Understanding COVID-19

onlinelibrary.wiley.com

A role for quercetin in coronavirus disease 2019 (COVID‐19)

Abstract

Several months ago, an outbreak of pneumonia of unknown aetiology was detected in Wuhan City (China) and the aetiological agent of the atypical pneumonia was isolated by the Chinese authorities as novel coronavirus (2019‐nCoV or SARS‐CoV‐2). The WHO announced this new disease was to be known as “COVID‐19.” When looking for new antiviral compounds, knowledge of the main viral proteins is fundamental. The major druggable targets of SARS‐CoV‐2 include 3‐chymotrypsin‐like protease (3CLpro), papain‐like protease (PLpro), RNA‐dependent RNA polymerase, and spike (S) protein. Quercetin inhibits 3CLpro and PLpro with a docking binding energy corresponding to −6.25 and −4.62 kcal/mol, respectively. Quercetin has a theoretical, but significant, capability to interfere with SARS‐CoV‐2 replication, with the results showing this to be the fifth best compound out of 18 candidates. On the basis of the clinical COVID‐19 manifestations, the multifaceted aspect of quercetin as both antiinflammatory and thrombin‐inhibitory actions, should be taken into consideration.

First published: 09 October 2020

1 INTRODUCTION

Viral diseases continue to pose a serious threat to public health. The world has witnessed several viral epidemics over the past 20 years, including severe acute respiratory syndrome (SARS) coronavirus (SARS‐CoV‐1) in 2003, the influenza disease called H1N1 in 2009, and the middle east respiratory syndrome (MERS) coronavirus (MERS‐CoV) in 2012. Several months ago, an outbreak of pneumonia of unknown aetiology was detected in Wuhan City, Province of Hubei (China) and reported to the China Country Office of the World Health Organization (WHO) on December 31, 2019. The National Health Commission of China reported the outbreak was associated with exposure in one seafood market in Wuhan City. The aetiological agent of the atypical pneumonia was isolated on January 7, 2020 by the Chinese authorities as novel coronavirus (2019‐nCoV). The date of January 22, 2020 is important as it is thought to be when the virus appeared in Europe. The virus was isolated in Bavaria (Germany) from a German patient infected by an individual from Shanghai (China). Subsequently, the virus was present in Italy on January 25, 2020. The unsuspecting individuals infected with the virus are thought to have been able to circulate in the area of Basso Lodigiano with few symptoms or with symptoms mistaken for those of influenza.

On January 30, 2020, the WHO declared the situation a public health emergency of international concern (World Health Organization, 2020a) and on February 11, 2020, the WHO announced that the disease caused by this new virus was to be known as “COVID‐19,” which is an acronym of “coronavirus disease‐2019.”

On February 20, 2020, the first symptomatic COVID‐19 patient was identified in Italy at the Emergency Department of Codogno Hospital, Basso Lodigiano, Province of Lodi.

On February 26, 2020, the Director‐General of the WHO announced that the number of new cases of the viral disease, now officially known as COVID‐19, reported outside China since the day before had for the first time exceeded the number of new cases in China (World Health Organization, 2020b). On March 11, 2020, the WHO declared this viral disease to be a pandemic.

2 AETIOLOGY

Coronaviruses constitute a large family of viruses. They are single‐stranded RNA viruses, with a crown‐like appearance under an electron microscope.

Coronaviruses were identified in the mid‐1960s and are known to infect humans and certain animals (including birds and mammals). The primary target cells are the epithelial cells of the respiratory and gastrointestinal tracts.

SARS‐CoV‐2 is a single‐stranded, positive‐sense RNA virus, having a diameter of 60–140 nm with a round or elliptic shape; however, it often exists in a pleomorphic state. Its RNA genome contains 29,891 nucleotides, encoding 9,860 amino acids, and shares 99.9% sequence identity compared to bat genome (bat‐SL‐CoVZC45), suggesting a very recent host shift into humans. Like other CoVs, it is sensitive to ultraviolet rays and heat. In addition, these viruses can be effectively inactivated by lipid solvents including chloroform, ether (75%), ethanol, peroxyacetic acid, and chlorine‐containing disinfectant. Chlorhexidine does not inactivate this virus (Chan et al., 2013; Chen et al., 2020).

3 TRANSMISSION

The new CoV, SARS‐CoV‐2, is a respiratory virus that spreads mainly through contact with the breath droplets of infected individuals, for example, through: (a) saliva, coughing, and sneezing; (b) direct personal contact; (c) hands, for example, by touching the mouth, nose, or eyes with contaminated (unwashed) hands. SARS‐CoV‐2 then uses the angiotensin‐converting enzyme II (ACE2) receptor expressed by human cells to attach to these, as with SARS‐CoV‐1 (Li et al., 2020). Studies have shown the virus survives on different surfaces for days and remains viable in aerosols for hours (van Doremalen et al., 2020). It is possible that transmission occurs via the faecal–oral route. Transmission of the virus from asymptomatic patients has been reported, with a high viral load in pharyngeal samples from minimally symptomatic patients during the initial period of the disease. This is different to what is seen with SARS and MERS, where infectivity peaks relatively later during symptomatic infection, and may account for the much greater spread of COVID‐19. However, the highest transmission rates have been reported to correlate with disease severity and are particularly pronounced in hospital settings, just as for SARS and MERS. The incubation period is thought to vary from 3 to 14 days, while onset of symptoms has been reported up to 14 days after exposure (Lauer et al., 2020) providing the basis for the length of quarantine/self‐isolation. A possible scenario resulting from this could therefore be potential transmission before the onset of symptoms: in fact, many cases were, unfortunately, isolated after the onset of symptoms (He et al., 2020).

4 CLINICAL PATTERNS

The symptoms that patients with COVID‐19 may exhibit are variable. Generally, patients are characterised by three main symptoms: (a) fever, (b) dry cough, and (c) dyspnoea.

We can classify the infection as symptomatic or asymptomatic. In addition, there are prodromal signs such as conjunctivitis (often the first sign) or gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and diarrhoea.

Some patients may present without fever, but with abdominal pain, anorexia, and dyspnoea. Less frequently occurring, but particularly typical of this new pathology, are anosmia and dysgeusia, often accompanied by gastrointestinal symptoms (Huang et al., 2020).

Negative prognostic epidemiological risk factors are older age, male sex, and smoking and poor prognostic clinical risk factors include associated comorbidities such as obesity, hypertension, diabetes mellitus, cardiovascular disease, chronic kidney disease, as well as—of course—respiratory diseases. The greater the number of risk factors and associated pathologies, the higher the risk of a poor prognosis (Chen et al., 2020). A mild symptomatology can resolve itself even without particular medical treatment at home or, instead, it can progress towards pneumonia (bilateral interstitial pneumonia) and respiratory failure, thereby requiring hospitalisation of the patient. Patients can progress rapidly towards acute respiratory distress syndrome (ARDS) with multiple organ dysfunction syndrome (MODS) and death (Wang et al., 2020).

5 THERAPY

Currently, COVID‐19 therapy is only supportive and prevention is the only way to reduce transmission and limit spread. From a pharmacological perspective, initial treatment with lopinavir/ritonavir and with chloroquine was attempted. Due to a lack of chloroquine, hydroxychloroquine was then used (Dong, Hu, & Gao, 2020).

In addition, a number of antibiotics have been used, such as ceftriaxone with azithromycin or piperacillin/tazobactam and doxycycline, and then back to azithromycin alone.

