It’s clear that pretty much everyone who died from the Flu Manchu had a serious underlying condition. Those who the news claimed had no other illness all later turned out to have an undiagnosed illness. It is indeed possible to have heart problems or diabetes or many other things without realising it. Naturally, if it’s severe you’ll notice it but many conditions can be a long way down the road of developing before they really hit you.
Several things seemed strange though. Why is a respiratory virus causing multiple organ failure? Why are those with diabetes getting hit really hard? Why does blood type seem to matter? Why is it acting like a septicaemia when it’s really a kind of flu? Why on Earth would an anti-malaria drug work?
It has absolutely devastated the lungs of those it has killed. Not just normal pneumonia, it’s shredded the lungs entirely. How can it go so much further than even swine flu or SARS?
Well, this might help explain it. I haven’t yet found the original studies he refers to, there are no references on the article and it is on a site that does not fact-check what people put on there so I’m going to call it a hypothesis. One that really should be tested, but it’s certainly plausible.
Basically, it says that the virus proteins mess up haemoglobin and release the iron from them. This isn’t just iron, it’s a positively charged ion, a very dangerous thing to have in your body in large amounts. However, it has to be there because that’s how haemoglobin transports oxygen. So, the iron is encased in the haemoglobin molecule in such a way that it can catch oxygen but cannot go all free-radical on the rest of your body.
Some of the virus surface proteins react with haemoglobin and break it so the reactive iron atom is released. In amounts too large for the body’s defences to deal with. It isn’t part of the virus’ ‘plan’, it’s not useful to the virus, it appears to be accidental.
This reactive iron is what wrecks the lungs. Then you also have red blood cells that can’t carry oxygen no matter how well ventilated you are. Multiple organ failure is then inevitable. Also, any blood/circulation-linked underlying condition is only going to make it worse.
There is no malaria vaccine. If you are travelling to a malaria-risk country, you take the malaria tablets daily for a month before you go, while you’re there, and for a couple of weeks when you get back. It does not produce antibodies, it blocks the parasite’s access to haemoglobin. This is not a permanent solution, you have to build it up and keep topping it up until the risk has passed.
Since it blocks access to haemoglobin, it seems it does the same to the virus proteins.
As for the blood type, well, it seems malaria has the same response as the virus. Blood group O is safest, group A is most at risk. There has not been time to sequence the virus proteins, maybe nobody has thought to do that yet, but if they are indeed the RIFIN proteins from malaria then this virus will look very much engineered. It would be one coincidence too many.
The first article linked to does point out that the reason so many news outlets and lefties want to disparage the hydroxychloroquine treatment is because Trump said it would work. Even though nobody on the planet believes he worked it out himself. I can believe that because the world, especially politics, really has become that petty. There are also deeper reasons involving (as usual) money and control.
Pharmers are working on a vaccine, the Billy Gates Gruff has seen this as an opportunity for his long-drooled-over ‘chip everyone’ scheme, the communists see it as an opportunity to end capitalism, the Kissinger (yes, he’s still alive!) has already pushed for a one world government to deal with it, Piers ‘I’ll scweam and scweam until I’m thick’ Morgan wants to bring back every failed Prime Monster, the Greens want to install this, the tobacco controllers want to take the opportunity to ban vaping and smoking (even though it has been shown that smoking/vaping has no effect on catching or getting sick from this virus) and the Temperance Loonies are trying to use it to ban alcohol.
If there is a cheap, simple cure for this virus, all of that and more falls apart. So there is a hell of a lot of resistance to this cure.
Doctors, meanwhile, are saying it works. I’m going with the doctors.
underdogs bite upwards 
Aha. Guess who spent the vast majority of February in a hyperbaric chamber ( well 20 sessions) *yours truly. Yet I was still knackered. Didn’t get the usual uplifting energy boost this time. If the virus is separating iron from heme then it is bloody dangerous.
As for azithromycin. I call that domestos. It’s saved me a couple of times from the green sputum chest infections.
No wonder we’re all under house arrest.
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Interesting,thank you.
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https://www.rfglobalnet.com/doc/fixed-wireless-communications-at-60ghz-unique-0001
This may be what you are looking for
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Thank you for an article that makes complete sense
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Thank you once again: that linked article certainly sounds plausible. As the author mentions, though, because the Jinja Ninja spoke of it, the – fingers crossed – best treatment will be downplayed by the MSM and so might be too late for a lot of people.
