COVID-19 battle: Health or Wealth?

April 16, 2020 #5 blog: 

COVID-19 battle: Health or Wealth?
Today, President Trump is expected to spell out when to “open up the US.”  Two impending priorities demand a battle: Health or wealth? Which is more precedent now? Contagious COVID-19 infection causing overload of hospital capacities and resources and death; or, economical suffocation due to unemployment increasing by the day.

For the medical personnel like myself, it is obviously health over wealth but to perhaps a majority of Americans, immediate needs such as shelter, food and clothes to wear are becoming more significant, even though we as a nation then gamble and play the odds of prolonging the contagious virus. 

There are a number of issues we need to sort out during the pandemic in my humble opinion. As news media said, “we are in this together” fighting the silent and deadly enemy. And because this virus is novel, no one can predict, and prepare for the best scenario when unknowns are stacked against our odds. This was manifested by unpreparedness in our most powerful country and medical experts. Medicine is truly practiced at this time.

  1. Americans are saying we need more robust testing.

Here are the current estimated numbers:

RegionTotal population# infected cases% infection# Death% Death
CA40 million  27,2260.07%    8930.002%
US328.2 million657,2300.2%29,9080.009%

– The deaths out of the total number tested is not a true percentage of the death rate caused by coronavirus. It is easy to mistakenly calculate as such.

– These statistics are not the actual numbers because testing is done only in the high risk people where COVID-19 infections are suspected following specific guidelines.

– Even in the current ER admission, unless met with specific symptoms and signs, nasal swab test is not being done.

– Drive-thru testing sites are open in many areas but one needs to have high risk criteria such as immunosuppressed states, diabetics, high blood pressures, etc.

– Even doctors and nurses and health care allies are not given the option for testing because we simply do not have availability of test kits and labs to run the test.

  • No tests currently conducted are “FDA approved.” 
    – No sensitivity and specificity studies are done; if the test result is negative, it does not necessarily mean one did not get infected. 
    – Sensitivity of nasal swab which is a PCR method (most common) and it is expected to have a 70% accuracy rate, which means 3 out of 10 tests may be a false negative result. 
    – Each test requires Sensitivity and Specificity analysis. Sensitivity test is the ability of a test to correctly identify those with the disease (true positive rate). Specificity test is the ability of the test to correctly identify those without the disease (true negative rate).
  • Many labs including commercial, individual hospital labs, and government labs are currently coming out with new rapid tests. None are FDA approved. Each lab test has different sensitivity and specificity rates. There is no national standard check point to validate the accuracy of the test given from each site.
  • Blood testing for antibodies against COVID-19 is the newest and entirely different test that Dr. Fauci talked about. The US FDA recently granted an “emergency use authorization” for this test. In Italy, politicians want to use antibody status to determine which people will get back to work. This test will be able to detect those “asymptomatic COVID-19 infected people” and it has a potential to reveal the true % of coronavirus infection rate. However, in order to do that, we will need to test all people. In the US, a collaborative multiyear project is underway which aims to provide a prevalence of nationwide antibody. The first phase is to collect samples fromblood donors in 6 major urban areas. This will be in combination of 3 national surveys of donors, supported by CDC in this fall and in the fall of 2021. Notice that this study involves blood donors, not entire regional areas, state or the US. How can we ever find out the true infection rate from these data?
  • The antibody test has many presumptions.
  • Influenza (flu), poliovirus and Varicella-Zoster (chicken pox) infections induce antibodies and not only tells who was infected, but provide protection that will be near universal, and have long-lasting resistance. Vaccines against these also provide a life time protection against re-infection. The immunity is permanent.
  • HIV infected people will often have large amounts of antibodies but it does nothing to prevent or clear the disease.
  • Hep B vaccine, Mumps, Measles, Rubella and Closterium (bacteria) which causes botulism need to have regular booster shots even if antibodies are detected in blood.  
  • The presence of coronavirus antibodies may not bring a long-lasting resistance as chicken pox. At this early stage of understanding, we simply do not know yet what it takes to be effectively protected from this infection, how long do coronavirus antibodies remain in the blood and do they protect against re-infection.
  • Do we really know how long asymptomatic coronavirus infected persons can actively transmit to others? It is recommended to be quarantined for 14 days (some say 10 days) but do we really know after these 14 days, it is contagious-free?
  • It is estimated that we will eventually have approximately 5% of the population in the nation to be infected which means 95% are free of infection, and needing vaccine. If we are thinking about re-opening the economy, wouldn’t it make sense to send the people to work who are not infected?
  • In some profession such as medicine, the majority may be exposed to COVID-19. If COVID-19 or antibody test results are positive, does that mean they cannot go back to work and for how long? Who then will remain in the hospital to attend to the sick?
  • COVID-19 Vaccine in works.
  • As of 4/8/20, there are 115 vaccine candidates and 73 are currently at exploratory or preclinical stages. Even though the scale and speed of the global vaccine research and development is at the highest focus, there is an indication that vaccine could be available in early 2021 (which is a disappointing timeline). To expedite the process, tremendous funding, strong international coordination and cooperation between vaccine developers, regulators, policymakers, public health bodies and government are needed.
  • Here is the summary of current vaccines in the pipeline:
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  • Current potential treatment: Recent JAMA paper is included for your review:

