Coronavirus Update 126: India, Japan, The Olympics, Mucormycosis

 

  Welcome to another MedCram COVID-19 update.

 In the United States, new reported cases are on the decline with fully vaccinated at 39% and at least one dose of the vaccine at 49%.

You can see that not only test, but hospitalized patients and deaths are definitely in decline. We can see here a map of hotspots across the United States, as well as total cases, deaths, and cases per capita. In terms of the global outlook, cases are coming down, but there are still hotspots in particular areas, and we'll talk about those.

One of those places is Brazil, where we did see a coming down off the peak, but really

has plateaued at this point and has not come down, and that's concerning, although total

daily deaths in Brazil have started to come down slightly.

When we look at the share of people in Brazil that have gotten vaccinated, it is certainly

less than that in the United States, but greater than the average of what we're seeing in the

world.

And they're at around 20%.

Of course, the other hotspot in the world is India, which has recently seen a large

spike with up to 400,000 people daily coming down with confirmed SARS-CoV-2 infections.

And what we've seen is repeatedly every day 4,000 people dying in India from COVID-19

and an overwhelming of the healthcare system.

In terms of vaccinations, which in terms, remember, ironically that India is the largest

producer of vaccines, and they are just above the world average in terms of vaccination

rates, just north of 10% at this point. One of the things that's complicating issues in India is the outbreak of mucormycosis,

otherwise known as black mold. This mold is just about everywhere - it's found in the soil - and some experts believe

 hat the steroids, which reduces the immune system and also increases the blood sugar, is providing a recipe for the invasion of this fungus, which is typically seen in patients

about 2-3 weeks after they recover from COVID-19.

In this BBC article regarding this, they report here that there was 58 cases of the infection that happen usually 12-15 days after recovery from COVID-19.

And that there had been 24 cases in the past two months, which was up from six cases a year in the past.

But why has this happened in India but not other countries?

There's an article in India Today that might shed some light onto potentially what is going

on.They say here that "the main reason is prolonged unhygienic oxygen delivery to patients, combined with indiscriminate use of steroids."

And part of the issue has to do with the lack of oxygen supplies in these countries where

the healthcare system is overwhelmed.

They say here that "there is a vast difference between medical oxygen (MO) and industrial

oxygen. MO is a highly purified version that more than 99.5 percent pure and is prepared through repeated steps of compression, filtration and purification.

The cylinders in which the liquid oxygen is stored, transported and used are rigorously

cleaned and disinfected.

This oxygen requires humidification before being administered to patients; so it is passed

through a container filled with sterile water."

And that's the key word there is "sterile water."

"The water itself must be sterilized and changed frequently as per protocol.

If the water is not sterile, it is potentially a source of the black fungus infection."

The fungus infection is typically starting out in the sinuses and eating its way through

into the bone, into the eyes, and potentially even the brain.

So, of course, the recommendation would be to make sure that blood sugars are checked

when the patients are on steroids to make sure that we don't have out of control diabetes,

to make sure that we're using medical oxygen, and to make sure that the humidification is

through the use of sterile water.

Based on the information that we currently have, these steps will help curb the increase

in this mucormycosis, or black fungus, surge that we're seeing in India.

Another country of concern is Japan, which remember is hosting the Olympics.

Those games are scheduled to start in just under two months, but as you can see, they're

in the midst of another surge, which at least equals any surge that they've had before and

the number of deaths every day at an all time high.

This is happening as it is being reported in Japan that the healthcare system is in

dire warning of system collapse.

There are reports of running out of beds and ventilators, and exhausted doctors, again, are warning of a "system collapse," advise against holding the Olympics this summer. This is particularly bad in the city of Osaka, which is the second largest city in Japan. And the reason why they believe this is happening now is because it's being fueled by the variant first discovered in the UK, and this seems to be hitting young people more than the first three waves in Japan. And the concern there is that the medical professionals that are working in Osaka are near exhaustion. The quote from the article states "Some of them are racking up 100, 150, 200 hours of overtime, and that has been going on for a year now... when on duty, they sometimes go home at one or two in the morning, and go to bed only to be awakened by a phone call at three or four." And as you can see, part of the issue has been that Japan has remained below averagein terms of world vaccination rates, at only 4.85 currently. And you may ask, why is this happening in Japan? As you can see here, Japan started vaccinating in mid-February. The question is, why did they wait that long to do that? And as reported in this AP story, "Japan began vaccinating healthcare workers in mid-February because of its decision prior to that to require additional vaccine clinical testing inside Japan -- as decision many experts said was medically meaningless and only slowed the inoculation process."Well, with the Olympics on the line in two months, and an overwhelmed healthcare system in its western region, Japan is taking a definite turn in terms of its strategy. And while up to this point, the Pfizer-BioNTech vaccine was the only one that was available in Japan, as of last week they made approvals for Moderna and AstraZeneca for "emergency use" and will be ramping up the immunization process. It'll be very interesting to watch how this unfolds. So this is a developing story, and we'll definitely keep an eye on this. Also in the news, the fact that Moderna will be applying for emergency-use authorization for its vaccine in teenagers greater than 12 years of age. And we'll be doing a video coming up about vaccination in teens and reviewing the data. Another intervention that we've talked about extensively over the past year is convalescent plasma.And while there was some initial data that seemed to show promise, especially in high-dose antibodies given early in the course, it seems as though the "final nail in the coffin,"

if you will, shows that convalescent plasma does not work and it is being dropped from

may protocols for the treatment of COVID-19.

And this was a randomized, controlled trial of 228 patients where they were given fairly

reasonable titers of convalescent plasma and they looked at the clinical status of these

patients and mortality, and there was no difference in mortality statistically significantly.

It was 10.96 versus 11.43.

And here you can see with the time on the x-axis and the probability of death on the

y-axis with red being the intervention, convalescent plasma, and blue being placebo, that there

was no statistical significant difference between those two groups.

And furthermore here, in terms of a probability of clinical improvement or hospital discharge,

you can see here that there was no statistical significant difference here at day 30.

Another one of the treatment possibilities that we talked about early in the course,

especially in our update 46 and 47, was the potential use of hydrothermal therapy and

whether or not a fever should be treated in COVID-19.

And I'm happy to report that that theory has been codified scientifically in a paper that

was published in Medical Hypotheses with experts out of Finland, where saunas are used quite

often, and California, specifically at the Weimar Institute.

And for those of you who are interested in the topic of hyperthermia and whether or not

a fever should be treated and the biological and biochemical aspects of that, I highly

recommend reading this article, which is a good summary of the research.

The authors conclude that SARS-CoV-2 is susceptible to elevated body heat, and elevated body heat also enhances the immune system.

 "We thus hypothesize that frequent treatments of heat followed by cold are the effective

first line approach in the prevention and treatment of mild to moderate coronavirus

2 infection... We recommend for all stages of COVID-19 that the most accessible method of hydrothermotherapy interventions should be used.

We urge that this hypothesis be implemented for the prevention and treatment of COVID-19

while we wait for results from studies designed to test the effectiveness of heat to improve

the immune system function and treat COVID-19."

OK, thanks for joining us.

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