As I write Boris Johnson has just locked down the UK and ordered police officers to enforce the lockdown. Almost simultaneously Donald Trump has declared that there is a “great weariness” among Americans for this social distancing business and he wants it to end in two weeks.
In a remarkably irresponsible press conference, even by Trump’s standards, he declared that the economy was tanking and Americans needed to get back to work. After all, “Those doctors would close the world if they could”. He opined the epidemic “with this China virus” would be over soon.
America has a disaster on its hands with the number of infections still climbing dramatically and the Nation’s health professionals desperate for masks, ventilators and hospital beds for so many who are critically ill. Governors are locking down States in a frantic effort to slow the spread of the disease and yet the president wants to get back to business as usual with the emphasis on business. After all he noted “People get killed on the road every day and we still keep driving” You couldn’t make this stuff up!
He then turned his attention to what he described as the “game changer”,the drug hydroxychloroquine. Loads of the stuff will be available in New York within a few days he told his TV audience. Trump is convinced that this will cure a COVID infection despite warnings from scientists that there is, as yet, little evidence to support this contention. Nonetheless he seems to believe its immediate use would allow America to return t normal life. I thought we might examine his claim that China was responsible for the COVID epidemic and take a closer look at the prospects for hydroxychlooquine as a “game changer”
Who is to blame for this Covid-19 pandemic?
The Chinese of course, says Trump as he adopts the term “Chinese virus”. His contention, which is wrong, has fuelled an outburst of very disturbing racism and soured the relationship between the US and China. For their part the Chinese say they think the US military may have created the virus in a laboratory and deliberately brought the virus to Wuhan Province. This also is nonsense. The world’s leading scientific journal “Nature” asked the seven most prominent virus laboratories in the word to study the genetic make up of the COVID-19 virus. Any human engineering would necessarily leave a biological fingerprint . All seven found no evidence of human manipulation. So who is to blame?
I am going to “name names” here for there is a capricious “woman” involved — “Mother Nature”. The Chinese are not responsible for the arrival of Covid-19, nor were the Saudi Arabians responsible for the Middle East respiratory syndrome coronavirus (MERS-CoV).
Viruses do not leave fossils for us to study but almost certainly viruses have been with us from the beginning of the evolution of genes with their coded instructions (RNA and DNA). In one sense viruses are primitive because they cannot reproduce themselves. They need to invade a cell that can do this for them. They command the infected cell to reproduce the invader.
Viruses don’t much care what sought of cell it is, humans, animals and plants are all satisfactory. For invasion viruses need to apply evolutionary principles constantly using a “trial and error” approach to change their surface structure to find a key that will open the door to a cell in which they can reproduce. As in many cases the unwilling host cells will eventually find mechanisms to protect themselves therefore viruses must keep finding new host cells.
We know that bats are a common species that “host” corona viruses. Using the approach outlined these viruses can mutate while in their Bat host and we have seen that process allow corona viruses to jump to birds for example .So where did COVID-19 come from?
Most scientists studying the question think the following is the most likely scenario. It is similar to the origin stories for a few other recent coronaviruses that have wreaked havoc in human populations. In the case of SARS, we contracted the virus directly from civets while it was from camels in the case of Middle East respiratory syndrome (MERS). In the case of Covid-19, it is likely that the animal was a bat, which transmitted the virus to another intermediate animal (possibly a pangolin) that brought the virus to humans.
We know that in pangolins, Corona viruses can develop the “hooks” that are present in the distinctive coronas we can all see in electron microscope photos of the virus. It is these hooks that allow them to bind to human cells. We also know that in human cells corona viruses can mutate to include on their surface a biological “can opener” to prise open the cell they wish to invade. No humans were to blame for the creation of the Covid-19 virus.
Certainly the Chinese government deserves strong criticism for the way it handled the emergence of Covid infections. Cases of respiratory disease with features seen in the SARS epidemic were noted by Chimes doctors in November 2019. It is understandable that initially there were a number of possibilities as symptoms are non-specific but enough cases were being seen to have Chinese doctors raise the suspicion that another SARS like virus was circulating.
China’s initial harsh treatment of those reporting their findings was despicable. Doctors were forced to lie to the public. The main “whistleblower” died from a COVID infection at the age of 35. Chinese authorities felt the virus was being transmitted to humans from animals and they so reported to the WHO on December 8, 2019. We know that by then evidence of human to human transmission was available with at least 200 cases identified before the Chinese told the world this grim news on January 21,2020.
Can Hydroxychloroquine be used to prevent or treat Covid-19 infections?
Naturally the race is on to try and find drugs that could prevent or treat Covid-19 infections. A vaccine is still some 18 months away. Hydroxychloroquine is a decades old drug that has been used to treat Malaria and some of the symptoms suffered by patients with “Lupus” and rheumatoid arthritis, serious autoimmune disorders.
Some 86 trials of various drugs are underway around the world and one with promise, but nothing more at the moment, involves the use of hydroxychloroquine. Laboratory studies have revealed that in the test tube the drug interferes with the entry of the Covid virus into cells.
In France researchers gave the drug to infected patients and found that the drug was “efficient” in clearing upper airways from the virus in three to six days in most patients. But the researchers only treated 26 patients in the study — a tiny sample size. As a result however, and appropriately so, six international well-resourced studies are underway.
