COVID 19 Archives - Professor Tony Magaña

Science vs the anti-vaxers is like Moses versus the Pharaoh

The Southern Republican defiance of the science and actions to benefit the American people reminded me of the Biblical story of Moses and the Pharaoh.

As children in Sunday school many of us learn the story of the events that lead to the exodus of the Hebrews from Egypt as described in Biblical book, Exodus. For hundreds of years the Hebrews were held as slaves to be used for manual labor. Their leader Moses who most of his young life had thought he was Egyptian but then by chance finds out his origins are really Hebrew. He discovers the Hebrew life of toil and worship during a temporary exile so as ordered by God when he returns he wants to convince the Pharaoh to whom he was an adopted brother to release the Hebrews from bondage.

Pharaoh refuses Moses demand to free the Hebrews in the Book of Exodus in the Bible

The Pharaoh refuses and this leads to Moses and his brother Aaron working with God to give a total of ten plagues including turning the Nile to blood, diseases, insects, burning hail, etc. However Pharaoh is so stubborn that he thinks he is a god himself to whom no one can give orders despite these manifestations of God’s power that he still refuses to let the Hebrews go. Well at this point God has had enough. When Pharaoh plots to kill every first born Hebrews God turns it around so that an Angel of Death kills all the first born Egyptians. Pharaoh is convinced to let them go but decides on the advice of his scorned wife that he should chase the exiting Hebrews to kill them. In the end his army is destroyed when the waters God had opened to make a passage through the Red Sea closes on the Egyptians.

The Southern Republicans are the new Pharaoh

Now how is this story relevant to the Southern Republicans? Let’s think of them as being analogous to the Pharaoh. The loving God who wants to protect his people and has allowed man to have intelligence to promote their welfare is Moses. The science of medicine is gifts of the spirit promised to those baptized that help them work to improve man’s lot against disease. Just like the believers in the Bible they can be protected from a plague. Thus the scientists and doctors are God’s work. God has already sent many plagues which here can mean earlier pandemics to teach man a lesson.

But instead these Republicans think they know better than to protect their flock. Like the Pharaoh they think only of personal gain and power. Advocating against good will they intend to make political hay against the well meaning scientists and doctors. Only it backfires because these actions cause the unvaccinated and unmasked, their followers, instead to be harmed and even killed.

I pray that that this sacrifice to the false god of Trump has paid enough of a price that finally they will see they need to see the way, the exodus, to a better place is to be a believer in the gifts of the spirit God has given us to use to help each other. To act out of love for our brothers and sisters not out of selfish personal gain that hurts others. May the Holy Spirt enter them to change their hearts and stop them being hardened like the Pharaoh.

Amen

Christian approach to willfully unvaccinated. Leave them to their fate!

Jesus Christ with his Apostles at the Last Supper

Rather than fighting about personal rights vs public health there is a Christian answer Jesus gives to his followers obviating this prominent protracted conflict about COVID-19 vaccination. Leave the willfully unvaccinated to their fate.

Although a little more than 50% of the adult population has voluntarily chosen to be vaccinated in most of the United States in contrast many Southern and Midwestern states have communities with rates as low at 10%. There is essentially universal concurrence among medical experts that vaccination will spare millions from death, prolonged illness, and disability with a very low risk of side effects.

Conservative political activists and politicians have redirected the discussion to one that focuses on the dangers of government mandates while ignoring the Constitutionally tested provision to promote the general welfare power of the government to mandate public health measures that are reasonable to protect the population. At this point I believe continued repetitive attempts to “enlighten” the immunization resistors will fail. The Center for Disease control had wanted to reach a 70% percent level of immunization to get to herd immunity which could reduce the epidemic to a rare occurrence.

Jesus in his ministry wanted his followers to make a conscious decision to follow him. Human beings are created by God with free will to sin or to love. To make right or wrong decisions for their own benefit. Being coerced into religion could not lead one to be truly faithful. Taking away that free will reduces one’s ability to willfully act justly. In the Gospel of Matthew he says if you are shunned by those who do not want you to visit or listen to you then you have no obligation to continue your effort to convince them. Instead you should “shake the dust of your feet” and move on. This is consistent with Christian morality.

I think this is the way we should deal with the anti-vaccination groups and individuals. If they become ill or die they will bear the burden of their actions. Those that believe in vaccination have the absolute right not to associate with them.

Floridians reluctance to COVID-19 immunization

“You can bring a horse to water but you can’t make him drink!”