From mid‐March 2020, lopinavir/ritonavir was replaced with remdesivir and the use of tocilizumab, and immediately after, heparin was suggested as a potential treatment. It was then proposed that glucocorticoids could be beneficial in the early stages of the disease; these had also been used in China, but there is currently some disagreement regarding their efficacy (Zhang et al., 2020).

Currently, the use of plasma with antibodies obtained from patients who have had COVID‐19 seems to have a good rationale, although the initial data from a limited number of patients are not encouraging (Zeng et al., 2020).

6 THE FLAVONOID QUERCETIN

Quercetin (Figure 1), chemical name 2‐(3,4‐dihydroxyphenyl)‐3,5,7‐trihydroxychromen‐4‐one or 3,3′,4′,5,7‐pentahydroxyflavone, is classified as a flavonol, one of the six subcategories of flavonoid compounds, and is the major polyphenolic flavonoid found in various vegetables and fruits, such as berries, lovage, capers, cilantro, dill, apples, and onions (Anand, Arulmoli, & Parasuraman, 2016). It is yellow in colour and completely soluble in lipids and alcohol, insoluble in cold water, and sparingly soluble in hot water. “Quercetin” derives from the Latin word “quercetum,” meaning “oak forest,” and as a flavonol, is not produced in the human body (Lakhanpal & Rai, 2007). Quercetin is one of the most important plant molecules, showing pharmacological activity such as antiviral, anti‐atopic, pro‐metabolic, and antiinflammatory effects. It has also been demonstrated to have a wide range of anticancer properties, and several reports indicate its efficacy as a cancer‐preventing agent. Quercetin also has psychostimulant properties and has been documented to prevent platelet aggregation, capillary permeability, lipid peroxidation, and to enhance mitochondrial biogenesis (Aguirre, Arias, Macarulla, Gracia, & Portillo, 2011; Dabeek & Marra, 2019).

7 QUERCETIN AND MOLECULAR DOCKING

Recently, in order to find new candidates expressing potential activity against SARS‐CoV‐2 viral targets, a number of studies reporting the use of computer modelling for screening purposes have been published (Liu & Zhou, 2005; Lung et al., 2020; Toney, Navas‐Martín, Weiss, & Koeller, 2004; Wang et al., 2007; Zhang et al., 2020). Typically, these models determine the free energy of binding between a ligand and a receptor (Forli et al., 2016). A lower binding free energy indicates a stronger ligand–receptor interaction. Although obtaining comparable results via different modelling approaches can be a challenge (Aldeghi, Heifetz, Bodkin, Knapp, & Biggin, 2016), computer‐based molecular docking allows visualisation of the relative binding affinity of thousands of molecules for the above‐listed viral receptors.

In addition to the speed and versatility of this method for rapidly finding a potent inhibitor of SARS‐CoV‐2, another advantage of molecular docking screening is the reduction of the high costs associated with physically screening the activity of large banks of natural substances (Chen, de Bruyn, & Kirchmair, 2017). Compounds that through this method demonstrate significant interaction with viral receptors can then be moved onto cell‐based assays to verify effectiveness and toxicity. Confirmatory results can then accelerate testing in animals and clinical trials.

Recently, the virtual screening (Lung et al., 2020) of 83 compounds commonly used in Chinese traditional medicine for activity against the RNA‐dependent RNA polymerase of SARS‐CoV‐2 identified the aflavin, an antioxidant polyphenol, as a potential inhibitor. Similarly, virtual screening of 115 compounds used within Chinese traditional medicine highlighted 13 for further studies (Zhang et al., 2020). Some of these were naturally occurring polyphenolic compounds such as quercetin and kaempferol, which have already received considerable attention for the treatment of other disease types (Cassidy et al., 2020; Khan et al., 2019; Tomé‐Carneiro & Visioli, 2016). In particular, the study showed a significant inhibition by quercetin of 3CLpro and PLpro with a docking binding energy corresponding to −6.25 and −4.62 kcal/mol, respectively (Zhang et al., 2020).

Moreover, Smith and Smith (2020) demonstrated for quercetin a theoretical, but significant, capability to interfere with SARS‐CoV‐2 replication, with the results showing this to be the fifth best compound out of 18 candidates. In fact, a reasonable target for structure‐based drug discovery was identified to be the disruption of the viral S protein‐ACE2 receptor interface (Figure 2). Once again, a computational docking model was used to identify small molecules that were able to bind to either the isolated viral S protein at its host receptor binding region or to the S protein–human ACE2 receptor interface, to potentially limit viral recognition of host cells and/or to disrupt host–virus interactions. Among the natural compounds tested, quercetin was identified as being between the top scoring ligands for the S protein:ACE2 receptor interface, further confirming its role as a promising antiviral agent that should be further investigated.

image
A reasonable target for structure‐based drug discovery was identified to be the disruption of the viral S protein‐ACE2 receptor interface. Rendering of nCoV‐2019 S‐protein and ACE2 receptor. Green represents the interface targeted for docking. Source: Smith and Smith (2020), ChemRxiv [Colour figure can be viewed at wileyonlinelibrary.com]

An in vitro molecular docking study was also performed to analyse the probability of molecular docking between quercetin and viral protease. Proteases play essential roles in viral replication, and specifically, 6LU7 was determined to be the main protease (Mpro) found in SARS‐CoV‐2. Quercetin formed H‐bonds with the 6LU7 amino acids His164, Glu166, Asp187, Gln192, and Thr190, with all of the H‐bonds interacting with amino acids in the virus Mpro active site (Khaerunnisa, Kurniawan, Awaluddin, Suhartati, & Soetjipto, 2020). The genome of SARS‐CoV‐2 is approximately 79% identical to that of SARS‐CoV‐1 (Hui et al., 2020). It is therefore not surprising that quercetin showed an IC50 of 8.6 ± 3.2 μM against SARS‐CoV‐1 PLpro (Park et al., 2017).

Nevertheless, 3 years have passed since this evidence was obtained, and unfortunately, no cell‐based assay of antiviral activity has been performed. Very recently, quercetin was reported to have antiviral activity with respect to SARS‐CoV‐1 by inhibiting also 3CLpro (Jo, Kim, Shin, & Kim, 2020).

8 MULTIFACETED QUERCETIN AND ITS CLINICAL RELEVANCE

On the basis of the results obtained by computational methods on molecular docking, it is anticipated that quercetin could have an effect on SARS‐CoV‐2 by interacting with 3CLpro, PLpro, and/or S protein. In addition to these targets, other findings could prompt us to consider quercetin as being endowed with a general, that is, not specific only for CoV, antiviral role (Chiow, Phoon, Putti, Tan, & Chow, 2016; Fanunza et al., 2020; Jo, Kim, Kim, Shin, & Kim, 2019; Mani et al., 2020; Nguyen et al., 2012; Park, Yoon, Kim, Lee, & Chong, 2012; Song, Shim, & Choi, 2011). In any case, based on the strong inflammatory cascade and the blood clotting phenomena triggered during SARS‐CoV‐2 infection, the multifaceted aspect of quercetin, which has been well described as exerting both antiinflammatory (quercetin dose‐dependently decreases the mRNA and protein levels of ICAM‐1, IL‐6, IL‐8, and MCP‐1) and thrombin‐inhibitory actions (Chen et al., 2011; Cheng, Huang, Pang, Wu, & Cheng, 2019; Liu et al., 2010), should be taken into consideration.