Dr Tony Fauci, director of the US National Institutes of Health, who is trying to get evidence based views accepted by a reluctant President, warned him that the evidence at the moment for hydroxychlorquine was “thin and anecdotal” and if used widely outside of controlled trials could produce very misleading impressions given that the infection in most cases is self-limiting. Hydroxychloroquine can cause headaches, dizziness, and diarrhoea, so it’s not something that doctors should prescribe without evidence for likely benefit.
However I have heard that a number of Australian doctors are providing the drug to family and friends as prophylaxis and such non-evidence based prescribing could leave us with a shortage of the drug .I suspect that after Trump’s statement today there will be a rush by Americans to get hold of the drug and what dangerous confusion has he created with his claim that there will be no need to continue social distancing in two weeks?
Here we also have a crucial two weeks ahead of us. We will find out if Australians are embracing with determination the imperative that is social distancing and adhering to the sensible restrictions now in place. If at the end of those two weeks we have not had near universal implementation of the social distancing we need (unlikely I am sorry to say) we should follow the UK and lock ourselves down.
Observations today suggest that many shops whose services are anything but “essential” are still operating. Maximum pain now for maximum gain will in the end result in less suffering and fewer deaths Failure will in all likelihood see us plunged into the utter misery and despair that has gripped much of Europe and indeed the US.
Professor John Dwyer, Immunologist and Emeritus Professor of Medicine UNSW
Professor John Dwyer AO, is an Immunologist, Emeritus Professor of Medicine at UNSW and for many years heavily involved in efforts to improve the delivery of healthcare in Australia. He was the founder of the Australian Healthcare Reform Alliance.
Comments
7 responses to “Trump declares he is convinced we now have a drug to terminate the epidemic”
“However I have heard that a number of Australian doctors are providing the drug to family and friends as prophylaxis and such non-evidence based prescribing could leave us with a shortage of the drug”
This is true as I have rheumatoid arthritis and find that I can’t get my prescription filled for Plaquenil. I’ve tried multiple pharmacies and my regular pharmacy and they all say they don’t have it and on’t know when it will be available.
I blame the economics-inspired, dog-eat-dog tradition of the pharmacy system for this. Pharmacists understand that supply chains get broken for no good reason if retailers don’t resist irrational spikes in public demand, but the system puts great pressure on them to push as much stuff out the door as they can. If we had a decent (socialist) government, it would already have regulations in place to ensure that people get what they need, and can’t just have what they want.
Sorry, John, I cannot agree that ‘No humans were to blame for the creation of the COVID-19 virus.’ That is a very narrow ‘scientific’ perspective on the issue and completely ignores the political economy of the appearance of novel infectious agents and much other scientific evidence. I touched on this in my Sunday environmental round up on 15 March with reference to just one article featuring an interview with Rob Wallace (https://climateandcapitalism.com/2020/03/11/capitalist-agriculture-and-covid-19-a-deadly-combination/ ) that explores how novel infectious agents are created and cross to humans. Humans were intimately involved with the creation of COVID-19 and the residents of Wuhan were simply one of the final links in the chain that started far away in the world’s centres of finance and commerce.
Of corse you are correct Peter if your context is linked to the grievous sins humans have committed as they failed in their duty of care for Mother Earth. The article you referenced provides an accurate but sad reflection on that reality and I commend it to P & I readers. Collectively we are all responsible for climate change and the creation of conditions that could favour transmission of viruses to humans from animals .
In the context of my article however my narrow focus is on the erroneous suggestions that a cluster of contermporary wicked humans (Chinese or American or others) deliberately created and disseminated COVID-19
[warning: this comment may offend humans]
Another way to think about this is that humans are the virus, potentially causing unstoppable harm to the viability of life on Earth, and Covid-19 is a way nature is fighting back!
The taste of too many Chinese for exotic animal species is based largely on false belief in their health benefits. That practice has turned out to be spectacularly harmful to humanity. So much for traditional Chinese medicine. The beautiful, persecuted pangolins have had a win.
Before we start blaming people or groups, we should take the behaviorist approach, blame the relevant cultural practices, and change them. We need to change harmful practices based merely on precedent, to practices based on the evidence of properly conducted experiment, properly collected data, and valid mathematical modelling derived from them. We need the rule of science, and we are thankfully getting it. The consumption of exotic animal species has been banned in China. The leadership understands science. They are first and foremost, servants of scientific socialism (the rule of science). When the evidence was clear, they acted decisively and, so far, successfully. They were prepared to risk their popularity amongst the uninformed by banning traditional practices that turned out to be harmful. Even most western leaders, when faced with the science have taken decisions that are unpopular with the uninformed. To prevent mass starvation, conservative leaders are bowing to the socialist principle, “From each according to his ability, to each according to his needs”. Those countries whose leaders persist in buckling to conservative populism face ostracism from countries who have been ruled ultimately by the science, and successfully rid themselves of this scourge.
At 10 days into my ‘self-isolation’, I can echo the sentiment – it is a right royal pain in the bum. As a citizen in the older age bracket however, I am doing it for my protection, and that of my family, and bear the ‘pain’ as a price to paid to play my part in handling the response to the virus, in addition to my own self-protection. I would like to see the total shut-down happen now – as someone who spent the bulk of my worklife doing policy analysis and development, I see an imperative to act decisively and quickly. The ‘quickly’ is long lost, ‘decisive’ appears too hot to handle, but the failure will be costly. The past is lost to us, but there is still ‘now’ – seize it, and stop the ultimate price from further escalation.