A reflection on Florida’s #COVID-19 Crisis and reluctance to vaccination

So yesterday I am in my local Walmart store in Florida which has become the new town square of suburban America. Every five minutes the speaker system throughout the large superstore is announcing that free COVID 19 vaccines are available with minimal waits right now. It was about 6 PM on a sunny afternoon and the store was moderately filled with a heterogeneous group of shoppers of different ethnic groups and ages. I wondered how many of them knew that Florida had become the number one state of new infections over the past week.

I remembered that the Republican party in Florida had said that yes COVID 19 was dangerous but only to seniors and that young people should not worry. Florida Governor DeSantis just a few months ago said the virus was no worse then the flu and that it would not cause significant hospitalizations. Now of course the rising tide of affliction is affecting, hospitalizing, and killing greater numbers of people ages 20 to 40 because the delta variant making up 83% of cases is much more infectious. In Florida this group has had low vaccination rates.

As I walked through the Walmart nobody was wearing a mask. The hand sanitizing station was unattended. Everyone entering the store just passed by it. Then I wondered over to the pharmacy to see if there was a line to get immunized. To my surprise there was none.

This made me think about an an old saying I learned a long time ago when I was working on ranch in South Texas. “You can bring a horse to water but you can not make him drink!” If we look at vaccination as an analogy to water we can see that the constant barrage by conservatives and other anti-vaxers has created a malignant lie that the water is poisoned. Large numbers of people have been convinced that they should act against not only their own interest but against that of their family, their community, their nation, and even the world. Let us hope that the horse will get thirsty enough to finally take that drink. For this to happen they have to realize that they have become pawns in a political power struggle that cares about winning not about health.

The immune response to SARS-CoV-2 can be life-saving or deadly

A Toll Like Receptor Type 3 may hold the key to treating COVID 19

A fundamental difference in the immunity of men and women is leading to research in how a difference in response of the immune system to SARS-CoV-2 can be life saving or deadly.

Even though women contract COVID 19 more often then men in part because women outnumber men in jobs like nursing, teaching, cleaning, etc. where there is frequent interaction with large groups or areas of people they do not seem to get as seriously sick or die as often. The same phenomena was seen with previous epidemics involving different coronaviruses then the current SARS-CoV-2.

Although at first differences in smoking or hygienic practices between the sexes were considered, the evidence did not confirm this hypothesis.

The male and female sex have significant differences in their immune systems relating to the X chromosome. Females have two X chromosomes while males have one X and one Y normally. On the X chromosome are a group of genes for Toll-Like Receptors (TLR). The TLR are located in organs which are very active in immune responses to fight infection including the spleen and white blood cells as well as those with exposure to contaminants outside the body including the lungs and gastrointestinal tract. Humans have ten different TLRs labeled TLR 1 to 10. Some of the TLR (TLR 2 and 5) are specifically sensitive to bacteria while TLR 3 and 4 may be sensitive to viral antigens.

Stimulation of TLRs can cause two reactions. For most except TLR3 one reaction results in the production of cytokines which are powerful inducers of inflammatory responses affecting multiple organs. Previous coronavirus epidemics and the the current COVID 19 have been seen in some patients to cause a cytokine storm syndrome (CSS). A cascade of reactions occurs leading to severe destructive inflammation affecting the lungs, heart, kidneys and even sometimes the brain to varying degrees. Organ failure, hemodynamic instability, and ultimately death can occur. The other reaction is to stimulate interferon beta which causes macrophages to engulf antigens (invaders or under some circumstance human ) and activates a form of T-Cells called Natural Killers.

SARS-CoV-2 can trigger a fatal cytokine storm

These reactions can be exaggerated causing damage to normal organs or early on may be protective. Research in mice in 2015 showed that stimulating TLR3 could create a protective response to a coronavirus.

Now getting back to the differences between the sexes. Women generally have two sets of TLRs in the body with two different gene types while men have one. Although most of the cells in the woman will randomly choose one set to be active which could be either gene this means in whole body some cells of each type will be present. Sometimes both chromosomes are working creating an approximately 15% higher level of TLR function than normal. It is suggested by some that having this situation at the time of infection may give women more protection then men as a group statistically.

The problem is that it is well known that women suffer more severely than men from chronic inflammatory conditions such as systemic lupus erythematosus. The interaction of TLRs with normal human tissues to which they become sensitized is being researched. Why do women not have a worse reaction leading to cytokine storm and more frequent death than men? Why do women do better? Could it be that having higher levels at the beginning and of two different types is important?

The controversial drug, hydroxychloroquine inhibits TLR4 response to lipopolysaccharide which in vitro studies suggest can inhibit the virus entering the membrane of the intended cell target. However when given to very sick patients resulted in worsening of lung function. Thus now it is being considered more for prophylaxis than treatment by some.