To date, a considerable amount of data has been accumulated describing the potential antiviral role (among others) of quercetin (Table 1). Indeed, several studies, using computational models and in vitro and in vivo assays, would seem to confirm this. At the present time, however, the critical lack of high‐quality clinical data must be highlighted, although some empirical and/or case–control clinical evaluations would appear encouraging. A randomised study performed a decade ago enrolled 1,002 adult subjects affected by viral infections of the upper respiratory tract; this showed that quercetin administered at very high dosages (1,000 mg/dose) for 12 weeks reduced the days of illness in middle‐aged and elderly subjects (Heinz et al., 2010). More recently, an empirical study conducted at a Wuhan hospital showed that an approach where, in addition to conventional therapies, patients were treated with traditional Chinese medicine remedies, including herbs with a high quercetin content, was medically safe, free from particular side effects additional to those obtained with the conventional approach alone, and was able to improve the symptoms of patients with COVID‐19 (Luo et al., 2020); (Table 1).

TABLE 1. Studies regarding quercetin

9 CONCLUSION

In the recent past, there have been several pandemics. Within the context of globalisation, some of these pandemics have truly raised the global risk to humankind. The COVID‐19 pandemic is the latest of these and is, so far, completely unresolved. In the meantime, as we await the development of an effective vaccine, researchers worldwide must focus all their efforts on selecting possible effective treatments, bearing in mind that the plant kingdom supplies chemical skeletons that, since ancient times, have provided humans with “drugs.” As a recent example, we remember the anti‐malarial drug artemisinin obtained from Artemisia annua, the studies on which resulted in 2015 in a Nobel Prize being awarded to the researcher Tu Youyou (Mikić, 2015).

Although a repeat of the artemisinin success story may be unlikely, the volume of data that recommends quercetin as a potential molecule candidate for an anti‐COVID‐19 role strongly supports the execution of a case–control clinical study with the aim of realising its possible efficacy within the context of this disease. On the basis of its poor pharmacokinetics profile, any galenic formulation aimed to improve its rate of absorption should be considered important. At our knowledge, the Phytosome form of quercetin could be a possible candidate.

CONFLICT OF INTEREST

The authors have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilised in the production of this manuscript.

AUTHOR CONTRIBUTIONS

All authors equally contributed in writing the manuscript.

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Unified approach to COVID-19

medpagetoday.com

Op-Ed: Great Barrington vs John Snow Is a False Choice

We need fewer pompously named petitions and instead, a COVID policy response that engages with people who hold views and perspectives different than our own; which acknowledges the lives lost from the virus and lost through the response; which is nimble and responsive to new data, new facts, and new perspectives; which engages values and preferences and local norms and the messy reality of the world as it is, not as we wish it were.

by Vinay Prasad, MD, MPH October 16, 2020

— Should whomever gets the most signatures decide our fate?

Dueling petitions about what to do about COVID19 — the Great Barrington Declaration and the John Snow Memorandum — are circulating online amongst physicians, public policy makers, and academics. I am not against policy statements, consensus building, or even petitions, but both of these documents trouble me. They are the dropping anchors when we should be open to sailing where the wind blows.

Let’s start with the obvious. SARS-CoV-2 kills people. When infected, older people and those with serious comorbidities are more likely to die than younger people. This age-gradient (extra risk of death among older people) is steep. At the same time, dramatic interventions to halt SARS-CoV-2 — such as closing schools, business, travel, economic activity, normal hospital functions — also kills people. Some of these deaths occur immediately — a person with a heart attack is dissuaded from seeking care, an uncontrolled tuberculosis epidemic in a low income nation, or even depression and suicide — and some of the downsides take a long time to kill: loss of upward mobility and economic potential for the next generation will shorten lives.

Downsides to lockdowns can also be hard to predict. Harms may include destabilizing democratic governments, civil unrest, and political turmoil. The goal of policy in each and every place on earth is to minimize the total harm to the people who live there. It may vary by place and even moment based on viral spread, age of population, safety nets (or lack there-of), and a number of other factors, including values and preferences.

First, consider the Great Barrington Declaration. It’s just 540 words long, and outlines a strategy of focused protection. Based on the idea that the risk of death varies dramatically with age, it proposes we shield and protect the vulnerable while allowing the young, and others at lower risk, to get on with life as normally as possible. It offers some ideas about how to guard nursing homes, which have experienced massive causalities, and endorses simple measures like handwashing. It nods to the idea that the herd immunity threshold (fraction of people in a population who have become immune before viral spread abates) is not a fixed value: it depends on the way in which populations mix and interact and on simple measures we choose to take, such as improved hygiene. It recommends that schools, universities, bars, and restaurants be allowed to open fully.

Limitations to the statement are its lack of guidance as to who exactly the vulnerable are, how they should shield themselves, and the fact that it lumps together very different things — such as bars and schools. Open bars can be replaced with drinking beers in the backyard with a friend seated at a distance with little loss of pleasure, but education, particularly for the poor, is one of the few ladders left in American society for a better life, a place to feed children, and a vehicle for detecting abuse. Another limitation is its lack of acknowledgement that in moments of explosive spread, temporary measures likely need to be taken to prevent, for example, hospitals from overflowing. Surely, policy responses must depend on the specifics of the time and place.

The John Snow Memorandum was filed in response. It’s longer, at 930 words. It calls Great Barrington’s suggestions to achieve immunity through naturally occurring infections a “dangerous fallacy unsupported by scientific evidence.” Instead it advocates for continued restrictions, along with social programs to minimize the harms of these restrictions. Signers believe this would lower viral spread to very low levels where contact tracing can be utilized to eliminate outbreaks. Finally, the strategy ends when we have an effective vaccine, which it predicts will occur in the coming months.

Limitations to the Snow memorandum include: How exactly will one create social programs to minimize the harms, and what exactly will those programs look like? What will you do in places like the U.S. where even basic economic stimulus talks have stalled? Millions of people are entering poverty in this country, and many more may face starvation globally. How precisely and quickly will you help them? Those who criticize the Barrington authors for not providing a plan to protect the vulnerable from the virus, must criticize the Snow authors for not explaining how they will shield the vulnerable from the harms of restrictions. Additionally, calling for contact tracing is easy, but practically, this faces severe limitations in a nation like the U.S. when many individuals contacted are reluctant to share information. Here too the Snow memorandum falls short on specifics.

The declaration and memorandum are both online and taking signatures, but is this how complex policy should be decided? I find the idea that the fate of the globe will hinge on who garners the most signatures to be Kafkaesque.

Worse, the dueling petitions further divide us, when we should be talking together and working together. It does not escape me that many forces seek to tie these petitions to the Republican and Democratic parties — a dangerous but growing movement to equate pandemic policy with politics.

Signing these petitions may already be a form of identity or virtue signaling, letting others in our political circles know that we are on the virtuous team. Moreover, having signed them, we may be less likely to be willing to change our mind: To think one moment “we ought to open universities,” and the next moment, “let’s consider alternative policies, if hospitalizations rise.”

Instead of these divisive petitions, surely there are things we can all agree to. There is a hierarchy of importance to activities and events in life. Bars, strip clubs, conferences for work — fall on the low end. Schools for young kids, particularly public schools in poor or minority communities, and hospitals are among the most important. There are simple interventions that we can test in controlled trials and implement in the meantime, such as face-shields, plexiglass barriers, widespread hand sanitizer, and masks. We must prioritize schools over bars, and policy must remain individualized (to specific nation/state/county and local preferences) and fluid — able to scale up and down, as we balance the harms of the virus with the harms of closure.

