Sunday, April 05, 2020

Coronavirus is possibly everywhere

This tweet

links to this news report

which should be headline news everywhere.

In Lombardy 40 out of 60 blood donations from healthy donors with no history of coronavirus illness are seropositive. They have been exposed, infected but were never ill.

In comments to a pervious post I suggested that the best advice re coronavirus was a) try not to be elderly and b) try not to be diabetic.

Obviously assessment a) was incorrect.

Being elderly is probably only a problem if you drop in to category b) as well. ie age is a surrogate for risk of metabolic syndrome or as Kraft would have described it "diabetes in-situ". There is a simple solution to diabetes in-situ.

Testing of UK blood donations, if it duplicates Italy, should allow some return to normality with continued or increased protection for those most at risk while we get their metabolic syndrome under control. That should take a few weeks of LC eating and might have to be maintained long term. Damn, bacon and eggs for breakfast every day and steak with broccoli and 'shrooms for supper. Cheese and olives for lunch if you're hungry. Sounds awful I know but sacrifices will have to be made.



Jay said...

Hi Peter, I saw that tweet and article too but I read Italian and I think it's being a little misreported. The study (and it is a research effort - an effort to harvest plasma with covid-19 antibodies to treat others) was done in one of the first 'zone rosse' of the north Italian outbreaks. The 60 who agreed to tests were asymptomatic, most of them knew they had probably been exposed e.g. to a family member affecte, and were given the same 'swab' and PCR tests (called 'tampone' or 'tampone a tapetti' in Italian) that are being used everywhere.
I've now read three different articles about this (the La Stampa one is behind a paywall)and all I can see is a theory (quite a reasonable theory to be fair) that people exposed and asymptomatic but positive (or even fully recovered IMO) would be carrying antibodies that could be used for a therapy. From reading three different articles on this it isn't clear to me that they've developed or have a specific enough antibody test yet. In fact one article clearly says that they don't.
Some of the articles I read on it give quite a different spin. Some highlight that asymptomatics may simply have had less viral load and so didn't develop symptoms. Another highlights the fact that they may still be unwittingly spreading it - just carriers - which highlights that they don't actually know that they have overcome the infection and are carrying antibodies (though my hunch would be that they are.)

Peter said...

Thanks Jacqueline,

I've been waiting for results from serology studies for about 10 days now, since they were first mentioned. These results, whatever the caveats, are suggestive that a lot of people can have the disease without becoming seriously unwell. If that trend extends through extended serology testing we are on a better trajectory than any worse case scenario. Protection of the susceptible would still be a priority... Serum harvesting for Ebola has certainly been used successfully in the past.


Jay said...

Yes, let's hope so. There is supposed to be a campaign in the Veneto to move to the next stage of testing blood but they said they were using tests from a company in China, and, like some of the tests tested in the UK, these may not have proved very useful after all. Let's hope someone finds a way.

Jay said...

Meanwhile, back to making face masks!

Frunobulax said...

I'd broaden the definition of "don't be diabetic" a bit here. And this comment is very generic. However...

We know that animal species (including humans) will suffer if they have to change their diet from whatever they were evolutionary adapted to. If the environment changes, very few species will starve (maybe koalas if they couldn't find eucalyptus). But we will see a lot more diseases. It's part of the evolution -- a few animals will be better adapted (through random mutations) and have a higher chance of survival. If there are enough animals that adapt to the new diet, their species will survive.

Humans have deviatet a lot from their "evolutionary normal" diet and behaviour. It's possible that we'll eventually find alternate food sources that are perfectly healthy for us, but my guess is that it won't be grains&sugar. It shouldn't surprise us that we become more susceptible to diseases, which is masked by the evolution of modern medicine. Now, Diabetes/metabolic syndrome is a sure sign that we don't eat what is healthy for us. But many people with autoimmune diseases are not (pre)diabetic, so metS is only the most common of the typical diseases.

So why is this relevant for COVID-19? It's striking that the mortality rate is practically zero for young people. I'd hypothesise that this is because damage from the western diet (like metS) builds up with age, and Corona severity is related to this damage.