Some researchers have said that TLRS are “double edged swords” that can cure or kill. How TLRs responses are regulated and when in the course of disease these reactions are therapeutically manipulated may determine if these interventions are helpful or harmful. Research is needed how to better control them to treat COVID 19, autoimmune diseases, and even cancer.

Hydroxychloroquine COVID 19: Misleading poor scientific diligence leads to questions

Failure of researchers to adequately perform their research, of reviewers to scrutinize the research before publication, and of government experts to examine the research in detail facilitates its exploitation for fame and political gain.

On March 20, 2020 Raoult et al in a preprint report in the Journal of Antimicrobial Agents (meaning it had not undergone the usual rigorous scientific review by multiple peer scientists) stated that in small number of patients that was not randomized or case controlled (26 initially but only 20 completed the study) treated with hydroxychloroquine and azithromycin over a 6 day period had a reduction in the virus in that the viral DNA was absent. This set off a fire storm of controversy which remains ongoing.

The normal routine for a scientific publication is for it to be reviewed by at least three independent recognized experts who have no links or interests to the authors or any products used. Under the best of circumstances this can take weeks and often takes several months. The pre-publication of this study which started on March 6, 2020 definitely did not allow a adequate analysis. One of the authors sits on the editorial board of the Journal which creates a real conflict of interest. The report was published without the inclusion of any raw data which is unusual in pre-print publications. Now the International Society for Antimicrobial Chemotherapy yesterday sent out a statement that the editor of the Journal should have recused himself and that scientific scrutiny and best practices should not be sacrificed.

An extensive analysis has been done by Elizabeth Bik and others over the past several weeks which finds many problems. The society which oversees the Journal now says it has significant problems with its validity. Although the study was approved by French authorities to extend 14 days there is only a 7 day report. Four of the patients treated who did not improve were not included in the study. The report of virus presence was only done on Day 6 and not on Day 7 or Day 14 as was approved by the French supervising body. Normally the treated and untreated groups should have similarities in demographic factors, history, findings, etc. but this is not present in this study. There are another 6 six patients whose reason for not completing the study remains a mystery. Finally the measure of success evaluated was in the volume of DNA indicating viral load not clinical improvement so the relevance of the study to clinical utility and outcome is unknown. So far 8 of the world’s prominent scientists in this field have raised major questions on it’s validity.

But this is only the beginning of the dilemma. Certainly because there is worldwide crisis, scientists and government leaders are eager to find treatments. However, one has to wonder to what extent those in government scientific positions really evaluated this paper. Did they really understand it well enough to know how weak it really was? Was it enough to say it was “anecdotal” or was that giving it too much credit. Then you add on Dr. Oz, the highly discredited TV doctor who has had at least 8 false claims made discovered by respected authorities and an avid Trump supporter pushing the benefits of this unproven regimen like it is the fountain of youth.

Unfortunately the lack of adequate review by the scientific publication and lack of review of it’s weaknesses which gave it more credibility that it was worth serves to give Trump and his supporters some cover. Remember he says “I am not a doctor”. Now we have a situation where millions of dollars will be spent and lives potentially put a risk because scientists and journals seeking rapid publicity were aided by superficial review of government scientists which all served the political self interest of a President who could care less about truth.

Let us hope that the necessary scientific scrutiny of this and any other potential treatments will from now on receive the rightful and intense evaluations that is absolutely essential for the public welfare.

COVID 19 To Bring a Medical Ethics Crisis to Ethiopia

The probable impending crisis of COVID 19 in the medical resource poor country of Ethiopia will likely bring controversies in medical ethics decision making. When we see New York city hospitals pilling hundreds of bodies in refrigerated trucks and having severe shortages of nurses, doctors, and ventilators in the setting of the one of the world’s richest countries what does that predict for Ethiopia. If and when the crisis hits fully we know there will be shortages. Ethiopia spends about $28 per capita yearly on healthcare while the United States spends more than $10,000 per capita yearly.

Yet although the Ministry of Health mandates that each health care facility maintain and review medical ethics standards very few do. Additionally the few documents, such as the Ethiopian Medical Association guidebook on Medical Ethics, and proclamations of the Federal government deal mostly with very general cases of proper behavior.

Real issues such as how patients will be triaged (who gets the ventilator and who does not), should a patient who is “hopeless” be removed with family consent to help someone with a better chance, brain death, etc. remain unclear.

Ethiopia has strong religious convictions in the Orthodox, Muslim, and Protestant communities. How medical ethics questions and distribution of resources are decided will have to take in account the religious and cultural traditions that are unique to Ethiopia. It is better to start these discussions now with community leaders, religious leaders, and academics then rush to make them in the heat of an epidemic.

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