Go to Jamanetwork.com,

Pharmacologic Treatment for Coronavirus Disease 2019 (COVID-19) by James M. Sanders. 

If China indeed had spilled out COVID-19 from Wuhan Lab (albeit accidently), surely, they should have antidote for this virus and the time to release it is now. 

After I spilled out my thoughts regarding COVID-19 which is all gloomy (I am sorry), I want to say I look for my comfort and peace in God who is called The Son of Man, The First and the Last, The living One, The Son of God, The faithful and true witness, the Lion of the tribe of Judah, the Heir of David’s throne, Lamb, Shepherd, Christ, the Word of God, King of all kings, Lord of all lords, the Alpha and Omega, the Beginning and the End, the bright morning star, Rock of Ages, Redeemer, Bread of Heaven, Living water, our sure foundation, good, fairest of ten thousand, Savior, Mediator, our Advocate, Almighty, the stone the builders rejected, wonderful counselor, friend of sinners, great physician, Anointed one, healer of broken hearts, prince of peace, blessed hope, our atonement, mighty fortress, shelter, the narrow gate, Lord of grace, God of all comfort, Word of life, Rose of Sharon, lily of the valley, Glorious, Immanuel, Living word, chief cornerstone, Creator, Ancient of Days, the eternal One, finisher of our faith, resurrection and life, the way, the truth and the life, everlasting Father, captain of the Lord’s army, strong tower, Yahweh, our defender, our friend, our comforter, the One who prays for us, the Most High Priest, and the most High…

These are just a few names and references for Jesus whom I trust, worship and give thanks to. It is indeed a miracle that we each have breaths today and live life as a gift from God.

Education on COVID-19

March 28, 2020

As I read more about Coronavirus, I wanted my family and friends to know about a few things and to call out to God in prayer. 

The definition of pandemic means a disease is prevalent over a whole country or the world. The definition of epidemic is a widespread occurrence of an infectious disease in a community at a particular time. The coronavirus started as an epidemic in Wuhan China and became a pandemic. Coronaviruses are a large family of viruses that cause common colds in people but they also infect other animals and different species. Throughout history, we know that viruses mutate constantly and at times they can become highly infectious and virulent. Corona means the upper portion or crown of a part, as of the head as appears in the electron microscope. This is an example diagram of Coronavirus from Google.

The Severe Acute Respiratory syndrome COronaVirus 2 (SAR-COV-2) and the disease it causes, Coronavirus disease 2019 (COVID-19) is known to have initiated from Wuhan China in December, 2019. The most common symptoms are reported as fever, dry cough and shortness of breath. The test is by polymerase chain reaction (PCR) from a nasopharyngeal swab. The New York Times Coronavirus dashboard as of today reported more than 606,200 people are infected and at least 28,050 people have died. The US Coronavirus cases and the number of deaths are continually rising. On 3/1/2020, New York Times headline reported “How prepared is the US for a Coronavirus outbreak?” and now merely within a month, we know we were not prepared. 