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I always thought there was (a lot) more to this than meets the eye. Either ‘they’ know something and not telling us or (more likely), like you say, they want to keep using the emergency situation for as long as they can to advance their agenda.
The entire Left seems to be in on it. It has already been used as an excuse to allow ‘home abortions’. That’s where the woman takes both treatments at home – mifepristone to kill her baby followed within the next 48 hours by misoprostol which causes painful cramps and bleeding to expel her baby’s dead foetus as well as other tissue up to the size of a lemon. Sounds like a pleasant experience to go through at home, possibly alone, but it’s a ‘woman’s right,’ innit?
There was no proper scrutiny via parliamentary debate or anything else – the abortion lobby owns parliament now – look at what they’ve just done to N. Ireland – from abortions only under very limited circumstances to one of the world’s most liberal abortion regimes. Because the politicians weren’t able/willing to reconvene Stormont in time to block this diktat from Westminster, the abortion lobby made a huge advance due to another political emergency situation.
Another dig at Google – their current ‘doodle’ honours our wonderful emergency services. The letter “e” is wearing a cop cap and gets hearts thrown at it (and the fireman “l”) by the “G” as a reminder for us to love the police who will be obeying orders to clamp down on us as required. But we must blow kisses at them as they taser us for being out after any future curfew or maybe for refusing a compulsory vaccination at some point, which will likely be my course of (in)action.
Sad to say that most people with the slightest bit of power tend to abuse it and crave more and more while disregarding those who they are supposed to serve and who pay their salaries, or like the N.I situation, having things you didn’t want forced on you by people who don’t even represent you.
There’s a local church here with a very small congregation. Only two couples attended services. One couple went away for a fortnight (the man was nominally in charge of church business), but something happened while they were away – I think the boiler needed repaired or serviced – and the other couple dealt with it. At the church service following their return, the man who was loosely in charge went berserk when he found out that the other chap had sorted something out without his permission and was so upset that an ambulance had to be called, as they thought he might be having another heart attack.
After that, the congregation halved to two people.
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Leggy, I’ve been looking for the missing smokers from the Chinese statistics, wondering if it was something else in the smoke.
Nitric Oxide Inhibits the Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus
2005
“Nitric oxide (NO) is an important signaling molecule between cells which has been shown to have an inhibitory effect on some virus infections. The purpose of this study was to examine whether NO inhibits the replication cycle of the severe acute respiratory syndrome coronavirus (SARS CoV) in vitro. We found that an organic NO donor, S-nitroso-N-acetylpenicillamine, significantly inhibited the replication cycle of SARS CoV in a concentration-dependent manner. We also show here that NO inhibits viral protein and RNA synthesis. Furthermore, we demonstrate that NO generated by inducible nitric oxide synthase, an enzyme that produces NO, inhibits the SARS CoV replication cycle.”
https://jvi.asm.org/content/79/3/1966
A different virus I know.
Remember Frank’s smoking mountaineers?
Study Finds Benefits of Pollutant
1993
“A group of Medical School researchers has discovered a bizarre twist on the harmful effects of car exhaust and cigarette smoke: nitric oxide, a component of both pollutants, can help treat a deadly type of pneumonia.
“Instructor in Anaesthesia Dr. Jesse D. Roberts, Jr., a member of Zapol’s research group, said the discovery also explains why mountain climbers short of breath often claim that smoking cigarettes makes them stronger. The seeming paradox may be due to the presence of nitric oxide in cigarette smoke”
“And nitric oxide may only be the tip of the iceberg. The idea behind the treatment, that pollutants that are toxic in high doses are actually essential chemicals in the human body, may open a whole new world of safe drugs for other diseases.
Carbon monoxide, another toxic gas present in automobile exhaust, has also been shown to be a chemical messenger between cells, Brain said. “It’s remarkable that it’s escaped everyone’s notice for so long,” he said.”
“According to Zapol, it all reduces to one simple thing. “Good things hide in pollutants and cigarettes,” he said”
https://web.archive.org/web/20051029212635/http://www.thecrimson.com/article.aspx?ref=222612
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The damage to haemoglobin also ties up with what the doctor in the link talks about. He says the symptoms (when it get really serious) are more like oxygen starvation or altitude sickness than pneumonia.
He says don’t use ventilators to just force air in to lungs, you might do more harm than good. Get more oxygen into the lungs.
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That is extremely interesting and quite plausible, old fella.
