AtlAg75 said:

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For the Dr.'s I am curious if you see merit in the below hypothesis. This comes from a friend of mine, a retired Episcopal Bishop. He is working with some team re: Covid 19 but I'm not sure who that is. I apologize if it has already been discussed, I just missed it if so. Here is the hypothesis he sent -

One of the most interesting hypotheses is that covid-19 is not attacking the respiratory system directly, but rather through our blood system. Many of the earliest symptoms, and late stage disease issues suggest that hemoglobin is being shorn of iron. This produces two problems: one, iron enters the bloodstream as a toxic oxidized free radical which our immune system detects as an emergency situation and devotes its major resources to, and two, the hemoglobin loses its ability to carry oxygen and the body starts becoming oxygen depleted. These two potential occurrences produce symptoms and consequences that some doctors believe are clearly being seen in many, even most, covid-19 patients.

If this hypothesis is true, it means we have been misdiagnosing the subsequent disease that the covid-19 produces. But the good news is.....if this hypothesis is true, then there is a clear path to treatment.......HZA. Hopefully they can move quickly to validate or debunk this hypothesis.

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That hypothesis made the rounds based on an article on Medium. Medium is a place where anyone can publish basically anything. Medium doesn't do any fact checking. The author didn't appear to have any significant biology/medical background based on some basic biology errors in the article. Turns out the author who used a pseudonym was actually a cryptocurrency blogger. And the article was later deleted after the author's identity was discovered.

https://www.truthorfiction.com/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-medium-post/

There is a Chinese research paper that suggests the heme attack hypothesis, but this is all based on computer modeling of protein homology. It has been a while since I have done computer modeling of proteins and I haven't read through the paper carefully, and, like most COVID science articles, it is a preprints that hasn't gone through peer review.
https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173/6

A general comment about protein homology modeling:
Proteins work because of their shapes. If the shape is complementary to another shape (protein, other molecule) the protein can bind to that other thing. Antibodies bind to viruses because they fit together. When two proteins have a similar shape, there is a high amino acid sequence, they might have a similar shape, and with a similar shape, they might have a similar function. It is a great way to get a good first guess at the function of an unknown protein. But you then have to go and see if the guess is right.

A month or so into this I'm very skeptical of any extremely simple fix to this virus or any gloom and doom stories.

BiochemAg97 said:

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Reveille said:

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Today's update!

https://m.facebook.com/story.php?story_fbid=2668066593476281&id=1998386763777604?sfnsn=mo

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Another less helpful alternative is that the antibody tests may have poor specificity.

The math is interesting here. If you have a low level of positives in the population, the false positives from the large negative population can significantly skew the results. Let's assume a false positive of 5% and 10% of the population has antibodies. The ~10% will test true positive. Of the negative group, 5% will be false positive (5%*90%=4.5%). That results in the test showing positive 14.5% of the time and about a 3rd of the people that test positive are actually negative.

When you get to higher exposures, say 50%, then you have ~50% real positives and 2.5% testing positive but actually negative and the errors don't matter so much.

I chose 5% because the antibody test authorized in the US is slightly better than 95% specificity. However, there has been a lot of evidence of some very bad tests floating around, either from supplier fraud for Chinese sourced tests or just poorly designed/made tests.

Given that people tested positive before COVID19, it could be false positives or it could be cross reactivity as you mentioned in the post. And cross reactivity may be good or it may be bad. The cross reactive antibodies might cross react to the protein used in the test but not actually react to the virus, or the cross reactivity antibodies may produce a weak immune response. That weak immune response may not be sufficient to protect against the virus, and given the whole cytokine storm, insufficient immune response may trigger bad outcomes.

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Very interesting! Thanks for sharing that. I appreciate your help. As physicians we sometimes forget the math behind sensitivity and specificity. Makes a lot of sense and could lead to even more people with a false sense of security. In addition when a person has a false positive and then later contracts the SARS-COV2 virus the media will likely run with this information as there is no immunity to the virus to create a major scare. Not likely even discussing that it was more likely the fact that a third of the people are actually a false positive.

