Matt Ridley Suspects Wuhan Lab Innocent of Creating Covid-19

(p. C5) RaTG13 is the name, rank and serial number of an individual horseshoe bat of the species Rhinolophus affinis, or rather of a sample of its feces collected in 2013 in a cave in Yunnan, China. The sample was collected by hazmat-clad scientists from the Institute of Virology in Wuhan that year. Stored away and forgotten until January this year, the sample from the horseshoe bat contains the virus that causes Covid-19.

. . .

. . . analysis shows that the most recent common ancestor of the human virus and the RaTG13 virus lived at least 40 years ago. So it is unlikely that the cave in Yunnan (a thousand miles from Wuhan) is where the first infection happened or that the culprit bat was taken from that cave to Wuhan to be eaten or experimented on.

Rather, it is probable that somewhere much closer to Wuhan, there is another colony of bats carrying the same kind of virus. Unless other evidence emerges, it thus looks like a horrible coincidence that China’s Institute of Virology, a high-security laboratory where human cells were being experimentally infected with bat viruses, happens to be in Wuhan, the origin of today’s pandemic.

. . .

Bats are sold in markets and supplied directly to restaurants throughout China and southeast Asia, but no direct evidence of their sale in Wuhan’s wet market has come to light. Also, horseshoe bats, which are much smaller than the tastier fruit bats, are generally not among the species eaten. The significance of the Yunnan cave sample is that it shows the bat virus didn’t need to recombine with viruses in other species in a market to be infectious to people. The role of the wet markets may be that other animals get infected there and produce much higher loads of virus than the bats would, amplifying the infection.

For the full commentary, see:

Matt Ridley. “The Bats Behind the Pandemic.” The Wall Street Journal (Saturday, April 11, 2020): C5.

(Note: ellipses added.)

(Note: the online version of the commentary was the date April 9, 2020 and has the same title as the print version.)

The New York Times Advises Its Readers How to Survive the Pandemic

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Jeni’s Splendid Ice Cream

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For the full story, see:

“The New Essentials: Family Fun.” The New York Times, AtHome Section (Sunday, May 24, 2020): 8.

(Note: all-cap heading, bolds, italics, and absence of period after italics, all in original.)

(Note: after a thorough search, as of 5/25/20, it appears that the New York Times did not post this article online.)

Methotrexate Hoped to Moderate Covid-19 Cytokine Storm

(p. A15) Today Dr. Frohman and his team of researchers believe one treatment for MS could do the same for seriously ill Covid-19 patients.

The drug is called methotrexate, and it’s already proven to calm the chaotic responses of panicked immune systems. “A blast of this drug, over a matter of hours . . . pulls the cord on the panic button and resets the immune system,” Dr. Frohman tells me.

The new research is set to be published as early as this week in the Journal of the Neurological Sciences. Methotrexate already has been approved by the Food and Drug Administration, meaning doctors treating Covid-19 patients could begin using it immediately. National Institutes of Health immunologist Avindra Nath said this week that combining methotrexate with remdesivir, an antiviral drug, may set a new standard for fighting the most serious Covid cases.

For the full commentary, see:

Peggy Wehmeyer. “A Covid Drug to Help Fight the Storm.” The Wall Street Journal (Thursday, May 14, 2020): A15.

(Note: ellipsis in original.)

(Note: the online version of the commentary has the date May 13, 2020 and has the same title as the print version.)

The Frohman research, mentioned above, is reported in:

Frohman, Elliot M., Esther Melamed, Roberto Alejandro Cruz, Reid Longmuir, Lawrence Steinman, Scott S. Zamvil, Nicole R. Villemarette-Pittman, Teresa C. Frohman, and Matthew S. Parsons. “Part I. Sars-Cov-2 Triggered ‘Panic’ Attack in Severe Covid-19.” Journal of the Neurological Sciences (in-press 2020).

Frohman, Elliot M., Roberto Alejandro Cruz, Reid Longmuir, Lawrence Steinman, Scott S. Zamvil, Nicole R. Villemarette-Pittman, Teresa C. Frohman, and Matthew S. Parsons. “Part II. High-Dose Methotrexate with Leucovorin Rescue for Severe Covid-19: An Immune Stabilization Strategy for Sars-Cov-2 Induced ‘Panic’ Attack.” Journal of the Neurological Sciences (in-press 2020).