Does that mean that the virus can target the haemagglutinins on the surfaces of erythrocytes? And if so, what sort? We learn that blood group A folks are more vulnerable.
I’m A [rhesus-D-positive] by the way! (I know – it sezz so here on a little slip i have from years ago.)
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Original research paper (summary) is at:-
chemrxiv.org
A Chinese chemical engineer from Sichuan.
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from the Head of ICU at the Royal Free. Please feel free to disseminate further.
“Dear All,
I have just finished a very useful ICU / NHS Nightingale teleconference, the aim of which was to consolidate experiences about CV19 and how best to manage the disease. I have provided a summary below. Please understand that the information is experience, not evidence. I think it highlights a number of areas that we need to discuss URGENTLY as a group. The take home message is that advice given at the beginning of this journey needs to be adapted as we learn more about CV19. The other important thing to begin to understand is that this disease has distinct phases and treatment will differ as patients move through these phases.
The call had about 80 people on it, most listening. There were about ten “experts” invited to speak, from high volume centres. I represented our site. Others included Georges, GSST & Brompton.
Ventilation
– Early high PEEP is probably not the right strategy and may be harmful. This is not ARDS in the early phase of the illness.
– Avoid spontaneous ventilation early in ICU admission as also may be harmful.
– There is clear microvascular thrombosis happening in the pulmonary circulation, which leads to an increased dead space.
– Also some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related, possibly inflammation related.
– Not many patients have reached extubation yet in London, re-intubation seems to be common. I highlighted our experiences of airway swelling / stridor / reintubation.
– Brompton are seeing wedge infarcts in the lungs on imaging, along with pulmonary thrombosis without DVT.
– Proning is essential and should be done early. Don’t just do it once. Threshold for many centres is a PF ratio of 13, but all agreed, do it even earlier.
– Early on in the disease, the benefit of proning lasts < 4 hours when turned back to supine, as the disease progresses into a more ARDS type picture, the effect is more long lasting.
– Many centres using inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with NO after 4-5 days.
– Generally people are using humidified circuits with HMEs.
– A very interesting thing they are doing at Georges is cohorting by phase of disease i.e. early, late, extubation / trachy. It involves more moving of patients but helps each team to focus on things more easily.
– Leak test before extubation is crucial, others are also seeing airway swelling.
– Wait longer than usual before extubating, high reintubation rates reported. Do not extubatne if inflam markers still high.
My conclusions from this are:
– Less aggressive PEEP strategy at the beginning of the disease and go straight for proning.
– Thromboembolic disease is prevalent, look for it. No one is sure about whether we should anti-coagulate everyone, this is probably too risky.
– An extubation protocol is needed immediately.
– We should consider using inhaled prostacyclin again (like we previously did) as it seems to be working early in the disease.
Fluid balance
– All centres agreed that we are getting this wrong.
– Most patients come to ICU after a few days of illness where their temp was 38-40 and they were hyperventilating i.e. severely dehydrated.
– High rates of AKI being caused by over zealous driving with frusemide, leading to unnecessary CVVHF.
– Hypovolaemia leads to poor pulmonary perfusion and increased dead space.
– Centres echo’ing their patients are seeing a lot of RV dysfunction without raised PA pressure.
– Many have improved oliguria by dropping the PEEP i.e. these patients are really hypovolaemic.
[On nights I have observed many of our patients with a zero fluid balance and temperature of 39 i.e. they will be 2-3 litres negative in reality.]
– Most centres are therefore now backing off of strict zero balance, particularly in hyperpyrexia. They are moving more towards avoidance of large positive fluid balance.
– Lung ‘leak’ not as prominent in this disease as classic ARDS
My conclusions from this are:
– Avoid hypovolaemia as it will impede gas exchange and cause AKI. Progression to CVVHF increases mortality.
– Avoid hypervolaemia
– How we achieve this is difficult, but the frusemide and noradrenaline cocktail needs to be carefully tailored, especially in pyrexial patients.
– Echo patients to understand their volume status.
Renal
– Higher than predicted need for CVVHF – ? Due to excess hypovolaemia.
– Microthrombi in kidneys probably also contributing to AKI.
– CVVHF circuits clot frequently. Georges and Kings now fully anticoagulant the patient (rather than the circuit) as it is the only way they can prevent this. One centre using full dose LMWH as they have run out of pumps.
– Kings now beginning acute peritoneal dialysis as running out of CVVHF machines.
