On The Coronavirus And Smoking, Infection Fatality Rates And More

Source: https://www.moonofalabama.org/2020/04/on-coronavirus-and-smoking-infection-fatality-rates-and-more.html

April 25, 2020
Moon of Alabama

On April 3 I had remarked https://www.moonofalabama.org/2020/04/the-science-says-maskup-a-look-at-two-new-virus-studies.html:

Interestingly smokers seem not to develop a cytokine storms during a Covid infection and are thereby less prone to end up in the intensive care unit (ICU)

(A cytokine storm is an inappropriate inflammatory response by the immune system.)

It was really curious that during a respiratory disease epidemic current and former smokers were less prone to end up in an ICU than people with other preconditions. (It was also a psychological relief for this chain smoking blogger but should be NO reason for anyone to start this otherwise dangerous habit.)

A French study https://www.qeios.com/read/FXGQSB has now confirmed this astonishing phenomenon:

In the study that two of us are reporting https://www.qeios.com/read/WPP19W.3 , the rates of current smoking remain below 5 % even when main confounders for tobacco consumption, i.e. age and sex, in- or outpatient status, were considered. Compared to the French general population, the Covid-19 population exhibited a significantly weaker current daily smoker rate by 80.3 % for outpatients and by 75.4 % for inpatients. Thus, current smoking status appears to be a protective factor against the infection by SARS-CoV-2.

The mechanism does not work through filling the lungs with smoke. Here nicotine works as a nerve agent. It is known to influence the process that regulates the number of ACE2 receptors on the cell surface. Current smokers do have less ACE2 receptors than non smokers. SARS-CoV-2 bonds to that receptor to enter a cell.

The study was led by Professor Jean-Pierre Changeux https://en.wikipedia.org/wiki/Jean-Pierre_Changeux who is quite famous for his discovery of that general regulation process and other findings. He now plans to use nicotine patches on Covid-19 patients to see if it can help in current cases.

*******

Other medications, especially those that U.S. President Donald Trump publicly pointed to, have proven to be rather worthless:

Financial Times @FinancialTimes – 19:00 UTC · Apr 23, 2020 https://twitter.com/FinancialTimes/status/1253398286544838656
Exclusive: The antiviral drug remdesivir, which many expected to be a good treatment against coronavirus, has flopped in its first randomised clinical trial, according to draft documents published accidentally by the WHO and seen by the FT on.ft.com/2VT6PXe

It turns out that study is already a month old and that Gilead, the company that sells remdesivir, had held it back while it continued to promote its useless drug. Someone at the WHO did not like that scheme and ‘accidentally’ published the results. Gilead’s stock then took a 10% dive.
Food and Drug Administration (FDA
Trump also marketed hydroxychloroquine or chloroquine as helpful against Covid-19. But both can have severe side effects like abnormal heart rhythms and the Food & Drug Administration (FDA) is now urgently warning https://www.fda.gov/media/137250/download against their use:

FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.
Close supervision is strongly recommended

*******

Bret Stephens is one of the super dumb columnists of the New York Times. In today’s column he argues for lifting the lockdowns and writes https://www.nytimes.com/2020/04/24/opinion/coronavirus-lockdown.html:

Right now, there’s a lot of commentary coming from talking heads (many of them in New York) about the danger of lifting lockdowns in places like Tennessee. Perhaps the commentary needs to move in the opposite direction. Tennesseeans are within their rights to return to a semblance of normal life while demanding longer restrictions on New Yorkers.
I write this from New York, so it’s an argument against my personal interest. But I don’t see why people living in a Nashville suburb should not be allowed to return to their jobs because people like me choose to live, travel and work in urban sardine cans.

Just yesterday the Tennessean reported this https://eu.tennessean.com/story/news/local/2020/04/23/nashville-health-department-coronavirus-cases-spike/3012302001/:

Nashville saw its highest single-day spike in COVID-19 cases Thursday when the Metro Public Health Department reported 182 new positive test results over the previous 24 hours.

In total, Metro health reported Thursday 2,144 confirmed cases in Davidson County since testing began, up from 1,962 the day before. There were 1,046 active cases Thursday, according to the department.

