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Artist, Heather Oliver             

Thoughts during the Pandemic

Wednesday, April 1st, 2020

Preamble: a few days ago, I received an anguished cri de coeur from a beloved friend in Athens (another beloved friend was among the first COV-2 victims in Greece). I sent the reply below, my effort to conquer my own fear. I’m only too aware of how easily societies can slide into savagery.

My dear,

I completely share your anger with the shenanigans of the so-called “leaders” across the globe, and the horrible sense that we’re trapped and powerless in the midst of this raging storm. The early lukewarm responses were essentially theater for rapid, easy reassurance. Unfortunately, the world chose incompetent rulers for this era. The (approximate) prosperity of the First World from 1950 to 2000 and the evolved medical technology allowed stupidity without consequences. The increase of the average human lifespan from 30 to 90 resulted exclusively from clean water, antibiotics and vaccines; and public health requires ceaseless vigilance. The crisis we’re facing demands leaders with courage and knowledge, with intellectual and moral stature. Not callous incompetents who won posts by dynastic wealth and demagoguery.

Let’s briefly examine the science of the pandemic before we continue to matters of individual and collective health. It’s entirely unknown whether temperature increases will slow the spread of the virus. We already know much about SARS-COV-2; today’s biomedical research and technology gave us the ability to learn facts almost instantaneously. But we still haven’t pinpointed what causes its rapid transmission, and exactly what in its genome makes it lethal. We have informed hunches, but they need to be confirmed. And since we don’t have herd immunity or effective drugs or vaccines, the current inhuman, corrosive isolation method is our only tool (I will return to this).

There can be no doubt that the real number of infections is at least tenfold higher than the official tally—and, as you say, this presents an inaccurate picture of susceptible groups, targeting them for further suffering and dangerous discrimination. Already, too many (“leaders” among them) have opined that as long as “old ones” are preferentially smitten it’s no big deal, just as they said at the start “third-world problem, nothing to do with us”. However, the underestimation of the real numbers contains two positives: 1) the fatality rate, though significantly higher than that of the regular flu, is lower than the unsophisticated index of current statistics, and 2) we may possibly be already developing herd immunity via asymptomatic carriers.

The current crisis has brought us once again face to face with a painful realization: we have 21st century technology (and problems), with still-Paleolithic physiology and behavior, and the complex interdependencies of our civilization have made it fragile and vulnerable. The human species hasn’t changed significantly since the time it evolved the large prefrontal cortex which gave it the ability to flood the planet with its descedants and the aftermaths of its technology. This means that we still think and act like our distant ancestors, who lived in small, closed groups for whom xenophobia was an important survival strategy.

One other attribute adds to our difficulties: we have two emotional centers, thalamus and cortex. From the former come the instinctive reflexes—among them, fear, which is also a survival tool, bypasses rational thought and instantly searches for scapegoats. For the cortical emotions and behaviors to prevail, we need composure, self-discipline and an advanced sense of communal involvement and responsibility. Yet another thorny problem is that the demand for isolation does not only affect our physical and mental health—with their requirements for motion, sense of freedom and choices, etc—but it also runs against our altruistic urges towards family, friends, colleagues, neighbors… At the same time, wishes for quick enrichment, revenge, dominance are always lurking (see the tragedy of ex-Yugoslavia, without going further in history).

Our civilization as we know it will endure as long as we remain collectively our best selves. The medical profession/vocation has proved its dedication to this ideal, continuing the unequal struggle without pause. Unfortunately, the good behavior of most humans stops at the threshold of their houses—hence the frequent appalling condition of most public spaces (which include parks and beaches) except for countries that have gained their citizens’ mutual trust. The US once belonged to that category, but not since it decided to revert to plutocratic feudalism. This means that societies may be able to obey hard orders willingly only when they trust those in charge…which brings us to previous paragraphs of this essay.