Trump Walks the Walk on Hydroxychloroquine

(p. A6) WASHINGTON—President Trump said he is taking hydroxychloroquine, an antimalarial drug that he has cited as a possible defense against the novel coronavirus but that some scientists have cautioned needs further study and could be dangerous.

“I happen to be taking it, hydroxychloroquine,” he told reporters at the White House on Monday. He said he had consulted with the White House doctor and suggested he is taking the drug as a preventive measure. Mr. Trump said he has been checked regularly for Covid-19, has tested negative and has no symptoms. He said he has been taking hydroxychloroquine for about a week and a half.

. . .

On Monday [May 18, 2020], Mr. Trump continued to stress anecdotal evidence in favor of the drug and told reporters, “I was just waiting to see your eyes light up when I said this.” He also expressed confidence in the drug’s safety. “I’m not going to get hurt by it. It’s been around for 40 years for malaria, for lupus, for other things.”

For the full story, see:

Catherine Lucey, Jared S. Hopkins. “President Trump Says He Is Taking Hydroxychloroquine as Preventive.” The Wall Street Journal (Tuesday, May 19, 2020): A6.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date May 18, 2020, and has the title “Trump Says He Takes Contested Drug for Prevention.”)

The key reference on advocates of a drug who take it first themselves, without confirmation from randomized double-blind clinical trials, is:

Altman, Lawrence K. Who Goes First?: The Story of Self-Experimentation in Medicine. Berkeley, CA: University of California Press, 1998.

China Sent Fewer Masks to World Than Claimed

(p. A6) This spring, Beijing energetically promoted its exports and overseas donations of medical supplies and asked foreign politicians to thank China publicly for the shipments. But a study released on Tuesday [May 6, 2020] found that the shipments were slow to get started.

. . .

The tonnage of China’s net exports of respirators and surgical masks was down 5 percent in March from the same month a year earlier, according to an analysis by Chad Bown, a trade specialist at the Peterson Institute for International Economics in Washington.

The analysis, based on Beijing’s own customs data, also found that China cut way back on exports of medical supplies in January and February and stepped up imports in those months.

For the full story, see:

“Top British Doctor Quits After Violating Lockdown.” The New York Times (Wednesday, May 6, 2020): A6.

(Note: ellipsis added.)

(Note: the online version of the story was updated May 21 [sic], 2020 and has the title “Top U.K. Scientist Resigns Over Coronavirus Distancing Violation.” The print and online articles are a series of brief articles that are only related by being on some aspect of the Covid-19 pandemic. In the online version, all of the brief articles must be searched-for under the name of the top brief article.)

Sarilumab Showed “Hint” of Promise for Critically Ill Covid-19 Patients

(p. A10) . . . , preliminary results on treatments with . . . sarilumab, marketed as Kevzara and made by Regeneron and Sanofi, indicate that it does not help patients who are hospitalized but not using ventilators.

. . .

The patients fell into two groups — “severe,” meaning they required oxygen but did not need a ventilator or so-called high flow oxygen, and “critical,” those who needed a ventilator, high flow oxygen or were in intensive care.

. . .

The results for the critically ill patients are not conclusive but there is a hint that such patients may be helped, so the study will continue with only critically ill patients. More than 600 have been enrolled. Results are expected in early June [2020].

For the full story, see:

Gina Kolata. “Drug Shows Slim Promise For Critical Covid Cases.” The New York Times (Tuesday, April 28, 2020): A10.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date April 27, 2020, and has the title “Arthritis Drug Did Not Help Seriously Ill Covid Patients, Early Data Shows.”)

Physicians Fighting Covid-19 Use Social Media “to Share Improvised Solutions”

(p. A9) In mid-March [2020], as U.S. hospitals scrambled for ventilators to treat a surge of coronavirus cases, a Vermont pulmonologist proposed a different treatment on a blog popular with emergency-medicine doctors.