I guess anyone can catch COVID-19, but people are a lot more likely to have severe symptoms if they eat low fat, vegan, high omega-6, rich in lectins, oxalates and whatever other antinutrients we avoided 10.000 years ago. Unfortunately we have little chance that someone does a study if those "healthy" food choices are connected to mortality.

Instead of "don't be old and don't be diabetic" I'd say "make sure you eat what our hunter-and-gatherer ancestors ate". Whether this should be Atkins, Keto, Carnivore, Paleo-AIP, raw, cooked or whatever -- this is open to discussion, but it shouldn't contain grains, emulsifiers and antibiotics :)

Dr. Rob said...

Hi Peter, many thanks for all your informative posts.

2 weeks of self isolation as a GP has given me a chance to take a deep dive into the SARS-CoV2 problem. I have approached it from a slightly different angle by taking a non linear thermodynamic systems view of the problem - and would value you opinion.

I’ve put my thoughts down here

Though there is a simpler version

My concern is we are looking at it as a linear problem - I have a/e consultant friends who say they have never seen anything like it - whereas it is a systems problem relating to energy/oxygen supply - which I think has great relevance to the “root cause” of all chronic diseases.

Best wishes


Ông Mỹ said...

My whole family in two households have had strange bouts of symptoms, for me spread and separated over 10 days. For my daughter and her family it was all like a partial regular flu with her husband having a "tightness of chest" for a few days. Wife who is diabetic and 70 Y.O. had a sever coughing three days with no other symptoms. SIL probably brought it all home to his house from the hospital where he is a pharmacy tech. He says there were lots of people in the ER with flu symptoms. At work several have laid out for 2-3 days with partial flu symptoms. I think it has been all through my county already and is just in the last ten days presented some cases severe enough to get officially notices. Bay County yesterday had 17 recognized cases.But these cases were probably started two to three weeks previously.

JustPeachy said...

This sounds like very good news!

Unknown said...

You said, "I guess anyone can catch COVID-19, but people are a lot more likely to have severe symptoms if they eat low fat, vegan, high omega-6, rich in lectins, oxalates and whatever other antinutrients we avoided 10.000 years ago. Unfortunately we have little chance that someone does a study if those "healthy" food choices are connected to mortality."

Back in the early 1900s most people didn't eat the way we do today. There was very little diabetes, heart disease, cancer, and people with MetS. Probably because they ate very little "low fat, vegan, high omega-6, rich in lectins, oxalates and whatever other antinutrients" back then. But, it didn't prevent 500M+ from becoming infected and 50M+ dying from the Spanish Flu.

Jay said...

They were probably - in many cases - less well-nourished than people today could be - or equally poorly nourished as junk food eaters are today. There was more poverty, there had just been a 'world war' - a devastating war in what was then the richest part of the world. A lot of poor people in Europe and worldwide (except perhaps for the USA) lived mainly on grains, root vegetables and probably little meat, especially thanks to the war. That was probably a factor.

annlee said... is a thread describing a Chinese preprint which *may* be of some value. "theorizes how and why coronavirus reduces blood O2 and causes "crushed glass" lung imagery (kicks out heme from RBCs), risk factors (high A1C, blood sugar, hemoglobin), and why certain treatments work" from

The basic premise is that one of lesser proteins in the virus "dislodges" the Fe ion from the porphyrin in hemoglobin. No Fe ion, no lung function (essentially). Successful meds bind to the offending proteins and prevent their action.

So far as I understood it, this is all based on computational modeling of the structure of the virus and implications of that for behavior. But possibly worth a look.

Might there be a protons-related reason the metabolically less healthy are more vulnerable? Good question, I'd say.

Tucker Goodrich said...

CDC data: March 5–14, 2020, 8% (!) of people reporting to a clinic with ILI had SARS 2, vs 23% with flu.

Shaza said...

Just goes to show, the infection is not the disease... so to speak

Frunobulax said...