Finally, we have to separate rules from behavior. You can allow restaurants to open, but it won’t help the economy if no one eats there. And, you can close everything, but you won’t slow the spread if people have backyard barbecues with dozens of people. What are the best ways to encourage desired behavior? That’s a harder problem.

Finally, there is no one-size-fits-all solution. What works in a remote island nation with a strong safety net, that can cut off contact with the rest of the world, may not work in a nation with hundreds of millions who face the threat of starvation if the economy grinds to a halt.

We need fewer pompously named petitions and instead, a COVID policy response that engages with people who hold views and perspectives different than our own; which acknowledges the lives lost from the virus and lost through the response; which is nimble and responsive to new data, new facts, and new perspectives; which engages values and preferences and local norms and the messy reality of the world as it is, not as we wish it were.

And, almost most importantly, one which is bipartisan, spanning political ideology, which unites rather than divides us.

And no, I don’t need your signature.

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Dissenting physicians oppose lockdowns

Great Barrington Declaration: COVID Lockdowns Unnecessary

Annie Janvier, PhD, one of the declaration’s cosigners and a pediatric and clinical ethics professor at the University of Montreal, said that “it’s not science that seems to be leading what’s going on with COVID, it’s public opinion and politics.”

October 16, 2020

Great Barrington Declaration: “Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open.”

The lockdowns of society and the cold stop of the world’s economy in the face of coronavirus disease 2019 (COVID-19) represents a huge mistake, argue some prestigious scientists in the world of epidemiology. The Great Barrington Declaration, released last week by scientists who argue that most of us should return to our pre-COVID ways of life, has generated a lot of attention and controversy.

The declaration is spearheaded by some heavy hitters in the scientific community including Martin Kulldorff, PhD, an epidemiologist at Harvard University, Sunetra Gupta, PhD, an epidemiologist at Oxford University, and Jay Bhattacharya, MD, PhD, a public health policy expert and a professor at Stanford University.

One of the arguments put forth by the three and about 35 cosigners amounts to saying that the cure has been worse than the disease for society as a whole.

“Coming from both the left and right, and around the world, we have devoted our careers to protecting people,” the declaration states. “Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health—leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.”

The cosigners represent a host of scientific disciplines such as public health, biostatistics, finance, and psychiatry. They include Michael Levitt, PhD, (who received the Nobel Prize in chemistry in 2013), Jonas Ludvigsson, MD, Angus Dalgleish, PhD, David Katz, PhD, and Mike Hulme, PhD.

The declaration states that growing knowledge about COVID-19 includes the facts that older and infirmed people have a “thousand-fold” higher increase of dying from it than the young. “Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza,” the declaration states.

As might be expected, push-back against the declaration was immediate and fierce. Some members of the scientific community contend that the declaration puts too much faith in the quick arrival of herd immunity and doesn’t account for so-called “long-haulers,” people who may suffer from the effects of the disease for years.

A group of experts—who also brandish impressive credentials—published a response that challenges many of the declaration’s premises. For instance, Rupert Beale, PhD, of the Francis Crick Institute, said that herd immunity depends on the wide distribution of a COVID-19 vaccine, which has yet to be developed. In his response, Beale also wrote that the “declaration prioritizes just one aspect of a sensible strategy—protecting the vulnerable—and suggests we can safely build up ‘herd immunity’ in the rest of the population. This is wishful thinking. It is not possible to fully identify vulnerable individuals, and it is not possible to fully isolate them. Furthermore, we know that immunity to coronaviruses wanes over time, and re-infection is possible—so lasting protection of vulnerable individuals by establishing ‘herd immunity’ is very unlikely to be achieved in the absence of a vaccine.”

Nonetheless, the basic premise of the declaration, which states that the lockdowns do more harm than good, resonates with many.

Annie Janvier, PhD, one of the declaration’s cosigners and a pediatric and clinical ethics professor at the University of Montreal, said that “it’s not science that seems to be leading what’s going on with COVID, it’s public opinion and politics.”

The declaration states that “Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”


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Vitamin D sufficiency reduces COVID complications

medscape.com

More Evidence That Vitamin D Sufficiency Equals Less Severe COVID-19

Since vitamin D supplements are inexpensive and generally very safe, it is reasonable to follow current public health guidelines to assure vitamin D adequacy and consider supplementing COVID-19 patients with vitamin D 1000-2000 IU/day.

By Nancy A. Melville

Patients hospitalized with COVID-19 who have sufficient levels of vitamin D show significant reductions in severe outcomes and a lower risk of death compared with insufficient levels, new research shows.

“This study provides direct evidence that vitamin D sufficiency can reduce the complications including the cytokine storm and ultimately death from COVID-19,” said senior author Michael F. Holick, MD, PhD, of Boston University School of Medicine, Massachusetts, in a press statement from his institution.

The research examines hospitalized patients with severe COVID-19 in Iran, and Holick worked with lead researcher Zhila Maghbooli, MD, of the Tehran University of Medical Sciences, and colleagues, on the study, which was published in PLoS One.

The findings come on the heels of another recently published study, in which Holick and his team found that people with sufficient vitamin D levels in the United States had as much as a 54% reduced risk of getting infected with COVID-19.

Although this latest research adds to a plethora of data on the potential role of vitamin D in COVID-19, many questions and caveats remain, commented E. Michael Lewiecki, MD.

“This study adds to an accumulation of data showing an association between higher serum levels of vitamin D and better outcomes in patients infected with COVID-19,” he told Medscape Medical News.

“There is biological plausibility for benefit of vitamin D, since it is known to regulate innate and adaptive immunity in ways that might reduce the viral load in patients exposed to SARS-CoV-2 and mitigate the severity and consequences of cytokine storm.”

“However, it is important to recognize that associations reported in observational studies do not necessarily mean there is a causal relationship,” cautioned Lewiecki, of the University of New Mexico School of Medicine in Albuquerque.

“It may be that higher vitamin D is a marker of better health and lower baseline risk of complications of COVID-19.”

Although Iran Is Sunny, Prevalence of Vitamin D Deficiency Is High

In the latest study published in PLoS One, which involved 235 patients hospitalized with COVID-19 infection in Tehran, Iran, through May 1, 2020, most patients (67.2%) had insufficient vitamin D levels, defined as serum 25-hydroxyvitamin D [25(OH)D] levels < 30 ng/mL.

“Iran is a sunny country but the prevalence of vitamin D deficiency is high especially in elder people who present with more severe clinical manifestations after exposure to SARS-CoV-2,” note Maghbooli and colleagues.

The mean age of those included was 58.7 years, and 37.4% were 65 years or older.

Overall, 74% of patients had severe COVID-19 infection, defined according to the Centers for Disease Control and Prevention criteria.

Those with sufficient vitamin D levels (≥ 30 ng/mL) had a significantly lower prevalence of severe disease (63.6%) versus those with insufficient levels (77.2%; P = .02).

And those with sufficient levels had significantly lower levels of unconsciousness compared to those with insufficient vitamin D levels (1.3% vs 8.2%; P = .03); the same was true for hypoxia (19.4% vs 39.2%; P = .004).

There were no significant differences in duration of hospital stay or ICU admissions between patients with and without vitamin D sufficiency, however.

No patients under the age of 40 died from COVID-19 infection, while among the 207 patients over 40, the mortality rate was 16.3%.