Joshua Farkas observed in the post on the EMCrit blog that many Covid-19 patients seemed to benefit from less-invasive alternatives to help their breathing, including pressure therapy used to treat sleep apnea—sometimes referred to as CPAP, for continuous positive airway pressure.

. . .

The post helped galvanize an emerging theory about the treatment of Covid-19 patients, which in recent weeks has taken hold in U.S. hospitals. In New York City, where ventilators are in perilously short supply, doctors say they have since embraced CPAP and other treatments to improve breathing in Covid-19 patients.

The shift is one example of how health-care workers are writing the playbook for treating coronavirus patients on the fly, knowing they can’t wait for peer-reviewed articles or studies in established medical journals. Instead they are tapping into social media, podcasts, inside-baseball medical blogs and text-message groups to share improvised solutions to supply shortages and patient care, forcing hospitals to quickly re-evaluate their practices.

“This has been a rapidly evolving process,” said Dr. Farkas, who has treated Covid-19 patients in the intensive-care unit at the University of Vermont in Burlington. “As we struggle with how to treat a disease that so recently was totally unknown, this rapid exchange and updating of information is crucial.”

. . .

Last week, Michelle Romeo, a chief emergency-medicine resident at NYU Langone and Bellevue hospital in Manhattan, tweeted photos of a jury-rigged breathing device involving a mask used for BiPAP—an airway pressure therapy similar to CPAP.

At Mount Sinai Hospital in Manhattan, pulmonologists worked with the hospital’s sleep lab to figure out a way to use BiPAP machines like a ventilator. The result was posted on Reddit, and got “all kinds of different responses,” said Valerie Burgos-Kneeland, a registered nurse in the hospital’s Medical Intensive Care Unit. “It’s kind of been an opportunity for people to get creative.”

For the full story, see:

Rebecca Davis O’Brien. “Doctors Improvise, Share Treatments.” The Wall Street Journal (Friday, April 10, 2020): A9.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date April 9, 2020, and has the title “Doctors Are Improvising Coronavirus Treatments, Then Quickly Sharing Them.”)

Drugs Targeting Cytokines Tried Against Covid-19

(p. A9) Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

. . .

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

For the full story, see:

Jared S. Hopkins, Joseph Walker. “Haywire Immune Reaction Linked to Most Severe Cases.” The Wall Street Journal (Friday, April 10, 2020): A1 & A9.

(Note: ellipsis added.)

(Note: the online version of the story has the date April 9, 2020, and has the title “Haywire Immune Response Eyed in Coronavirus Deaths, Treatment.”)

“The Spontaneous, Uncoordinated Effort of Businesses, Entrepreneurs and Innovators”

(p. A1) True Value Co. heard from its more than 4,500 affiliated hardware stores last month that hand sanitizer was flying off the shelves, leaving store staff with none for themselves.

At the company’s factory in Cary, Ill., which makes cleaning products and paint, John Vanderpool, the company’s divisional vice president of paint, recalled asking, “What can we do to help here?” After a tip from his wife, a pharmacist, he consulted with the Food and Drug Administration, then huddled with his maintenance team and engineers over two weekends to retool two paint-filling lines to produce jugs of FDA-approved hand sanitizer.

Starting this week they are being shipped free to stores for their own use. The product will go on sale to the public eventually.

The changeover at True Value’s factory from paint to hand sanitizer is one of countless private-sector initiatives that represent an underappreciated asset in Americans’ fight against the coronavirus. It is a 21st-century version of the “Arsenal of Democracy,” the mobilization of industrial might that helped win World War II, only this time to make personal protective equipment, ventilators, tests and vaccines instead of uniforms, ammunition, tanks and bombers.

And where that arsenal was orchestrated by the federal government, this one has been largely the spontaneous, uncoordinated effort of businesses, entrepreneurs and innovators driven as much by the urge to contribute as by future profit.

. . .

(p. A9) Joel Mokyr, an economic historian at Northwestern University, said national crises such as wars and pandemics historically generate a hive of entrepreneurial innovation, from the late 18th-century search in England for a treatment for smallpox to a German drive in the run-up to World War I to use atmospheric nitrogen for explosives.