@Unknown A very interesting point. The key difference between COVID-19 and the spanish flu is that the spanish flu killed predominantly young people (20-40), while COVID-19 kills almost exclusively older people (50+). COVID-19 has a very special mortality pattern that deviates from almost all other epidemics that we know: Usually small children are at high risk, with cholera half of the victims were small chilren. So COVID-19 mortality is not a matter of a "weak immune system".

Diseases and epidemics are a normal part of evolution. The strong survive, the weak die. Modern medicine usually prevents the latter for humans (thank god!). However, deviating from the "evolutionary normal" makes us susceptible to *additional* diseases that we would normally defeat.

With COVID-19, the thing that kills us is the autoimmune reaction that starts in the second week, a malfunctioning immune system. But this is consistent with the spanish flu. Why does COVID-19 kill mostly older people who are diabetics, have hypertension and other chronic diseases? It's not a matter of a _weak immune system_, it doesn't kill people with weak immune systems (small children), it doesn't kill people with a strong immune system (20-40yo) either, it kills only older people. People with a 50-year history of eating sugar, lectins, oxalates, omega-6, emulsifiers, artificial flavors, antibiotics, all of which throws off our immune system with time. The older people get, the more common are autoimmune diseases.

Correlation is no causation, and there could be other reasons why this disease is deadly for older people. I just haven't seen any alternative sound explaination for this phenomen.

Dr. Rob said...

Hi Frunobulax- if you view it as a metabolic problem and the infection is another stressor on that system then you can see why these people are more vulnerable.

Unfortunately it is being treated as primarily an infection.

Thomas said...

OH, the horrid sacrifices we make for health" LOL

cavenewt said...

@Tucker, re

Wasn't that 11%?

Slight aside: they only tested a small percentage of the *influenza-negative* people for Covid-19. I'm just curious how likely it might be that a person could be infected with both influenza and Covid-19?

Bob said...

Hi, cavenewt.

I think Tucker refers to this sentence from the Discussion section.

"If it is assumed there were no influenza and SARS-CoV-2 coinfections and that persons with negative test results for influenza and not tested for SARS-CoV-2 were similar to those who were tested, then an estimated 8% (19 of 226) of persons seen at participating urgent care centers with respiratory symptoms had COVID-19."

The paper then refers to a similar study in a Los Angeles clinic.

Both papers indicate community transmission is prevalent and needs to be addressed with "more aggressive mitigation" strategies. My guess is that means the kinds of lock-downs we see.

None of this contradicts what Peter says in the post. The recommended public health approach is to prevent viral exposure to the metabolically challenged, "for they are always among us".

Justin said...

So I belong to few sheep groups on Spacebook and this article has been circulating recently. I couldn't help but chuckle after picturing people injecting Ivermectin after reading it. Lol!

Justin said...

Sorry for the poor grammar. My fingers are faster than my brain sometimes.

ctviggen said...

I live in CT, where Tucker lives. A dad from a family we know is in the ICU in Danbury because of covid-19. The dad is younger than I am (I'm 55), and has kids about my kid's ages (9,12). I have no idea whether he has comorbidities.

I know of another 35 year old who is in CT and on a ventilator.

This is an interview with a doctor on the front line in NYC:

She discusses cases of younger people being on ventilators, although the question of comorbidities was not resolved.

I am getting sickened of all of us Holier than Thou people saying that if everyone only ate a "perfect" diet (whatever that is), there would be much less death under this virus. We have no way of knowing that. If that dad does not make it out of the ICU (been in there at least a week), his family will be missing a father and a husband.

At least we could have SOME respect for those afflicted, without being sanctimonious.

Bob said...


For whatever it's worth, I don't see comments here about diet as sanctimonious attacks on anyone struck down by this disease. I certainly hope the people you've mentioned make it and recover fully, and I'm sure everyone else here does as well.

scotpole said...

Hi Peter

Long time reader, first time poster. What are your thoughts on this?



Puddleg said...