Reveille said:

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BiochemAg97 said:

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Reveille said:

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Today's update!

https://m.facebook.com/story.php?story_fbid=2668066593476281&id=1998386763777604?sfnsn=mo

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Another less helpful alternative is that the antibody tests may have poor specificity.

The math is interesting here. If you have a low level of positives in the population, the false positives from the large negative population can significantly skew the results. Let's assume a false positive of 5% and 10% of the population has antibodies. The ~10% will test true positive. Of the negative group, 5% will be false positive (5%*90%=4.5%). That results in the test showing positive 14.5% of the time and about a 3rd of the people that test positive are actually negative.

When you get to higher exposures, say 50%, then you have ~50% real positives and 2.5% testing positive but actually negative and the errors don't matter so much.

I chose 5% because the antibody test authorized in the US is slightly better than 95% specificity. However, there has been a lot of evidence of some very bad tests floating around, either from supplier fraud for Chinese sourced tests or just poorly designed/made tests.

Given that people tested positive before COVID19, it could be false positives or it could be cross reactivity as you mentioned in the post. And cross reactivity may be good or it may be bad. The cross reactive antibodies might cross react to the protein used in the test but not actually react to the virus, or the cross reactivity antibodies may produce a weak immune response. That weak immune response may not be sufficient to protect against the virus, and given the whole cytokine storm, insufficient immune response may trigger bad outcomes.

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Very interesting! Thanks for sharing that. I appreciate your help. As physicians we sometimes forget the math behind sensitivity and specificity. Makes a lot of sense and could lead to even more people with a false sense of security. In addition when a person has a false positive and then later contracts the SARS-COV2 virus the media will likely run with this information as there is no immunity to the virus to create a major scare. Not likely even discussing that it was more likely the fact that a third of the people are actually a false positive.

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Exactly my fears with the rush to do antibody testing.

As for your patients who test positive for the antibodies, individually they should have a less than 5% chance of being a false positive, so they should be safe to ease up, but it is still advisable to continue to be careful (masks, social distancing, washing hands) as we learn more about how immunity works with this virus.

Today's update!

https://www.facebook.com/1998386763777604/posts/2668976176718656/?sfnsn=mo

Loss of clinics and hospitals using UV light to disinfect! I use it in my clinic but you can get it much cheaper than $100 per day if you but your own units. They take longer then 2 minutes but still the same result. UVC kills 99.9% of molds, viruses and bacteria!

http://www.drcoates.net/for-your-protection.html

The part of your write up about people being afraid to go to the doctor is heart breaking, but it makes sense. When everything you hear is stay home no matter what (don't even go to the store anymore, if you think you have covid, just stay home unless you think you're near death, and on and on and on) people are naturally going to be scared to go to the doctor. Most of the doctors on here have posted some version of "you don't want to be anywhere near a hospital right now" and that's consistent with what the media puts out.

From your update, I get the sense that you are frustrated that people won't go to the doctor if they are sick. Unfortunately, we've done such a good job of scaring people that I don't think we can have it both ways. It seems like it's just another unintended consequence, and a very sad one.

PPlayboy87 said:

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Couple of questions for the docs. . .

I've been wearing shoes in my house since I got a new puppy. Used to only wear socks, go barefoot, or wear house slippers. I designated one pair as my "house" shoes, and my other shoes and boots were for going on errands. But I realized yesterday while out walking my dog in the neighborhood, that I was wearing the house shoes. Because of the puppy I'm spending a lot of time on the floor. So, do I need to tighten up on the discipline and switch to different shoes any time I leave the house? Also, do I need to worry about disinfecting my dog's paws when we come back from a walk? If disinfecting is recommended, any suggestions on how to do that?

TIA

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There is no need to worry about your dog's feet or even your shoes if you are just outside. The probability of the concrete or dirt having the virus for any extended period of time is very small.

Now shoes you wear in a high risk place like a hospital could potentially bring the virus home with you.

AggieAuditor said:

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The part of your write up about people being afraid to go to the doctor is heart breaking, but it makes sense. When everything you hear is stay home no matter what (don't even go to the store anymore, if you think you have covid, just stay home unless you think you're near death, and on and on and on) people are naturally going to be scared to go to the doctor. Most of the doctors on here have posted some version of "you don't want to be anywhere near a hospital right now" and that's consistent with what the media puts out.