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New York has done some blood testing for antibodies to SARS-CoV-2. These test are new and not yet very reliable https://www.nytimes.com/2020/04/24/health/coronavirus-antibody-tests.html:

The tests were particularly variable when looking for a transient antibody that comes up soon after infection, called IgM, and more consistent in identifying a subsequent antibody, called IgG, that may signal longer-term immunity.

Such tests should not be used to write “This person is immune” certificates. But they are good enough for epidemiological research.

The tests have found that some 20% of all people in New York City may already have had Covid-19 and have probably acquired some immunity. Considering the number of Covid-19 death in New York this points to https://threadreaderapp.com/thread/1253398325245603840.html# an infection fatality rate (IFR) of ~1%. The infection fatality rate is heavily dependent on population demographics and the health care system.

Christian Drosten, a famous German coronavirus specialist, has estimated the current IFR in Germany to be about 0.53. But the German number is now steadily increasing. The Covid-19 epidemic in Germany first appeared in young to medium age people who were infected during skiing and partying in Austria and Italy. It further developed within that age group and is only now entering assisted living and elderly care centers where it tends to wreak havoc. The IFR will therefore increase and we do yet know where it will end up.

New York City and Germany have well developed health care systems. Countries with less reliable systems are likely to see much higher IFRs of 2-3+%.

For the quite bad flu season of 2017-18 the Center for Disease Control and Prevention (CDC) estimated https://www.cdc.gov/flu/about/burden/index.html 45 million infections which in total caused some 61,000 deaths. That gives an IFR of 0.13% for the flu which again proves the point that Covid-19 is not like one. The seasonal flue has an R0 of 1.2. SARS-CoV-2’s R0 is 2 to 3. The virus is at least two times more infectious than the flu, only few have immunity against it and even in well developed countries Covid-19 is 4 to 8 times more deadly than the flu. We can thereby expect that the total death rate from Covid-19 will be 10-15 times higher than the number of deaths caused by the seasonal flu during a bad year.

Our health care systems are sized to keep up with a bad flu plus the other usual cases. They are not sized to take ten times the flu cases plus the other ones. It is therefore obvious that social distancing will have to continue.

*******

A non-scientific study by Quillette has looked a super spreading events https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/ during which dozens or hundreds were infected at one time in one place. The result in short is that everything that is fun should now be prohibited:

When do COVID-19 SSEs happen? Based on the list I’ve assembled, the short answer is: Wherever and whenever people are up in each other’s faces, laughing, shouting, cheering, sobbing, singing, greeting, and praying.

A Chinese study found that more that 99% of all infections happen indoor https://www.medrxiv.org/content/10.1101/2020.04.04.20053058v1:

Home outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport (108; 34.0%; note that many outbreaks involved more than one venue category). Most home outbreaks involved three to five cases. We identified only a single outbreak in an outdoor environment, which involved two cases. Conclusions: All identified outbreaks of three or more cases occurred in an indoor environment, which confirms that sharing indoor space is a major SARS-CoV-2 infection risk.

The results may be skewed a bit as the Wuhan outbreak happened during the cold season in December to February. We can expect a slight relief during summer when more people open windows or are outside. But the next cold season will likely be the most difficult time for everyone.

I had earlier pointed out https://www.moonofalabama.org/2020/03/more-bits-on-the-corona-crisis.html that the Chinese authorities stopped the home outbreaks by isolating the mildly sick and even people who had only had contact with a Covid-19 patient in special quarantine centers instead of leaving them at home with their families. That I urged to do similar here was the starting point of my conflict with Off-Guardian https://www.moonofalabama.org/2020/04/it-is-not-authoritarian-to-support-quarantine-measures-it-just-makes-sense.html.

Italy now finds that the Chinese method is the right thing to do https://www.nytimes.com/2020/04/24/world/europe/italy-coronavirus-home-isolation.html:

Italian households represent “the biggest reservoir of infections,” said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases “the possible restarting point of the epidemic in case of a reopening.”

The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. “This is a ticking time bomb,” he said.

The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighborhoods of Rome and Milan.

Letting infected persons stay with their family is a great method to kill whole families and to help the the epidemic continue its course.

A two week quarantine in a hotel or public facility during which one is well provided for should be an acceptable sacrifice when it is know that it helps to save the lifes of others in one’s community. It is hard to understand why some people continue to reject this.

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