My conclusions from this are:
– Aggressive anticoagulant strategy required for CVVHF, potentially systemic.
– If we run out of machines, PD may / may not help (our previous experiences with it are not great, but I have no alternative other than using CVVHF like intermittent dialysis and sharing machines)
Workforce
– A ’tactical commander’ is essential on every shift, who is not directly responsible the care of ICU patients.
– Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU.
– Training has largely fallen by the wayside as it is too large a task. People are being trained on the job.
My conclusions from this are:
– On call consultant to coordinate but not be responsible for patients (as is the model we have now adopted).
– We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve ++ with this. Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU – this is unacceptable.
There were some brief discussion about CPAP:
– Proning patients on CPAP on the ward is very effective, I tried it the other day – worked wonders.
– Prolonged use of CPAP may (I stress the word may) lead to patients being more systemically unwell when they get to ICU.
– Considerable oxygen supply issues with old school CPAP systems.
My conclusions from this are:
– As per local guidelines, assess the effectiveness of CPAP after an hour, if it isn’t effective then bail out and consider intubation.
– If effective, regular review is required. If at any point it is failing, bail out and consider ventilation.
– Whilst we may have a shortage of ventilators, holding people indefinitely on CPAP may be short-sighted as it may be converting single organ failure into multiple organ failure.
OK, that’s all I have.
I will stress again that this is simply a summary of discussions, none of which are backed up by large, robust multi-centre RCTs.
My conclusions after each section are nothing more than suggestions to be discussed.
We need to adapt fast to what we learn about this disease and learn from our colleagues at other centre. We are all in this together and joined up thinking is required.
Lastly, we desperately need to look at our own data to understand whether we are getting this right or not.
Good luck, stay stay safe and be kind to one another.
Dan
Daniel Martin OBE
Macintosh Professor of Anaesthesia
Intensive Care Lead for High Consequence Infectious Diseases
Royal Free Hospital
London
My alumni group got this
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Comments on chloroquine: the antiparasitic effect on malaria parasites acts because of a couple of lucky accidents. Firstly, chloroquine is actually concentrated by malaria parasites in their food vacuoles (protozoan equivalent of a stomach), and this chloroquine acts not be poisoning the parasite directly, but by blocking part of the parasite’s digestive pathway. Blood consists mostly of haemoglobin, and the bit of the haemoglobin molecule containing the iron, i.e. the heme molecule, is toxic. Malaria parasites really just want the protein that surrounds this and view heme as toxic waste.
Chloroquine binds to heme and prevents the malaria parasite from converting it to a non-toxic form; the antiparasitic effect of chloroquine is the parasite being given a choice between starvation and poisoning its self with toxic waste.
Chloroquine does other things, and is a noted antiviral that is active against influenza viruses, HIV and quite a broad range of other viruses including this new corona virus. I cannot find reference to it being active against heme in conjunction with viruses.
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That mechanism won’t work on viruses since they don’t metabolise anything. So the mechanism against viruses is still unknown.
If it works though, we can worry about the mechanism another time.
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Very interesting. Thank you. The Grauniad is dead against hydroxychloroquine, which confirms your hypothesis. However, it has been used in Israel since the outbreak began (five weeks now) and the death rate is very low. 10,000+ diagnosed ill with Covid-19, about 150 in intensive care, about 100 deaths, overwhelmingly in the very elderly, which is also very sad, but clearly their immune systems couldn’t cope. May not be scientific but the sizeable anecdotal evidence is there.
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I’m totally disgusted, and horrified, that politics, mainly the left, it seems, is encouraging. promoting almost, the deaths of 1000s of people just to make a point.
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Very recently I heard Robert Kennedy Jnr., I think it was him, say that the Guardian and the BBC both receive funding from the Bill and Melinda Gates Foundation for their overseas reporting, so there you have it. Their reporting is constrained, biased and fraudulent. Can’t believe anything they publish now. I must say I began to suspect something was afoot when they refused to print my letters regarding 5G in the past two years.
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I think this is very interesting
https://www.statista.com/chart/21176/covid-19-infection-density-in-countries-most-total-cases/?utm_source=Statista+Global&utm_campaign=fc276c361c-All_InfographTicker_daily_COM_PM_KW20_2020_TH&utm_medium=email&utm_term=0_afecd219f5-fc276c361c-309194421
It sems to tell the whole story as was fairly evident from the beginning.
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