From your update, I get the sense that you are frustrated that people won't go to the doctor if they are sick. Unfortunately, we've done such a good job of scaring people that I don't think we can have it both ways. It seems like it's just another unintended consequence, and a very sad one.

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You make a very good point which I agree with but I don't think we should live in fear! We should respect the virus and take the necessary precautions for it but let it completely control us.

And yes it is frustrating to see people get seriously ill or even die from problems that we can fix. We become doctors to save lives and we spend almost all of our time and energy on that. When you see people pass that could have been treated but they were too scared to go to the Emergency Room or the doctors office it is upsetting. The virus will kill enough people on it's own we don't need fear of the virus killing even more.

Reveille said:

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AggieAuditor said:

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The part of your write up about people being afraid to go to the doctor is heart breaking, but it makes sense. When everything you hear is stay home no matter what (don't even go to the store anymore, if you think you have covid, just stay home unless you think you're near death, and on and on and on) people are naturally going to be scared to go to the doctor. Most of the doctors on here have posted some version of "you don't want to be anywhere near a hospital right now" and that's consistent with what the media puts out.

From your update, I get the sense that you are frustrated that people won't go to the doctor if they are sick. Unfortunately, we've done such a good job of scaring people that I don't think we can have it both ways. It seems like it's just another unintended consequence, and a very sad one.

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You make a very good point which I agree with but I don't think we should live in fear! We should respect the virus and take the necessary precautions for it but let it completely control us.

And yes it is frustrating to see people get seriously ill or even die from problems that we can fix. We become doctors to save lives and we spend almost all of our time and energy on that. When you see people pass that could have been treated but they were too scared to go to the Emergency Room or the doctors office it is upsetting. The virus will kill enough people on it's own we don't need fear of the virus killing even more.

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I'm an example of this. A couple of weeks ago I had a weird sensation in my chest and it made my head euphoric for a second. I was like on day 45 of working 12 hour days with no days off. It was a very stressful time at work. We had an earthquake (and many many aftershocks including a 4.2 last night) in the middle of it. Along with the stress of the pandemic and me being likely exposed. I wasn't sleeping. Drinking at night to calm down. Not exercising. Bad combo all around.

All that to say, the stress of it all caught up to me and my coworker took my blood pressure and I was at like 160/112. I went home and monitored my blood pressure and it kept rising... approaching 180/115. I didn't want to go to the ER to potentially expose myself to the coronavirus. I was freaking out that I was about to have a stroke or heart attack. Ended up giving in and going to instacare hoping I wouldn't get the virus. Luckily, everything turned out ok and all testing says I'm ok. But I realized at that point that I need to chill. Especially with deep diving into reading more and more about the coronavirus which had me in such a panic that I had already written my epitaph.

These are uncharted waters for all of us and it's ok to be respectful of the virus and do everything you can to avoid getting it or spreading it. But I'm no longer living in fear. And most of what helped me was to reduce my reading here on texags which fed my anxiety and rarely if ever look at the news.

We're all gonna get through this. Take care of yourselves!

Goodness, I'm not sure what you do, I thank you for doing it as it's something I'd never be willing to do, and I'm glad you are alright.........

but if there is any way to avoid it, please never work 45 days straight again! Particularly 12 hour days on minimal sleep, no exercise, and drinking a lot. Nothing seems worth that.

beerad12man said:

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Goodness, I'm not sure what you do, I thank you for doing it as it's something I'd never be willing to do, and I'm glad you are alright.........

but if there is any way to avoid it, please never work 45 days straight again! Particularly 12 hour days on minimal sleep, no exercise, and drinking a lot. Nothing seems worth that.

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Believe me...it wasn't my choice. The oil business can be brutal, and if you wanna keep your job then you do what they say. I did tell them I wasn't going to be in on time the next day. And luckily I was able to go in late and get my computer around 10am and go back home and work. Refinery Turnarounds are exhausting. Long hours. High stress. Lots of angry people. It's a recipe for physical and mental disaster. Luckily there's not another one for about 3 years.