Of those over 40 with sufficient vitamin D levels, 9.7% died from COVID-19 infection, compared with 20% of those with insufficient vitamin D levels.

For those with serum 25(OH)D levels of 40 ng/mL or higher, the mortality rate declined further to 6.3%.

While the optimum serum level of 25(OH)D required for a healthy immune system remains debatable, the findings offer insights, Maghbooli and coauthors note.

“A blood level of at least 40 ng/mL may be optimal for vitamin D’s immunomodulatory effect,” they write.

Among the patients, 66% had a history of a chronic condition; 36.6% had a history of diabetes, 44.4% hypertension, 1.3% immunological disorders, 1.3% chronic obstructive pulmonary disease, 22.1% heart disorders, 0.9% malignancy, 5.5% lung disorders, 4.3% asthma, and 3% rheumatology disorders.

However, after adjusting for factors including age, sex, body mass index (BMI), smoking, and history of chronic medical conditions, vitamin D sufficiency was still significantly associated with decreased COVID-19 disease severity (P = .01), as was lower BMI (P = .02).

Is it Worth Supplementing Anyway?

Patients with vitamin D insufficiency also had significantly higher levels of the inflammatory marker C-reactive protein (P = .01) and lower lymphocyte levels (P = .03).

These data add to the evidence that vitamin D potentially mitigates the severity of the cytokine storm that can be detrimental in COVID-19, the authors speculate.

“Indeed, the anti-inflammatory role of 1,25(OH)2D could explain the protective role of vitamin D against immune hyper-reaction and cytokine storm in a subgroup of patients with severe COVID-19,” they write.

Furthermore, vitamin D is known to modulated the renin-angiotensin pathway and down-regulate angiotensin converting enzyme 2, which has been implicated in COVID-19, the authors note.

But Maghbooli and colleagues do acknowledge their study has many limitations.

“It is recommended that further studies, including randomized controlled trials, need to be designed to evaluate the role of vitamin D status on risk of developing COVID-19 infection and mitigating complications and mortality in those infected with the virus,” they conclude.

Opinions on this issue continue to be divided, as has been extensively reported by Medscape Medical News, starting back in April and May when the emerging association first became apparent.

Still, most experts repeatedly state that randomized controlled trials are needed to draw sound conclusions on the issue.

“I look forward to a higher level evidence from prospective randomized trials to determine whether there is indeed a causal relationship,” Lewiecki told Medscape Medical News.

“Meanwhile, since vitamin D supplements are inexpensive and generally very safe, it is reasonable to follow current public health guidelines to assure vitamin D adequacy and consider supplementing COVID-19 patients with vitamin D 1000-2000 IU/day,” he recommended.

Maghbooli and colleagues recommend “vitamin D supplementation, along the guidelines recommended by the Endocrine Society to achieve a blood level of 25(OH)D of at least 30 ng/mL, to children and adults to potentially reduce risk of acquiring the infection and for all COVID-19 patients especially those being admitted into the hospital.”

Holick has reported being a consultant for Quest Diagnostics and being on a speakers bureau for Abbott and Hayat Pharmaceutical Industries. Lewiecki has reported no relevant financial relationships.

PLoS One. Published September 25, 2020. Full text

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Violent crime increases among Palestinian Arabs

al-monitor.com

Palestinian Authority cracks down on drug, arms traffickers in West Bank

Louay Arziqat, a spokesman for the Palestinian police, told Al-Monitor that Abbas and Prime Minister Mohammad Shtayyeh have issued clear instructions to the security establishment to pursue arms dealers and perpetrators of crimes.

 

Reprinted from Al-Monitor, September 29, 2020

Ahmad Melhem

By Ahmad Melhem

@ahmadme44502893


RAMALLAH, West Bank — Palestinian security services intensified in early September their security operations in the West Bank in pursuit of arms and drug traffickers and individuals who have used arms during family quarrels.

These security operations, which include raids, incursions and ambushes, come in response to the presidential decree issued by President Mahmoud Abbas on Sept. 1 amending the Firearms and Ammunition Law No. 2 of 1998, to increase prison terms and financial fines imposed on crimes related to the possession, use, trafficking in, manufacturing and smuggling of firearms in violation of the law.

Louay Arziqat, a spokesman for the Palestinian police, told Al-Monitor that Abbas and Prime Minister Mohammad Shtayyeh have issued clear instructions to the security establishment to pursue arms dealers and perpetrators of crimes.

He added that the security services have begun to tighten measures, and in the coming days strict measures will be adopted to control weapons and arrest traffickers and users.

The security services, according to Arziqat, rely on their intelligence operations for information on the movement of arms and drug dealers amid ambushes set up for the involved individuals.

These services also rely on security personnel and officers depending on their competence, and most importantly they also rely on cooperation with citizens who do not hesitate to report the movements of arms and drug traffickers.

The phenomenon of the proliferation of weapons and the resulting chaos is causing concerns for the Palestinian Authority (PA). This phenomenon has expanded with the ongoing stifling political and economic crisis the PA is going through amid concerns that some parties such as Israel might exploit the situation to cause chaos in the Palestinian territories. This phenomenon also bodes ill as it portrays a negative state of chaos that might prevail in the West Bank in the event of the PA’s collapse. Also, its continuation affects the prestige and position of the PA, hence the latter’s security operations to impose its prestige.

Since the beginning of this year, the West Bank witnessed a significant 42% increase in murder crimes compared to last year, according to Arziqat.

In this context, he said, “Since the beginning of the year we have had 37 killing cases, most of which were with weapons, so it was necessary to intensify security work to pursue this phenomenon,” adding that most of the perpetrators are young people aged between 18 and 30 years.

Amid all the security operations carried out by the security services, these operations remain incomplete, especially considering their inability to play any role in the lands classified as Area C as per the Oslo Accord. These lands account for 60% of the West Bank and are completely subject to Israeli security and administrative control.

On Sept. 18, the southern area in Hebron turned into a war zone following a quarrel that broke out between families and degenerated into armed clashes during which firearms, some of which were machine guns, were used, and several homes and vehicles were set ablaze. The clashes resulted in several injuries and ended after the intervention of influential tribal figures in the area.

On Sept. 17, a young man and two girls were killed in the Wadi al-Nar area, northeast of Bethlehem while they were in their vehicle. They were shot by four armed people who stopped the vehicle and opened fire on it due to family disputes.

Arziqat said the challenge facing the security operations lies in the “areas where the security services are not deployed and cannot enter and areas considered as a starting point for smuggling weapons to other areas.”

He said, “A few days ago, the southern area of ​​Hebron turned into a battlefield knowing that we are prevented from entering it. Although the area is located under the control of the Israeli army and is only meters away from the settlers, the army did not lift a finger, just like when three citizens were killed in Wadi al-Nar,” which is located near an Israeli military checkpoint in Area C.

Arziqat said Israel is turning a blind eye to arms smuggling to the West Bank through merchants from Israel who bring such arms into Area C and distribute them to several areas. This indicates the presence of hidden hands tampering with security and spreading instability, he said.

The presidential decree amending the Firearms and Ammunition Act was preceded by a movement by human rights and official institutions to address the phenomenon.

In this context, the Independent Commission for Human Rights held a meeting Aug. 18 attended by the Public Prosecution, the Military Judicial Authority, the Ministry of Interior, the Ramallah and al-Bireh governorate, the police, the Preventive Security Service and human rights institutions.