“We have this huge reservoir of creative energy spread around the economy. When you have an event like this all of a sudden, everyone says, ‘Oh wow let’s look at this problem—let’s see what I can do to solve it.’ ”

This time, innovators are exploiting tools and methods that didn’t exist in previous crises. In mid-March, Lennon Rodgers, director of the Grainger Engineering Design Innovation Lab at the University of Wisconsin in Madison, fielded a plea from the university’s hospital to make 1,000 face shields.

He often gets requests from around the campus to manufacture random items and “initially, I didn’t take it too seriously,” he recalled. But after his wife, an anesthesiologist, told him the shields were indispensable for dealing with highly infectious patients, he scoured hardware and craft stores for parts.

He teamed up with Delve, a local design firm, and Midwest Prototyping, a contract manufacturer, to design their own “Badger Shield,” named after the University of Wisconsin mascot. They expected to use 3-D printers, then concluded that wouldn’t achieve the necessary scale. They uploaded the design to their website along with the necessary parts for anyone to download. A few days later Ford Motor Co. did, and, with tweaks of its own, began turning out face shields for Detroit-area hospitals.

For the full story, see:

Greg Ip. “Health Crisis Awakens Spirit of Private-Sector Innovation.” The Wall Street Journal (Friday, April 17, 2020): A1 & A9.

(Note: ellipsis added.)

(Note: the online version of the story was updated April 16, 2020, and has the title “Shoes to Masks: Corporate Innovation Flourishes in Coronavirus Fight.”)

“Real World Evidence” on Effectiveness of Experimental Drugs Can Be Extracted From Electronic Health Records

(p. A7) . . . analysis of compassionate-use data, about the experimental drug remdesivir from Gilead Sciences Inc. published in the New England Journal of Medicine, came under criticism. Scientists pointed out that the Covid-19 patients received the drug in centers around the world where care may have differed, data on some patients was incomplete and there was no comparison group.

That study’s first author, Jonathan Grein, of Cedars-Sinai Medical Center in Los Angeles, said given how little is known about the coronavirus and how to treat it, “I think at this point any information is potentially helpful.” He said the study, funded by Gilead Sciences, noted the findings were limited and preliminary. “It is a starting point, an opportunity to aggregate our initial experiences,” he said.

. . .

The FDA . . . has worked closely with companies trying to extract “real world evidence” about patients’ experiences with new or experimental drugs from sources such as electronic health records.

For the full story, see:

Amy Dockser Marcus. “Hundreds Get Plasma in National Study.” The Wall Street Journal (Wednesday, April 22, 2020): A7.

(Note: ellipses added.)

(Note: the online version of the story has the date April 21, 2020, and has the title “Hundreds Receive Plasma From Recovered Coronavirus Patients in National Study.”)

Blacks Deficient in Vitamin D Are at Greater Risk of Cytokine Storm from Covid-19

(p. A15) Black Americans are dying of Covid-19 at a higher rate than whites. Socioeconomic factors such as gaps in access to health care no doubt play a role. But another possible factor has been largely overlooked: vitamin D deficiency that weakens the immune system.

Researchers last month released the first data supporting this link. Based on a link between levels of the inflammatory marker C-reactive protein and severe cases of Covid-19, they estimate that tens of thousands of lives could be saved world-wide by normalizing vitamin D levels, through its modulation of the inflammatory cascade.

Vitamin D is produced by a reaction in the skin to the ultraviolet rays in sunlight. Many Americans are low in vitamin D, but those with darker skin are at a particular disadvantage because melanin inhibits the vitamin’s production.

For the full commentary, see:

Vatsal G. Thakkar. “Vitamin D and Coronavirus Disparities.” The Wall Street Journal (Friday, April 17, 2020): A15.

(Note: the online version of the commentary has the date April 16, 2020, and has the same title as the print version. Where the wording of the online and print versions differs, the passages quoted above follow the online version.)

The research working paper mentioned above, is:

Daneshkhah, Ali, Vasundhara Agrawal, Adam Eshein, Hariharan Subramanian, Hemant Kumar Roy, and Vadim Backman. “The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in Covid-19 Patients.” (April 30, 2020).