ah, but you are not valuing death — the thing that should have been done is for the media to stress to people that everyday somebody dies. These people are essentially in the same age band, and they die from Corona and other comorbidities, other diseases.”

“The World Health Organization, and epidemiologists in general, can only go wrong if they give [politicians] a number smaller. If I said it’s going to be 1 billion deaths from coronavirus and it’s, “oh, you guys have done what I’ve said and there’s only gonna be a hundred thousands,” that is considered good policy. They overestimated bird flu by a factor of a hundred, or ten thousand in The Guardian. The Guardian wrote about this. Ebola was overestimated by a factor of 100 I think. They see their role as scaring people into doing something. I can understand that and there’s something to be said for it. If you could practice lock down with zero economic costs, and zero social costs — let’s do it. But the trouble is that those costs are huge, we’re gonna have fatalities from hospitals being closed down, additional children in trauma, businesses damaged — maybe less so in the UK because of the compensation policy — but certainly massive economic damage in the USA and in Israel, and in other countries. So you need to balance both of these things.”

“We have become very influenced by [rhetoric] that. I think this is another foul-up on the part of the baby boomers.

I am a real baby-boomer, I was born in 1947, and I think we’ve really screwed up. We cause pollution, we allowed the world’s population to increase three-fold, we’ve caused the problems of global warming, we’ve left your generation with a real mess in order to save a really small number of very old people. If I was a young person now, I would say, “now you guys are gonna pay for this.”

We have my family whatsapp and very early on I said this is a virus being designed to get rid of the baby boomers. You know I don’t know, I think my wife thinks this is going to be a take it to the streets thing,and we’re gonna have the young people on the street saying you guys have really screwed up it’s time to go. And I always joke with her, saying well at least I’ve made lots of friends among the young people, I’ll be okay.

But quite frankly you know I’ve had a great life, and I must say this to all the young faces in front of me. I have a grandson who’s 17. I’d much rather have young people live for a very long time. That said I do have a mother who’s a hundred and five years old living in London with my brother, she’s in lockdown and I talk to her by whatsapp every single day on FaceTime, and she’s fine. She still uses her phone and so on so you know these differences but…

You guys should get out there and do something don’t accept this anymore we screwed up too much”

No country over 1K. UK showed a big increase in deaths 556.

MA lead the way for the US at 189 deaths

Albany NY is showing up a darker red in the county map for deaths. Essex and Middlesex is the epicenter for MA deaths.

Brazil is the leader in confirmed cases when you break out the US – Russia and then NY. UK leads the death category followed by Italy, Brazil, and NY.

Brazil is actually looking like it has peak in 7 Day MA deaths. Mexico has been flat to. India and Russia continue to grow. Note UK spike.

Origin of virus Beijing now joining the bandwagon that it did not start in the wet market in Wuhan. https://www.dailymail.co.uk/news/article-8373007/Beijing-admits-coronavirus-DIDNT-start-Wuhans-market-DID-come-from.html?

“Centre for Disease Control and Prevention’s Gao Fu admitted no viruses were detected in animal samples

He said they were found only in environmental samples, including sewage

Gao’s sudden reversal came after series of studies cast doubt on his original claim”

“‘At first, we assumed the seafood market might have the virus, but now the market is more like a victim,’ said Gao Fu, director of the Centre for Disease Control and Prevention”

Someone is going to have to admit they were wrong and potentially caused much more death than needed – https://www.hindustantimes.com/india-news/80-dip-in-infection-risk-for-health-staff-on-hcq-study/story-4Btz0DoDQtM0qacOCWZn7I.html

“80% dip in infection risk for health staff on HCQ: Study

The results of the study are based on a case control study for which participants were randomly drawn from the countrywide Covid-19 testing data portal maintained by ICMR.”

““… Ability of this compound to inhibit the infection by SARS-CoV-2, as well as viral replication in cell cultures in a time- and dose-dependent manner made it a primary choice… These laboratory findings encouraged researchers to consider HCQ, originally used for malaria, as a repurposed agent for prophylaxis against SARS-CoV-219,” says the study.”

Weekly Sunday great numbers no one above 1K US and Brazil lead the death and confirmation category.

MA leads US death at 78

Will be interesting to see if we start observing increase incidents in areas that riot/protested. IF not then social distancing outside is not a factor.

Google data with their own ranking of baseline shows still no one going to work and mainly working from home. Transit is starting to pick up but retail still overall negative. Data is a week old.

US represents about 30% of global death and confirmed totals.

It has been 129 days since Washington state in US has first count of covid yet deaths are still around 8 per day. Japan at 11. Germany 125 days at 37. France at 128 with 62. It would seem to completely eliminate covid-19 seems to be a goal that is unachievable.

Dr. Ing was gracious enough to respond to my email and gave me their treatment plan which as noted involved 128/217 positive – with only 16 with symptoms – 8 medically evacuated – 4 intubation and ventilation – 1 death.

“Mildly symptomatic patients were just managed with paracetamol

More symptomatic patients including dyspnoea were also managed with oral Azithromycin. Some required supplemental oxygen but were not evacuated.

Medically evacuated passengers were managed with Remdesivir, Hydroxychloroquine and Azithromycin; and those intubated were managed in the prone position.

Regards

Alvin Ing”

FYI Paracetamol – Acetaminophen (Tylenol).

This was an amazing outcome compared to all the other outcomes. Fatality rate 0.8% – Death per capita 0.5%.

I have asked for the demographics of those above and will update it when I get it.