The participants highlighted “the need for a political will in order to prosecute those who illegally possess, trade or use weapons, regardless of their status and position, as well as the security personnel who use weapons for personal reasons.”

For his part, Jenin Gov. Akram Rajoub told Al-Monitor the new security measures to pursue arms and drug dealers are a better start than previous measures. “If there is a strict implementation of the instructions issued by the political leadership, then we are on the right path to get rid of the phenomenon.”

Rajoub added, “Security policies need to be strictly implemented, negative phenomena prosecuted so that citizens feel the authorities are working to protect them and are capable of establishing security.”

“This requires sustainable and continuous security work and not just sporadic episodes when we feel that Palestinian citizens are in danger,” he continued.

Asked about these phenomena affecting the prestige of the PA among Palestinians, Rajoub said, “These phenomena will certainly affect the presence and prestige of the PA and the prestige of the security forces. Citizens are aware that the PA can enforce the law and pursue all phenomena but are sometimes shocked by the lack of response on the part of the security institution and the executive bodies.”

The Palestinian security services might sometimes manage to arrest some arms or drug dealers, but there are many reasons that will prevent them from eradicating this phenomenon. Chief among these is the widespread proliferation of weapons among citizens, families and clans. This infers that they could enter into disputes with them if they try to seize weapons by force. Add to this the inability to enter many areas in the West Bank in which the arms trade is promoted. More importantly, such services do not control the contact points between the West Bank and the 1948 lands through which most of the arms and drug smuggling operations take place.

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Prominent epidemiologist explains lockdowns

timesofisrael.com

Israel could see 3rd, 4th lockdown, warns top UK epidemiologist who moved here

The purpose of lockdown is not to get back to normal but to get a situation in which we can reopen. But it’ll be in a controlled way with restrictions. It’s possible to live this way consistently for a long time. If people make the same mistake again and think we can go back to normal, we’ll be in third lockdown…Is it possible to bring cases close to zero through lockdown? Probably not. But what it can do, in a few weeks, is to begin having an impact on the number of new cases and bring this back to a more manageable level, as well as taking hospitals out of danger of being overwhelmed.

By Nathan Jeffay

After leaving a top post in England’s COVID-19 fight and moving to Israel, epidemiologist Michael Edelstein is worriedly surveying his new country as it slides into a Yom Kippur like no other: under lockdown, in a desperate battle against the coronavirus.

Health Ministry director-general Chezy Levy warned on Sunday morning that Israel is “almost at the point of no return.” His ministry had just announced that 5,855 new coronavirus infections were confirmed Saturday, after it reported a record 8,373 new cases diagnosed on Friday.

As many Israeli Jews pray for the nation to be “sealed in the book of life,” Edelstein says its fate does indeed still hang in the balance, and will be determined by the actions of leaders and citizens.

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What happens during the current lockdown is important, he said, but “the real make-or-break will come after the lockdown.”

Epidemiologist Michael Edelstein (courtesy of Michael Edelstein)

If the country doesn’t get things right then, “there could be a third and a fourth lockdown,” he said in a wide-ranging interview on COVID-19 covering Israel’s predicament and his support for the lockdown, his admiration for the Swedish approach, and what we’ve learned about the virus so far.

Edelstein worked at Public Health England, the executive agency of the London-based Department of Health, since 2015, with responsibility for public health programs. He left the post last month to take up a professorship at Bar Ilan University’s medical school in the Galilee city of Safed, focusing heavily on “health inequalities” that affect Arab and Haredi communities.

Edelstein is also president of the infectious diseases section of the European Public Health Association and a fellow of the UK Faculty of Public Health. He has served on expert groups for the World Health Organization and the European Centre for Disease Prevention and Control, and is deputy editor of the journal Epidemiology and Infection.

Epidemiologist Michael Edelstein (right) briefing Liberian politicians during the 2015 Ebola outbreak in West Africa (courtesy of Michael Edelstein)

Will this lockdown work?

It depends what the desired effect is. Is it possible to bring cases close to zero through lockdown? Probably not. But what it can do, in a few weeks, is to begin having an impact on the number of new cases and bring this back to a more manageable level, as well as taking hospitals out of danger of being overwhelmed.

The real make-or-break will come after the lockdown. It’s a question of whether the government will get its act together and have clear restrictions that are enforced, mass testing, and capability to trace contacts of infected people. All of this needs to be prepared when in lockdown. And it’s also a question of whether people will realize it’s serious and play by the rules. Because if not, there could be a third and a fourth lockdown. This could go on in cycles until a vaccine becomes available.

An employee puts away the furniture of a restaurant in the coastal city of Tel Aviv on September 18, 2020, ahead of a nationwide lockdown to tackle a spike in coronavirus cases. (JACK GUEZ/AFP)

You recently arrived in Israel from the UK, and have a strong understanding of the situation in Europe and internationally. How do you assess Israel’s current predicament?

The situation in Israel is a serious situation. There’s no doubt Israel has one of the highest rates of new infection in the world and it’s a real concern. Infections and outbreaks don’t behave in a linear manner; they can be exponential. Cases went from around 2,000 a day to around 8,000 in the space of two to three weeks. That increase is very worrying, and large gatherings without adequate precautions over holidays could lead to a much  bigger outbreak.

Many people are steering clear of indoor prayers for Yom Kippur, but unsure whether or not to take part in outdoor prayers. What do you think?

Ultra-Orthodox Jews during morning prayer in a synagogue during a nationwide lockdown to curb the spread of the coronavirus, in Bnei Brak, Sept 21, 2020. (AP Photo/Oded Balilty)

Evidence is that being outdoors as opposed to indoors reduces transmission, and that social distancing plus masks protects us and others. Praying in small groups outdoors and respecting the two-meters rule can reduce risk, though there are things to consider, such as whether really loud singing may be an issue that increases risk. The same goes for when a small service becomes much larger if people start bringing families and kids, and the size of the gathering grows. If conducted responsibly, I think the risk of outdoor prayer is low.

How did we get to the current situation, from the success story of the first wave to the first country back in lockdown?

Medical staff cheer an Israeli air force aerobatic team flying over Ichilov hospital in Tel Aviv on Israel’s 72nd Independence Day, April 29, 2020. (Miriam Alster/Flash90)

The mistake Israel made first time around was, after the first lockdown, giving people a sense that it was over and we can go back to normal and don’t need to worry anymore. Coronavirus is not going to go away anytime soon, but we know from some examples, like Sweden, that if there are successful measures in place it’s possible to keep it at a manageable rate.

The purpose of lockdown is not to get back to normal but to get a situation in which we can reopen. But it’ll be in a controlled way with restrictions. It’s possible to live this way consistently for a long time. If people make the same mistake again and think we can go back to normal, we’ll be in third lockdown. But it’s hard to convince Israelis.

We’ll return to Israel’s situation in a moment, and also find out more on your thoughts about the Swedish approach. But first, let’s talk briefly about the virus itself, which is still baffling doctors. We’ve had more than half a year to become familiar with it. What are the most important things we know now that we didn’t know in March?

3D medical animation still shot showing the structure of a coronavirus (https://www.scientificanimations.com/coronavirus-symptoms-and-prevention-explained-through-medical-animation/)

Some factors that affect risk levels are very well understood now. Age is an important factor. Having chronic health conditions, especially respiratory, is an important factor, but none of this explains why some people who are young become very sick and some people who are older don’t. What we understand more and more is how the virus attacks body and binds to ACE2 receptors — which are like docking stations that sit on the outside of the cell, and the virus attaches there — and research suggests people have different forms of the receptor that make the body more susceptible to the disease, while others are less susceptible.