@Dr Rob,

loved your pdf and interpretation of the smoking effect. If nicotine is effective by downregulating ACE2 then andrographis extract is the logical drug-of-choice for COVID-19, even more so because it also has innate immunity effects similar to probiotics, elderberry and echinacea and significantly increases seroprotection rates after vaccination.

This latter is why they're trialing BCG vaccine, but there's most evidence for probiotics.

Gyan said...

How justified it is say that children immune systems are Weak?

Gyan said...

If people with metabolic syndrome are disproportionately affected by this virus then it is certainly justified to say that adoption of a diet that rectifies metabolic syndrome would reduce severity of the viral disease

Frunobulax said...

@Gyan Just statistics. Before modern medicine, children usually had a high mortality rate in any pandemic.

@ctviggen I didn't want to be disrespectful in any way. (I'm in a high risk group myself, with an autoimmune disease and recovering from metS. There is a decent chance that I'll kick the bucket if I get Corona.)
I apologize if I have offended you. Hope those people recover quickly.

Kajus said...

It seems logical procedure to breathe with nose Buteyko style for co2 to carry oxygen to the lungs, someone who has experience with this. Helped me to get better lung capacity.

Peter said...

Fruno, I regard diseases of civilisation as evolution in action. On a population basis evolution works by the non-reproduction of individuals poorly suited to the new circumstances. Miki Ben-Dor had a great post on this years ago. Met Syndrome is now applying real selection pressure by affecting children and reproductive age adults giving DM T2 rather than just affecting the elderly. Medicine is the blunting of this evolutionary progress. Turning back the clock, environmentally, should stop the process and relegate medicine to the side lines with respect to chronic diseases.

Hi Dr Rob, there’s a lot to get my head round there, it will take time.

Ông Mỹ, our best hope for a short pandemic is to find that it’s nearly over by the time we get serology testing available!

Hi annlee, I find that one a bit difficult to get too enthusiastic about. Most of the pathophysiology sounds quite normal for the progression from serious infection through SIRS to ARDS from what I’ve read.

Tucker and cave, yes, they never tested for coronavirus unless the patient was influenza negative. In the middle of a pandemic in China due to arrive in the USA. Amazing. So 8% is the absolute lowest number. What was the value for the healthy population (rhetorical question).

Justin, with the number of antiviral drugs coming out of the woodwork it’s a wonder there are any viruses left. Oddly enough I have plenty of ivermectin lying about for worming the goats. I’m not thinking of splashing it on myself.

Shaza, this time. Maybe not always.

Scotpole, anaesthetists always self question. What is the best protocol has to worked out, it won’t come from experts on high. We can probably always improve. Backing off on the frusemide might be a good start. There are similar discussions in the UK.

ctviggen, the worry for the USA is that the percentage of people who are metabolically healthy is quite small. Considering that most diabetics are only diagnosed based on elevated fasting blood glucose the guesstimate is that they have probably had “diabetes in-situ” for a decade before they get given the label. That puts even “healthy” people at risk

There is a responsibility for the development of diabetes and associated problems. That does NOT lie with the patient or “pre-patient”. As you know I consider that these people are in trouble because they have been told for decades to avoid fat, especially to avoid saturated fat and that sugar and starch are healthy. Vegetable oils, sugar and starch simply make people hungry and this cannot be argued with in the long term. Two or three steps down the line gives the “label” of diabetes.

Each death is a serious loss. At some stage the dietary advisory bodies need to take responsibility for this outcome. This particular pandemic does appear to target those with metabolic syndrome and this does not develop without reason.

Kajus, sadly I’ll never be able to nose breathe. An at least one time broken nose as a kid. Seriously stenosed, both nostrils.


Bob said...

Hi, Frunobulax.

"With COVID-19, the thing that kills us is the autoimmune reaction that starts in the second week, a malfunctioning immune system."

I'd love to see a reference for this. I hadn't heard of anything like this before. Thanks!

Frunobulax said...