Even in turnarounds you gotta give your workforce staggered breaks. We usually do 13 on and 1 off or 6 on and 1 off. Going 45 in a row is how people screw up and get someone hurt.

beerad12man said:

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Goodness, I'm not sure what you do, I thank you for doing it as it's something I'd never be willing to do, and I'm glad you are alright.........

but if there is any way to avoid it, please never work 45 days straight again! Particularly 12 hour days on minimal sleep, no exercise, and drinking a lot. Nothing seems worth that.

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I did that for 4 years stright - bought the firm, immediate market sag, 2 floods hit back to back and rebuilding from that; my mother going from prime of her life to hospice to passing; her house out of town flooding and rebuilding remotely; a tornado hit my house in the middle of that, just after rebuilding from the floods; rebuilding from that; flooded again as soon as i was done with that rebuild; fathers house in the eye of harvey at the same time, helpimg with that; prenatal niece dying; biggest litigation in years kicking up at work....

coronavirus seems like a relief honestly, though now business is slow from that.

Bottom line, though i lost a lot of years of fun and friend and family interaction, we are still together, still have our love, and sometimes you just have to buckle down until the world breaks before you do, and get it done.

That said....i wouldnt do it for just a fat paycheck. Life is indeed too short.

Dang, CBR. If what doesn't kill you makes you stronger, you may be my nominee for strongest man in the universe.

That sucks. You get less productivity running people into the ground.

SPF250 said:

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Dang, CBR. If what doesn't kill you makes you stronger, you may be my nominee for strongest man in the universe.

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Nah, nobody out does MFBarnes...

Granitestate said:

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Thank you Doc and all health care providers. You are doing amazing work.

My question relates to a male in Italy who had tested positive. He had minor symptoms and then showed no symptoms by day 14. He was retested and still showed positive at day 21 and at day 30. Is it possible that asymptotic host can carry the virus for extended periods of time and would they still be able to infect those around them?

https://www.msn.com/en-xl/lifestyle/coronavirus-europe/why-do-italians-test-positive-after-symptoms-are-long-gone/ar-BB12BHDe?li=BB10Jn1k

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This is probably a better question for biochemAg97 as I don't know the exact specificity of the reverse transcriptase PCR test.

Reveille said:

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Granitestate said:

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Thank you Doc and all health care providers. You are doing amazing work.

My question relates to a male in Italy who had tested positive. He had minor symptoms and then showed no symptoms by day 14. He was retested and still showed positive at day 21 and at day 30. Is it possible that asymptotic host can carry the virus for extended periods of time and would they still be able to infect those around them?

https://www.msn.com/en-xl/lifestyle/coronavirus-europe/why-do-italians-test-positive-after-symptoms-are-long-gone/ar-BB12BHDe?li=BB10Jn1k

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This is probably a better question for biochemAg97 as I don't know the exact specificity of the reverse transcriptase PCR test.

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there was a study in monkeys where they found in took up to a month to clear the virus from the initial infection. So not really surprising someone could continue to test positive for close to a month. In the monkeys, they reinfected them after they cleared the virus and then couldn't detect the virus, which suggests immunity is protective. They also directed one of the monkeys during the initial infection and found the virus in a lot of tissues. Not surprising it takes the immune system a good while to find everywhere the virus is hanging out.

There are other viruses that go dormant for a while. Some Herpes viruses are like that, which leads to cold sores that flare up periodically.




Specificity is hard to nail down without knowing the specific test. Improved specificity was a design requirement for the commercial tests in the US. RtPCR works by copying a piece of RNA, which requires a primer to specifically bind to a spot on the virus genome. If you have poor primer design, you can pick up other virus genomes (false negative) or miss some mutants of this virus. It actually takes some art and skill to identify a primer that is unique to this virus but isn't in a spot that is changing or at least encompass all variations.

There were rumors of the test in China being wrong half the time (not sure if that was false positive or false negative) and that CDC test was bad 30% of the time. I think the newer tests are significantly better. However, EUA doesn't require publishing the sensitivity and specificity data like you would for an approved test.

Today's update!

https://www.facebook.com/1998386763777604/posts/2669891136627160/?sfnsn=mo