Young children don’t get infected that easily and aren’t a major driver for the virus, unlike with flu. And one hypothesis is they don’t have a developed form of this receptor. Ethnic factors are relevant and it seems there is a combination of genetic makeup and social and economic factors.

Elderly women wear face masks in Jerusalem, on April 26, 2020 (Olivier Fitoussi/Flash90)

Is there anything people can do, beyond hygiene measures and social distancing, to protect themselves?

One of the factors that affects whether you get very ill if infected is the status of your body, and in this context obesity is a big factor. If you have a balanced diet and exercise regularly, you have better chances. The idea that vitamin D offers a benefit is an interesting theory, but it is still unclear.

The pandemic is very confusing for people, as many still don’t fully understand what symptoms they should be looking out for. What is your latest assessment?

One of the challenges of COVID-19 is that most of its symptoms are shared with other diseases such as flu or even the common cold. The most widespread symptoms are cough and fever. If you get cough or fever there’s no way of knowing from symptoms whether it’s COVID-19 or something else. The threshold for being tested should be really low. The slightest symptoms should trigger testing. There’s a fear of being quarantined following testing. But failure to get tested puts loved ones and strangers at risk. There are other symptoms like badly losing your sense of smell and sense of taste. So people with systems including fever, cough, difficulty breathing, and loss of taste or smell, should get tested.

Illustrative: Doctor using forehead thermometer to check body temperature for COVID-19 symptoms.
(RyanKing999/iStock by Getty Images)

What is your snapshot explanation of the causes for spiraling case numbers in Israel?

It’s a combination of factors. There was, until recent, some unclarity about who leads coronavirus response. The other thing is there’s clearly a behavioral component and there’s quite a lot of complacency in Israeli society, with people holding large gatherings and sometimes not wearing masks. There are people with symptoms who don’t get tested, which has an impact, and there are cases of people not getting tested because they don’t want to be quarantined. There are also lots of people living in crowded neighborhoods and multi-generational households. It’s not about blaming people but about understanding different factors.

Are high infection rates among Arabs and Haredim due to circumstances faced by the communities, or their conduct? 

It’s not a black-or-white situation, but a combination of both.

Tell us more about your thoughts on the approach of Sweden, which assiduously avoided lockdown.

Having a complete lockdown for very extended periods of time is very hard to assert. It’s hard, and people lose income and ability to live. Sweden didn’t have a lockdown. It was heavily criticized but there’s a balance. Sweden made a deliberate choice to have more cases, but to allow life and the economy to continue functioning. In Israel we put a very high value on individual lives. It reflects Jewish ideals in many ways, and this informed early responses. Personally, I believe in balanced approaches and I think Sweden made a bold move at a time when there was very little evidence, but retrospectively, it was a sensible thing to do, particularly if you can protect people who are very vulnerable.

I think the way Sweden did things is, in a sense, what Israel was doing now in practice until the second lockdown. It’s wasn’t an explicit policy but this approach enables a degree of infection and keeps almost everything open. We know there’s a price to pay for keeping society open. However, if people are not sensible, ignore the recommendations and don’t get tested, we will see a rapid increase in the number of cases that could mean higher deaths and overwhelmed hospitals. We’re learning that we can manage without full lockdown, but it only works if people play by the rules.

Morbylanga, in Sweden on May 10, 2020. In the absence of a lockdown patrons at an outdoor cafe practiced social distancing (Alexander Farnsworth via iStock by Getty Images)

Some people may think you are contradicting yourself, saying it’s right that we’re in lockdown, but on the other hand can learn from the Swedes. Can you clarify?

It’s not a contradiction. It really depends at what point you are in the epidemic. Any country, at Israel’s current level of transmission, needs a lockdown. If Sweden had this level of transmission, it would also go to lockdown. But if there were steps that had been taken after the first lockdown, [the Swedish model] would have worked. In Sweden there were low-level restrictions and people stuck to them. It really depends on timing, public willingness to hold by restrictions, and public trust. In Israel, trust in government is low, while in Sweden it’s high.

We are hearing some suggestions that Israel is nearing herd immunity. The assumption is that many more people have been infected than test numbers show, and the threshold for herd immunity is lower than imagined. What do you say?

Israel is nowhere near heard immunity, even after accounting for under-diagnosis. It is not clear what percentage needs to be infected to achieve it but it’s impossible to achieve that with a modest percentage.

You were heavily involved in the response in England before coming to Israel. How do the two countries compare in terms of the coronavirus?

In a sense the English and the Israeli experience are almost polar opposites. At the very beginning, England was one of the later countries to impose restrictions and a lockdown, and this led to high levels of transmission and a high number of cases early on. Though the numbers looked bad at the time, this led to a significant part of the English population being infected early on, including the most vulnerable such as nursing home residents. So this meant there were less people to infect two to three months later, especially among vulnerable groups. This meant there’s less of a pool of people to be infected in the second wave.

Israel had very strict regulations early on and as a result of that had fewer infections and fewer deaths. But in a sense there’s a price to pay for that — as people who are vulnerable weren’t infected early, and got infected when the restrictions were relaxed.

A sign tells passengers to ‘wear a face covering’ at Waterloo train station in central London, on June 8, 2020, as the UK government’s planned 14-day quarantine for international arrivals to limit the spread of the novel coronavirus COVID-19 begins. (Photo by JUSTIN TALLIS / AFP)

Are there any common features to the two countries?

One thing neither country has done particularly well is find the right balance between allowing people to carry on with their lives while minimizing the risk of infection. This requires, among other things, tracing all contacts of each case. Contact tracing hasn’t been done optimally in either country, but if you’re able to do it, you can have more freedom of movement.

England’s Jewish community has been particularly badly hit by coronavirus deaths. Is there any explanation?

The Jewish community in England has a uniqueness. The first aspect is the Jewish community is much older than the general population. Also, Purim coincided with start of outbreak, when awareness wasn’t high, and Purim parties were a real catalyst for this.

Cleaning workers disinfect an ATM at a bank in Ramat Gan, June 3, 2020.(Flash90)

Can you explain the latest thinking, as you understand it, on how the virus spreads? At first, there was lots of emphasis on the danger of picking up the virus from surfaces, and hand hygiene, while now the talk is more about droplets, and there is some talk of the virus being aerosolized, meaning turned into small droplets that may be able to hang around in the air.

The virus lives in the respiratory system and when someone coughs, their infected droplets travel. It can survive a certain amount of time on surfaces. Early on, there was much more emphasis on surfaces, now it’s more emphasis on person-to-person droplets. It’s quite a big virus in terms of size, so it doesn’t travel that far. There are studies suggesting it can be aerosolized, but it is unclear how much of a role that plays and the main method of transmission is droplets going from person to person. The idea it can float into air is unlikely to be a major mode of transmission. In viruses you see that are commonly aerosolized, there are higher rates of transmission.

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Communities devastated by COVID

aljazeera.com

The little talked about side-effects of COVID-19

Based on research across 14 countries, including a survey of 1,400 refugees and crisis-affected people, we found a staggering 77 percent had lost their jobs or income since the start of the pandemic. The economic shock to already vulnerable communities is pushing them further into destitution.

By Jan Egeland


In March, we predicted that the 70 million people fleeing violence and persecution across the world would be hit hardest by the coronavirus pandemic. I underestimated the impact of the disease. Its knock-on effects are proving more devastating than the virus itself.

