Thursday, March 26, 2020

Lacking Good Information

Impatiently Waiting,

New coronavirus information on PubMed dried up in the past 2 weeks.
March 10 review was that "hydroxychloroquine is promising, with lots of clinical trials ongoing in China and elsewhere, and we await the findings". We are still in that holding pattern.

The research paper which showed such good clearing of coronavirus on swabs with hydroxychloroquine, at a higher than usual dose turns out to be not real. 
French investigator Dr Raoult has a very good reputation, but this research was carried out at multiple sites in France and Vietnam, by multiple researchers. (Did Dr. Raoult sign off too soon? Was he manipulated?)
The sad fact is that the graph looked so good because they threw out the data of people who got worse and went to ICU. Throwing out a couple of data points like that in a small study makes all the difference. 
There were a lot of other procedural flaws. 
Mainly, the data was shaped to look good. 
There is actually no good data to suggest the use of azithromycin + hydroxychloroquine..

This link is highly politicized, amounting to a hostile-peer-review, but this time it's just what the doctor ordered. Thanks Lauren..  

Also, if we are not able to check blood levels, we should probably not push the hydroxychloroquine dose past 200 mg twice per day (in people with good kidneys and normal QT interval on EKG). We have to wait for good information.  

Wikipedia is pretty good on chloroquine and hydroxychloroquine.
The narrow therapeutic window is like digoxin. 1 pill good, 2 pills dead, kind of thing. Low end of fatal range is less than twice the upper level of therapeutic range, based on blood levels, and it distributes and hangs around a long time. 

This article on 4 coronavirus treatments has good information, no drama, and looks at the question of whether blood pressure medicines that act in relation to the ACE receptor sites, where SARS-CoV-2 binds, may be good or bad for coronavirus patients. There is no answer at all yet.

A Quarter of the 2 Trillion Dollar "Stimulus" Bill is Devoted to a Useless Accounting Gimmick 
(This kind of gimmick often turns out to actually be the whole plan.)

Economic Historian, and current Economist, Professor Michael Hudson, says there is no way around a debt jubilee for all the people who are in debt bondage as bank fees keep piling insult onto injury. These debts are hopeless, and they make these people hopeless. That sickens the economy further.
 Critics warn of a creditor collapse and ruinous costs to government. But if the U.S. government can finance $4.5 trillion in quantitative easing, it can absorb the cost of forgoing student and other debt. And for private lenders, only bad loans need be wiped out. Much of what would be written off are accruals, late charges and penalties on loans gone bad. It actually subsidizes bad lending to leave them in place.
 In the past, the politically powerful financial sector has blocked a write-down. Until now, the basic ethic of most of us has been that debts must be repaid. But it is time to recognize that most debts now cannot be paid — through no real fault of the debtors in the face of today’s economic disaster.

Debt forgiveness for really huge bad debts gets packaged as "Brady Bonds", invented when Mexico defaulted on it's debt. Michael Hudson again:
​ ​A close parallel to this situation was the state of Third World debt in the mid-1980s. Mexico’s announcement that it could not meet its foreign debt service was the shock that brought ugly financial reality into conflict with the assumption that somehow any government debt could be paid – even debts denominated in a foreign currency.
​ ​The international financial system was rescued by the issue of Brady bonds – “good” new bonds for old “bad” ones. The capital value of these bonds was still far below the original debt, but they had the virtue of setting realistic levels by bringing the debt balance more in line with the actual ability of debtor countries to earn the dollars or other hard currencies needed to service these bonds.
​ ​The current crisis requires a similar wrote-down and recognition that fictitious price levels must give way to reality at some point. In fact, we have reached the end of an illusion – the illusion that bond (and stock) prices could be sustained indefinitely simply by financial engineering, without an economic base capable of producing enough surplus revenue to justify existing bond and stock prices.

​Bibi Netanyahu makes good personal use of the coronavirus crisis in Israel, at the expense of almost everybody else.
​ By a series of moves Netanyahoo has neutralized the courts and the parliament and has thrown the country into a constitutional crisis. Even cabinet sessions are only held by telephone and without the cabinet members receiving the written proposals Netanyahoo wants them to vote on.
 Meanwhile Netanyahoo puts out new emergency regulations every day that steadily get harsher:
Anyone who leaves their place of residence for reasons not exempted by the emergency regulations is liable to be fined up to NIS 5,000. A person who has gone beyond the permitted distance [of 100 meters] could receive an NIS 500 fine or six months’ imprisonment, while one who operates public transportation in violation of the regulations can be fined NIS 5,000 or be imprisoned for six months.
 The emergency regulations were approved last night by the cabinet.
In which democracy can a cabinet enact imprisonment penalties without a parliament vote on an applicable law?