HCQ is going to be reviewed in history books in the future not sure on the conclusions just yet but no doubt this was mismanaged and politicized for no good reason. The line in the sand is drawn now with the WHO abandoning HCQ and many of the media bashing HCQ. The positive is there are countries (e.g. Saudi Arabia, India (see below) )and doctors who will continue the drug and so time will tell who was right.

https://theprint.in/health/hcq-breakthrough-icmr-finds-its-effective-in-preventing-coronavirus-expands-its-use/427583/?

“The Indian Council of Medical Research (ICMR), the country’s apex body in the field, has found that consuming the drug hydroxychloroquine reduces the chances of getting infected with Covid-19.”

““amongst healthcare workers involved in Covid-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it”.

“National Institute of Virology in Pune has found in laboratory testing that HCQ reduces the viral load.”

“observational study was conducted among 334 healthcare workers at the country’s largest public hospital, New Delhi’s All India Institute of Medical Sciences (AIIMS). The 248 workers who took HCQ as preventive drug for an average of six weeks had lower incidence of the infection than those not taking the pill.”

“With available evidence for its safety and beneficial effect as a prophylactic drug against SARS-CoV-2 during the earlier recommended 8 weeks period, the experts further recommended for its use beyond 8 weeks on weekly dosage with strict monitoring of clinical and ECG parameters, which would also ensure that the therapy is given under supervision”

“the final results of the studies (HCQ prophylaxis among 1,323 healthcare workers), the ICMR found mild adverse effects such as nausea in 8.9 per cent workers, abdominal pain in 7.3 per cent, vomiting in 1.5 per cent, low blood sugar (hypoglycaemia) in 1.7 per cent and cardio-vascular effects in 1.9 per cent.

The advisory states the drug should be discontinued if it causes the “rare” side effects related to the heart, such as cardiomyopathy, a disease which makes it harder for heart to pump blood to the entire body, and heart-rate disorders.

The advisory mentions that HCQ, in rare cases, can cause visual disturbance, including “blurring of vision, which is usually self-limiting and improves on discontinuation of the drug”.

ICMR has clarified that “for the above cited reasons — heart and vision — the drug has to be given under strict medical supervision with an informed consent”.

Once again a small per cent with heart issues (1.9%) – however they are rational in not sacrificing the remaining 98% for the small amount of risk which can be mitigated through supervision. NOTE the LANCET study was only 3.7% and WHO decided to pull the study. THE OVERALL side effect is minimal – highest was nausea 8.9% – hence HCQ has been used for decades to treat malaria! HCQ risk is understood quite well. The rewards is not so clear – but even a placebo effect could be worth it given the minimal risk.

NY retrospective observational study HCQ and zinc sulfate – https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1

“After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR 0.449, 95% CI 0.271-0.744). Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.”

“No funding was provided for this work.”

The not so clean side of quarantine and lockdown and beyond just the economy – which is more apparent in countries who standard of living is much lower. Sacrificing the many for the few who could die from covid is a real math equation that needs to be factored in all policy decision. https://www.livemint.com/news/india/how-covid-19-response-disrupted-health-services-in-rural-india-11587713155817.html

“India could find itself in an acute health crisis over the next few months and the direct cause of it will not be the SARS-CoV-2 virus. Hundreds of thousands of children might already have missed vital immunizations, shows a Mint analysis of the latest health ministry data. Thousands of adults may have missed potentially life-saving medical treatment as the novel coronavirus epidemic spread and a lockdown came into force.”

“the number of unattended home births is likely to have gone up.”

“At least 100,000 children did not receive their BCG vaccination, which can provide some protection against tuberculosis (TB), and another 200,000 missed each dose of the pentavalent vaccine, which provides some protection against meningitis, pneumonia, whooping cough, tetanus, hepatitis B and diphtheria, and the rotavirus vaccine, which prevents diarrhoea-causing rotavirus infections, in March, suggests the analysis.”

“At least 350,000 fewer people received outpatient treatment for diabetes, 150,000 fewer people received outpatient treatment for mental illness and nearly 100,000 fewer people received outpatient cancer treatment in March 2020 as compared to March 2019.”

““A person who misses her tuberculosis or cancer medication today might not die this month but some months down the line. We should really be pushing for all-cause mortality data for the whole year ahead to understand the impact of this virus and lockdown on broader public health. You don’t want a situation where you save 300,000 deaths from covid and then 1.2 million people die of other causes," said Jain of Jan Swasthya Sahyog.”

“The analysis of the latest NHM numbers suggests that a serious public health crisis is already brewing, with the potential to erase gains made against a number of diseases over decades.”

Brazil continues to lead confirmation 26928 with 1124 deaths. US death 1193. NY has tested almost 10% of the population – so far nearly 2% of the population tested positive.

New Jersey leading the way for the US with 122 deaths.

County view allows one to dive into the real issues. Not like Minnesota needs any more issues but Hennepin county is not looking to good on the covid front – https://www.kare11.com/article/news/health/coronavirus/live-updates-covid-19-developments-in-minnesota-and-wisconsin-5-11-2020/89-e8d97669-dd6a-42bb-b274-b4ae9cd6ecfd

“One third of the state’s confirmed cases are in Hennepin County, and Hennepin and Ramsey Counties combined make up 40% of the state’s total cases, MDH Commissioner Jan Malcolm said on the department’s daily briefing call Monday. About half of the new cases reported Monday were in those two counties, as well. Malcolm said seven counties have outbreaks in food processing plants, and those cases account for about a third of the new cases. Those outbreaks, she said, are beginning to level off.”

Once again it looks like our food system needs to be revisited.

Russia death per confirmed now over 1%. Russia and India now 10% of daily death.

Mexico looks to be moderating now – however India and Russia still accelerating.