This week my organisation, the Norwegian Refugee Council, published a report, Downward Spiral, showing that the world’s most vulnerable communities are facing a quadruple crisis because of the COVID-19 pandemic: a health crisis, a hunger crisis, a homelessness crisis and an education crisis.

Based on research across 14 countries, including a survey of 1,400 refugees and crisis-affected people, we found a staggering 77 percent had lost their jobs or income since the start of the pandemic. The economic shock to already vulnerable communities is pushing them further into destitution. For a Syrian refugee living in Lebanon’s Bekaa Valley, or a Yemeni mother forced to flee her home because of air raids, even a small loss of income can be devastating.

Three out of four people hit

Most seriously, a hunger pandemic is looming. The World Food Programme warned in June that the number of people severely hungry could soar from 146 million to 270 million by the end of the year. Our report found that 73 percent of people surveyed had had to cut meals for themselves or their families. These are people already facing food crises because of conflict, or natural phenomena like droughts or plagues of locusts.

Many people we spoke to in conflict countries say they are more afraid of the hunger crisis brought on by COVID-19 than they are of being killed by the disease itself.

The unfolding crisis of homelessness is another side-effect of the coronavirus. Seventy-one percent of respondents told us they had difficulty paying rent or other basic housing costs. Many reported having been evicted since March. These are people who have already had to flee violence and persecution, some multiple times.

We spoke to a refugee mother of six in Uganda who was evicted because she owed $555 for four months’ rent arrears. She had been unable to gather enough money to cover her rent since the pandemic hit. The money that kept her head above water – remittances from family working in Australia – came to a halt. Her situation is dire but, sadly, not unique.

Another consequence of the loss of income for displaced people is that their children are even less likely to go to school. At least a third of the world’s schoolchildren – 463 million children globally – were unable to access remote learning when COVID-19 shuttered their schools, according to UNICEF. Three in four respondents who had children told us they were less likely to send them to school because of their current economic situation, brought on by COVID-19. The right of these children to go to school and their future prospects are being undermined. For those children who relied on school meals for their nutritional needs, hunger also looms.

We are creating a lost COVID generation.

An opportunity for political leadership

It is understandable that countries look inward and prioritise their citizens during a moment of such global uncertainty. Rich countries have raced to protect their people from the disease and expand social safety nets as well as support businesses. Unfortunately, these are not options for countries like Afghanistan or Yemen.

But COVID-19 is also a reminder that humanity’s problems do not stop at borders. Every part of the world has been affected by the virus, and the same is true for its economic impacts. Inward-looking policies will not solve global, interconnected problems.

Quick and decisive global action is required to stem the growing catastrophe that crisis-affected communities are facing. The G20 countries will convene in Saudi Arabia in November. They should take three concrete actions to improve the lives of millions being hammered by the economic impacts of the pandemic:

First, they must commit to fully fund the United Nations COVID-19 humanitarian aid appeals for both 2020 and 2021. This year’s $10bn appeal is currently only 26-percent funded. Rich G20 and OECD nations invested $11 trillion in stimulus packages to save their economies, that is 100 times what aid organisations need to help the world’s poorest.

Second, G20 leaders must agree a comprehensive debt-relief plan for conflict-affected and refugee-hosting nations. Even the World Bank has said there needs to be broader international action than its existing loans and grants and those by other financial institutions. The G20 made this happen during the 2007 financial crisis. It must do it again for today’s unprecedented human crisis.

Finally, G20 leaders must call for extending social protection for vulnerable communities. Displaced children, women and men are often discriminated against and stigmatised, excluded from services and the labour market. The governments hosting them must include them in economic response plans and social safety nets; they must protect them from eviction. And the governments without the resources to do this must get support from those better off.

The Riyadh gathering is a unique opportunity for the world’s powers to show international solidarity towards protecting the world’s most vulnerable people against the impacts of COVID-19. It requires not only a recognition of the problem but real political leadership to address it.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.

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French physiologist against lockdown

French expert: Covid has exposed the limits of the human species

Things have improved for the patients. So we have to decide if this is now a common infectious disease or is it something new? Do we have to stay inside our bunkers, not going to school, and not providing the necessary finance for the economy and, importantly, the health economy?

8,330 views
Sep 24, 2020
Interviewing Jean-Francois Toussaint often felt more like speaking to a philosopher than a physiologist. Coming from a professor of physiology at the University of Paris and director of IRMES, his emphasis on giving people back their “ability to taste and live” and rediscovering the joys of life might sound unusual, but this is why we found him so intriguing. In Toussaint’s view, the Covid-19 pandemic has exposed the “ceiling” of humanity, which is evidenced by the fact that some of the worst affected regions in the world are also the most developed. This, he says, has forced us to confront the limits of our species. As such, we should turn our attention to “filling” life rather than keeping ourselves “in a cave” (lockdown) for perpetuity.  Agree with him or not, the professor is certainly taking the Covid debate in a new direction. Have a watch above and let us know what you think! On whether there is a second wave in France It seems as though there is a very slow and small but regular increase of around 30 to 40 deaths a day, which is concerning only in the southern regions of France. These regions were not directly affected in the first wave… This is similar to the United States where eastern regions were affected in April and in June, and southern states in July and August. It looks like it’s the same kind of situation in France. On testing We are the only continent in the world that has the means to track the virus to every European nose. Every nose has been targeted and what we see is that we are diagnosing people by saying that they have the virus. We then say ‘well you are sick,’ which is not the case. All they have is a fragment of the dead virus, which leads to the amplification of the PCR. It is telling us nothing about what the battle was, and we still don’t know how to tell the difference between the people who were really sick and the ones who have been cured. On waiting for a vaccine The question now is what hopes are there in the vaccine? Would you like a Russian or Chinese vaccine? We don’t know when it will come, from what country, and how safe it will be. So the question is: do we have to stay in a cave until something pops up and says ‘now you’re safe’. Or do we have to understand that this is not the Black Plague? It is a serious disease for which we’ve improved the treatment; in many places all over the world, we’ve seen a 30-40% reduction in mortality rates inside the hospitals… Things have improved for the patients. So we have to decide if this is now a common infectious disease or is it something new? Do we have to stay inside our bunkers, not going to school, and not providing the necessary finance for the economy and, importantly, the health economy? What will we have next year if we don’t have the necessary investment for techniques for people inside the care systems if the economy falls by 10-20%?  On the negative impact on society Trust in people and confidence in the future is at a much lower rate than what is seen in Sweden. Young people are now the designated people for not just the transmission of the disease, but also the economic consequences which came directly from lockdown. And still we don’t have the absolute number of those who were saved by lockdown. What about the people who are dying from being isolated without human contact with their families? And suicides? We have had a lot of examples of these elements, but instead we are focused on the positive effects of this isolation. The Oxford study shows there is no relation at all between the stringency of lockdown and mortality rate in the 188 countries that have declared at least one case of Covid. On the limits of the human species We are having higher rates in countries that have already experienced a plateau in life expectancy growth, which means that we are touching a ceiling. We are reaching the limits of development for the human species. Interestingly, we have the highest level of death rates in that 20-55 degree northern latitude, which stretches from Japan to the United States and includes all the European countries. These countries had the highest development rates in the twentieth century but they have experienced for the last two decades some plateauing in many parameters: health, life expectancy, height, obesity and the economy. Many of those elements seem to provide clues into the highest rates of Covid-19 mortality.
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