According to the Center for Disease Control (CDC) records, flu season in the US which runs from October through May claims 29,000 to 59,000 lives, with most common cause of death from complications such as pneumonia, heart attacks and strokes. Last year, an estimated 80,000 Americans died of flu which was the highest death toll in at least four decades. The death rate from influenza (flu) is generally a fraction of 1% (0.1% to be exact) but the Coronavirus induced death rate is over 1%, (reaching 4.7% today worldwide),  so it is at least 10 times more than seasonal flu.

In 1918, a flu pandemic caused by an H1N1 virus which lasted nearly 2 years killed more than 50 million and infected 500 million (1/3 of the world’s population). It is reported that H1N1 virus originated from genes of avian (bird) origin. In that era, there were no vaccines, antibiotics and medical facilities with ventilators like today and the only way to combat the pandemic was by isolation, quarantine, good personal hygiene, use of disinfectants and limitations of public gatherings; non-pharmaceutical intervention.

In 1957-58, a new influenza (H2N2) virus emerged in East Asia spreading a pandemic (Asian Flu). This virus was first reported in Singapore in February of 1957, Hong Kong in April of 1957, and in coastal cities in the US in summer of 1957, according to the CDC records. The estimated death numbered 1.1 million, with 116,000 of those in the US. This virus originated from Avian Influenza A.

In 1968, Pandemic H3N2 virus comprised a new mutated Avian influenza A. And again in 2009 a novel (new) influenza A (H1N1) virus (H1N1)pdm09 virus, otherwise known as swine flu arose, implicating its origin from swine, occurred in the spring.

The current COVID-19 is thought to have arisen from smuggled pangolins used for both food and medicine. Another possibility is bats, because these two animals have similar genetic codes as in coronavirus. Exactly how the virus jumped from a wild animal to other animals or humans remains a mystery.

According the recent publication in JAMA, the mechanisms leading to death by coronavirus is by filling the lungs with fluid as seen in congestive heart failure symptoms. Human lung is like a tree branching with the end of the tree twigs having grapes with empty sacs. These sacs have a thin membrane which transports oxygen molecule, which is absorbed into the blood flow to provide life to all cells within the body. With COVID-19 infections leading to death, all these grape-like sacs are filled with fluid which leads to inability for oxygen transport. By imaging, the radiologists describe the condition as the “ground glass opacity”. The ventilator is the only way to deliver some oxygen by pushing positive pressure into the lungs. The strong pressure can cause these sacs to “pop” (causing atelectasis) which will damage to the lung permanently. More chronic consequence is the fibrosis/thickening of sac membrane. COVID 19 infection causes this kind of dire situation very fast (within 1-3 days). As in all flus, the most devastating effects are seen in elderly, diabetes, immune deficient populations and other pre-existing medical conditions. 

Knowing these facts, and the history of pandemics, what can we deduce from then and what do we do now? We wait for the specific vaccine against COVID-19. Until then, we go back to what we do know in how to combat the virus; non-pharmaceutical intervention. As we are changing the life style of norms, it is perhaps easy to blame others-governments, organizations such as CDC, WHO, the people of Wuhan China, the President, by saying “only if… “ Strangely, we are so connected by a few people in Wuhan China; their business of what they eat and do are no longer just their business but we are so intimately affected. Their business is now our business whether we like it or not. So, shall we blame the Chinese? What if the next strain of virus comes from a small town in the US? 

When one thinks like the virus, the success depends on the reproduction, increase in potency and easy transport by new and clever mutation of genetic codes and it has nothing to do with the boundaries, races, ages, genders etc. The question we need to ask is when is the next pandemic, and not if. 

As we fight against with this virus today, the only logical way is to distance from each other to stop the spread which will cause less burden to our health care workers and their resources. Most of the health care workers are prepared to fall and are ready to die for the sick. It is their dedication to sick people and promise to the professional Hippocratic oath.

There are always two perspectives and we can choose to see one way or another. One good thing is we have the social media, a technology to connect to the ends of the earth through your phone. We are not alone and thank God for this.

The other thing we can do together is to pray the prayers David had in Psalm 86, 1-3,11-13.

Bend down, O Lord and hear my prayer, answer me for I need your help. Protect me, for I am devoted to you. Save me, for I serve you and trust you. You are my God. Be merciful to me God, for I am calling on you constantly.