@Bob Being from Germany I listen to the daily podcast from Christian Drosten (available on Youtube and Spotify), the leading Corona researcher maybe in all of Europe because he's been researching other Corona viruses for 20+ years. It's a great source because he talks more than 30 minutes a day, anwering a lot of questions and discussing newest research. He talked about this autoimmune reaction a lot in the context of antiviral agents, which he considers to be effective only if administered in the first week after infection. The podcast in German of course, so this may not help you much :)

But I guess you'll find a lot of references to that. A quick google (try corona cytokine storm) finds and more.

Dr. Rob said...

Hi - it’s not auto immunity it’s the innate immune system overreacting to the problem.

Hypoxia is a “big” problem to an aerobic organism - so all hell let’s loose.

Hypoxia ➖ ⬆ HIF-1 ➖ ⬆ LPS ➖ ⬆ TLR (4) ➖ ⬆ Innate immunity ➖ Cytokine storm

Hypoxic conditions favour anaerobes - imbalance in Microbiome- SIBO type symptoms

However, as we know, there are good anaerobes and bad anaerobes - if we can get good anaerobic bacteria to reduce the bad ones then potientially we can reduce the inflammation.

Frunobulax said...

@Rob I used auto immunity as an abbrevation for "immune system activation for an unknown reason, other than external stimulation" (virus, bacteria etc.). Having said this, it should be clear that there is no such thing as an "auto immune reaction". There is always a causal chain for the activation, as the immune system doesn't just activate itself. But with our medicine rarely looking for root causes, a lot of the time we don't understand the reason for the activation.

Can't really comment on your hypoxia theory. You may be onto something here. But I'm not familiar enough with this area, so it takes more time to digest a theory like this (time which I didn't have in the last days). But I'll have a go at it for sure soon.

Justin said...

Man, I wish Dr. Art Ayers still maintained his blog. He always posted good stuff.

Passthecream said...

Peter, the haemoglobin hypothesis mentioned above is interesting for a couple of reasons one of which would be the release of reactive Fe and consequent damage from that which could include lipoperoxidation, in turn relating to the observations of increased 4HNE and the drop in circulating pufa levels in ARDS per your recent posts on that topic.

But how do the virus proteins get into blood, specifically RBCs to be able to do that?

So, a question arising is whether ARDS always involves the destruction of haemoglobin and release of reactive iron species from that, triggering something like the lipoperoxidation cascade as described by Spitteler? I imagine there is a lot of damage in severe respiratory infections, cells bursting/necrosis I presume and virus bits everywhere and blood circulating through many of these lung cells which have functions centered on haemoglobin and gas exchange. Big mess.

Choloroquine and relatives sound like Swiss army knife chemicals, they get everywhere and do lots of different things and hang around for some time. Your lysosome idea is interesting. One other proposal is that they change the pH of endosomes and might interfere with endocytosis of viruses --- they are better known for doing the same thing to the digestive vacuoles of malaria bugs infesting RBCs.

Passthecream said...

Well, not 'through' those cells obviously. RBCs being presented homehow, ready to get their haemoglobin oxidised again.

BTW quinine sulphate is the basis of one treatment for porphyria.

Unknown said...

@Passthecream, this suggests how the virus gets into RBCs.

Justin said...

Peter this is real off topic, but is your go to feed protocol for dogs with diarrhea? I was thinking scrambled eggs in a little bit of beef tallow would be a good start since egg should be easily assimilated. Made some white rice for him cooked in beef broth earlier today. Any advice would be greatly appreciated!

Galina L. said...

to Dr.Rob - may be it is the link you wanted to see

Dr. Rob said...

Hi Frunobulax - I guess the point I’m trying to make is that the “root cause” for any disruption in a thermodynamic system must involve energy and entropy.

For any aerobic organism the energy is essentially oxygen, the entropy is any stressor on that system.- which in this case is the virus.

The virus is affecting the energy/oxygen supply to the cells and generating a load of inflammation/entropy.

It’s a simple concept based on a number of heuristics:

Life is thermodynamic

Energy is needed for life

Oxygen is the energy of aerobic life

This virus is information looking for energy/oxygen

I believe this virus has opened up a window to our evolutionary past and illuminates on how the “game of life” should be played!