Previous similar crises show that humanity usually recovers from them, but not always: the world recovered from the 1918 influenza (10% fatality), Europe from the black plague (30-40%), China from SARS (15%). In marked contrast, the native civilizations of the Americas (90% fatality) not only disappeared, but their existence and achievements were nearly forgotten—perhaps because that served the claims and consciences of the “heirs”. The universe is not hostile but indifferent, and it is certainly not ruled by a divine gaze that “sees all” and measures fates in balances…which means that the collective responsibility for our path remains entirely with us. But each of us, justifiably, feels pain, fear, anxiety—and what most of us can do is endure, keep faith with our deepest sense of humanity, and become bulwarks against the flood. Those of us who meet on the other side of the shore will rebuild the world, as our predecessors did so many times, provided we don’t cross an irreversible turning point. Perhaps this time we won’t forget the lessons we got taught by reality, although human intelligence avoids unpleasant memories. This, too, is a survival tactic—though not an ideal one for shaping long-term solutions.

I kiss you both with love, and hope we’ll get to hug each other again,

Athena

Hold on, my heart, hold on, for years upon years,
Like mountains hold heavy winters,
Like trees hold strong winds,
Like the sea holds all those ships,
Like the sky holds all those stars,
Like iron holds hammer blows,
Like bronze holds in the smith’s hands.
Hold on, my heart, hold on, whether you want or not.

—Folksong of Pontos

Image: beached ship hulks in Moy’noq, once a port on lake Aral, another major disaster from willful stupidity (photo: Arian Zwegers)

Possible Helpers in the Fight against COV-2, Explained

Saturday, March 21st, 2020

Image: RNA virus life cycle (NIH image via Wikipedia; Creative Commons)

COV-2 is an RNA virus whose surface glycoprotein attaches to cell receptor ACE2 (angiotensin-converting enzyme-2, a regulator of heart and kidney function). COV-2 a close relative of SARS and MERS, with bats as primary reservoir.  The fact that it’s an RNA virus means that it can mutate rapidly; other RNA viruses include hepatitis C, Ebola, HIV, polio, and influenza. COV-2 already has two variants. Not surprisingly, the most recent one causes higher lethality.

There are three potential treatments in train to help stem the COV-2 avalanche that’s now paralyzing our world. The main catch: to work, each has to be administered before people go into respiratory arrest or cytokine storm. My brief, lay summation of each potential therapeutic path follows. Please bear in mind that this is a rapidly evolving topic, and my earnest hope is that a vaccine soon gets added to the list.

1. Remdesivir, an adenosine analog that gets used by viral RNA polymerases, short-circuiting viral replication. Remdesivir was originally developed to treat Ebola, Marburg & MERS — and it does, though less efficiently than competitors. From these clinical trials, it’s known to be non-toxic, and the COV-2 polymerase is close enough to its original targets to be successfully decoyed. Because human RNA polymerases differ significantly from their viral equivalents, this treatment is likely to have low side effects.

2. Losartan and its relatives, anti-hypertensives that bind to the same cell surface receptor co-opted by COV-2. A known entity with established dosage and relatively low-key side effects, it exists as a generic. One major shortcoming is that it cannot be taken during pregnancy.

3. (Hydroxy)chloroquine, a well-established anti-malarial also used for lupus and arthritis, which blocks the release of viral RNA into host cells. As with losartan, it’s well-established but has some alarming side effects: cardiac arrhythmia that can be lethal (which means doses must be carefully calibrated according to weight), permanent retinal damage (increased chances if used long-term). The side effects have made compliance difficult even for people with malaria, but this would not be a barrier with COV-2 emergency treatment.

At this point, some US hospitals are already using Remdesivir and chloroquine, and the NIH has started expedited trials. I suspect the hospitals are not doing double-blind studies, because they’re faced with real life-and-death decisions. The true picture of efficacy, side effects, correct dosage, etc. will emerge from the NIH and its equivalents across the world, and it will take time. Where saving lives is involved, doctors at ground zero may have to opt for rapid non-guaranteed deployment of whatever promises to work.

ETA: a reader has also mentioned favipiravir, a synthetic molecule that disrupts the function of viral RNA polymerase.  Favipiravir has shown promise equal to that of remdesivir in preliminary sallies.

Sites with important information:
National Institutes of Health (NIH)
Johns Hopkins
Centers for Disease Control (CDC)