Teach me your ways, O Lord that I may live according to your truth. Grant me purity of heart so that I may honor you. With all my heart I will praise you, O Lord, my God. I will give glory to your name forever, for your love for me is very great. You have rescued me from the depths of death.

Snake on a Pole

Numbers 21: 4-9

Then the people of Israel set out from Mount Hor, taking the road to the Red Sea to go around the land of Edom. But the people grew impatient with the long journey, and they began to speak against God and Moses. “Why have you brought us out of Egypt to die here in the wilderness?” they complained. “There is nothing to eat here and nothing to drink! And we hate this horrible manna!” So, God sent poisonous snakes among the people and many were bitten and died. Then the people came to Moses and cried out, “We have sinned by speaking against the Lord and against you. Pray that the Lord will take away the snakes!” So, Moses prayed for the people. Then the Lord told him, “Make a replica of a poisonous snake and attach it to a pole. All who are bitten will live if they simply look at it!” So, Moses made a snake out of bronze and attached it to a pole. Then anyone who was bitten by a snake could look at the bronze snake and be healed. 

Jesus was hung on the cross, whosoever believes in Him by just turning the head to look will be saved from the sin. The consequence of sin is death. In 2020, we are facing a pandemic caused by coronavirus which affected the globe, including all 50 states in the U.S. The most tangible way to know how this virus affected our lives is to see the empty streets, highways, restaurants, bars, retail stores and what’s called “non-essential” businesses now. A few places we can see people at are the groceries where toilet paper and food stacks are empty, and the hospitals where the healthcare workers are anticipating and facing the sick without supplies for their own protection. It is as if they are going to the war zone on our front lines without guns and ammunition. Some doctors who treat the infected patients sleep in their own cars so that they reduce the chance to infect their own loved ones, family and friends. 

As we watch the news media, fear rises as the numbers of the infected and the death rate increases daily. Every day we hear new findings, altering our immediate needs and adjusting into a new normal. Fear creeps in, tension rises and the imagination of worse apocalyptic ideas enters our discussions at the table. In times like this when everything seems surreal and it is hard to find norms, we tend to look to see where we can find some controls to fill the void of insecurities. Even fighting over buying a toilet paper package is still comforting because fighting is a part of the norm. People can easily go into a rabbit hole, focusing on the number of infected people and death tolls, preparing for the worst and even exaggerating the scenarios, predicting economic disaster to a point of no return. It is much harder to reflect and ask why is this happening, what can we learn from this experience and what must we do to benefit each other. That answer usually comes from God, who created everything—even the viruses—and who controls the whole world, life, and death and even each breath we take. 

We actually do not have any control over these, but God has already counted the number of hairs each one of us has. He feeds the birds in the sky and birds have no ability to store the food supplies. And this God who is the same yesterday, today and tomorrow says anyone who looks at the bronze snake attached to a pole will live. Now, why wouldn’t anyone just turn their head and look at it? This would be such an easy task yet there were people who did not. It is the pride that would prohibit a gaze because what God said does not make sense. Our education, common sense, and every  grain of logic prohibits such a gaze. But God is not of this world and naturally God’s logic will not make sense to us. Why would a loving God make such an infectious virus called Coronavirus, why now, why do we have to face it globally, why is this happening on this earth, why do I have to live through this unprecedented time, who is to blame, who will pay for all these consequences, where is God in all these anyway and all kinds of questions arise without answers. 

When all the dust settles, the turmoil of our mind, confusions and even anger subsides, then we have two choices: To look or not to look at the snake on a pole. I have decided to put down my pride and take a look at it, even if I wind up dying with this virus. We all die at one time; no one has escaped the death except Jesus who died and resurrected. Even though it may be a miserable way to die, and not able to breathe with this virus, the end is the same. Death is a worst scenario. The good news is that physical death is not the whole story of Christian belief. The victory is already determined and we know Jesus has conquered the death and we will be living in heaven in God’s bosom where there will be no more tears. So, calm your hearts, now that God is in control of this Covid19, and focus on Jesus who took away our sins by dangling like a bronze snake on the cross. Turn your head to look at it and receive eternal salvation. Fill your mind with God and pray for our nation and the world. God will hear your prayers and our Good Father will grant your wishes and give you peace that surpasses our understanding.