Ned Kock said...

> Sounds awful I know but sacrifices will have to be made.

You are funny Peter!

Passthecream said...

Dr. Rob, I fear it's more like this

Dr. Rob said...

You are probably right Passthecream - I am a realistic optimist though, and paradigms don’t break themselves!

cavenewt said...

@Passthecream, I keep running across articles pushing the Fe hypothesis. The chemistry is way over my head. Is it nonsense, or plausible? A little bit quoted to give a taste.

(Sorry it's a pdf)

"...patients may be experiencing a form of acquired acute porphyria... the role of erythrocytes in the pathophysiology of Covid-19 is under-estimated... human Covid-19 patients have subnormal haemoglobin levels... Hyperbilirubinemia [high bilirubin] is observed... consistent with ineffective erythropoiesis (Sulovska 2016) and rapid haemoglobin turnover. Elevated serum ferritin levels are typical of acute porphyria (Trier 2013) and would be expected upon dissociation of iron from haem [heme]. A mechanism by which SARS-CoV-2 might attack the 1beta chain of haemoglobin has been proposed; the product of open reading frame 8 (ORF8) binds to the porphyrin of haem and displaces iron, according to bioinformatics prediction analyses (Wenzhong 2020). The oxygen-carrying capacity of erythrocytes would therefore be compromised by SARS-CoV-2, thereby exacerbating the difficulties already experienced by the patient, in terms of maintaining partial pressure of oxygen in the alveoli (PaO2)..."

Bob said...

Hi, cavenewt,

There was an exchange yesterday on Malcolm Kendrick's site in the comments on this subject. User barovsky posted this link:

The article is by a an anonymous character and is unsourced, but I found what appears to be a supporting Chinese paper (now in revision six since March 5)

Note Dr Kendrick's response to a comment that COVID-19 was not much more than the flu:

"...I have not encountered anything like it before. People are quite well, then they fall of the edge of a cliff. This is, of course, in the elderly population, many co-morbidities. It is, however, weird. Very little distress, then then oxygen level crash, still with little distress. They just go spaced out on you, then they die...."

Like you, I'm a layman. I just read these smart guys (Peter and Dr Kendrick) and try to understand. Still, it seems like there's something to this virus-and-hemoglobin thing.

MP said...

@Peter, you might be interested having a look at this: They touch on the subject of mice used in studies. As you read lots of mice studies, the direct relevance might be that Bret Weinstein stumbled upon the phenomena that mice used in research seem to have longer telomeres than wild mice due to the economics of breeding mice for studies, and that this has some particular consequences for those lucky subjects.

On another note, more relevant to the current pandemic, I found this also interesting and would love to hear your thoughts on it:

Frunobulax said...

@Bob, be also sure to read as followup on this "libertymavenstock" post.

Doesn't mean he's wrong, it certainly sounds credible. But there are all kinds of theories thrown around right now that sound equally credible. I'm wary of anything praising hydroxychloroquine, because word here (from virologists like Drosten) is that from the current studies it seems to help somewhat, but it's by no means an effective treatment. Let's hope we get more information from the dozens of studies that are underway.

Bob said...

Hi, Frunobulax,

Thanks for the link. Very helpful. I think I saw the Small Dead Animals piece the other day for an entirely different reason, and that's why "libertymavenstock" looked familiar.

Yes, Gaiziunas's piece is well-written and compelling on the surface. Maybe that's as deep as it goes.

You've probably heard of Vladimir Zelenko, the NYC doctor treating patients with low-dose HCL, zinc sulfate, and azithromycin. He reports great results. The knock on him appears to be that he has no idea for sure if he is treating COVID patients. If so, he has no idea if he is treating COVID patients who would get better without his treatment.

Did you look at the Chinese paper? TruthOrFiction really didn't say anything negative about it, other than that it's a work-in-process, which everything really is now in this crisis atmosphere.

One thing I've found compelling is the haemoglobin conjecture combined with Dr Kendrick's clinical experience. It may or may not be right, but it "makes sense".