 Netanyahoo's current plan seems to be to go for a fourth election. Every second day he is holding a prime time TV briefing to update the population on the corona crisis. That will likely bring him additional popularity. Even Trump's approval numbers for handling the coronavirus crisis are at 60% despite his botched response.
 Gantz's current majority depends on support from the Arab parties. He will have difficulties forming a stable coalitions with them. His only alternative is to ally with Likud and that would likely keep Netanyahoo at the helm. If Gantz agrees to keep Netanyahoo at the top his Blue and White party may well fall apart.
By blocking the courts and parliament Netanyahoo wins time to make that scenario more likely.
 Meanwhile the novel coronavirus will indiscriminately affect the Jewish as well as the Palestinian population. But the Zionist racism against the Palestinians guarantees that they will get less help. As both populations can not be separated that behavior will likely increase the peak and the consequences of the outbreak for everyone. Additionally the Haredim cult members will protest against the government's measures of prohibiting religious services and passover festivities. The current mixture of political, racial and epidemic pressure in Israel may well blow up in everyone's face and cause serious conflagrations.

How Did Spain Get It's Coronavirus Response So Wrong? 
(A: By delaying drastic action until it was obviously necessary) 

Scott Ritter has the story of how a critical intelligence agency was sidelined to create a blind spot in US national response to novel coronavirus. The natural question is, "who stood this agency down, when, and why?"
 The U.S. response is something President Trump has likened to a “war,” going so far as to label himself a “wartime President,” leading the U.S. against “the toughest enemy” in a struggle in which he vows “total victory.” If the fight against the coronavirus is a war, then the virus clearly took the U.S. government by surprise. “Certainly we didn’t get an early run on it, Trump noted in a press conference on March 17. “It would’ve been helpful if we knew about it earlier.”
​ ​It is the job of the U.S. intelligence community to provide senior U.S. government policy makers, including the president, with advance warning about potential crises. The U.S. taxpayer pays a premium for this service; in 2020, the budget for the National Intelligence Program, which includes all programs, projects and activities of the U.S. intelligence community, was $62.8 billion.
​ ​Included in this budget is a small, specialized intelligence unit known as the National Center for Medical Intelligence (NCMI), which operates as part of the Defense Intelligence Agency. The mission of the NCMI is to serve as the lead activity within the Department of Defense (DoD) “for the production of medical intelligence,” and to prepare and coordinate “integrated, all-source intelligence for the DoD and other government and international organizations on foreign health threats and other medical issues to protect U.S. interests worldwide.”
​ ​For a small agency, the NCMI packs a large punch in terms of the overall impact of its product. For example, in April 2009—two months prior to when the WHO and the U.S. Centers for Disease Control and Prevention (CDC) officially declared the global outbreak of H1N1 influenza a pandemic, NCMI published an intelligence product, known as an “Infectious Disease Risk Assessment,” which predicted that a recent outbreak of the Swine Flu (H1N1) would become a pandemic.

​Home coronavirus testing on a mass basis, like once a week for everybody who has not yet been infected, coupled with early treatment (when safe and available) and isolation of everybody who tests positive, is the recipe for success.
Currently, we do not even have enough tests to test one person out of 100. In the US it is 1 test available per 1000 persons, and they are taking over a week to report, due to backlog.​
This home finger-prick test from the UK is different. It looks for existing immunity. It determines who is relatively safe to self and others, and can therefore get back to work. 
I would sure like access to this, and might have it some time soon, depending on lab availability. From my perspective, I would like to get it myself, as should other medical practitioners. A few of us will turn out to be already protected, having had asymptomatic illness.
​ ​Millions of 15-minute home coronavirus tests are set to be available on the high street or for Amazon delivery to people self-isolating, according to Public Health England (PHE), in a move that could restore many people’s lives to a semblance of pre-lockdown normality.  

​Inquiring Mind​

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