There is a lot of talk about COVID-19 and mortality and it has important implications for our policy decisions. I devote an entire section in my book, COVID-19 Survival Manual, to the topic with a chapter entitled, Understanding Risk: The Actuary’s Perspective. You can get the book at the link above.
From the beginning of 2020 when the pandemic began to roll across the continents a major focus was the death rate for COVID-19: Who dies from it? What is the risk of dying? How does it compare to other diseases, especially influenza which we have some familiarity with?
But all of these discussions were being had, and are still being had, in a vacuum; the not well understood background that death is an ever present aspect of, as the Bee Gees said so energetically in their Billboard Number One song of 1977, Stayin’ Alive.
The following Table explains what I am trying to illustrate.
In 1932 the famous US Supreme Court Justice, Louis Brandeis, wanted to highlight one of the amazingly important, but often overlooked, aspects of the governmental structure of the United States: the tripartite separation of “rights and power” between the People, who start with all the rights and all the power according to the Preamble of the Constitution, and the Federal Government, which is only supposed to be granted the power that is written down, enumerated, in the Constitution, and the States, which is the default place for powers not specifically granted to the Feds on the one hand and specifically granted by the People through their state legislative bodies.
“A single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.“
What does this have to do with COVID-19 you ask?
The experiment of NOT sheltering-in-place and shutting down businesses.
It turns out that seven states did not shut down businesses for the COVID-19 pandemic while 43 states did. [To be clear however, schools were shut down in 49 of 50 states. This despite the known facts that COVID-19 in children is either mild or asymptomatic and deaths are much lower than for influenza.]
So in seven states, lives were disrupted because childcare instead of school was a new necessity for people with children to deal with but nothing else changed. No businesses were closed, no restaurants shuttered, churches were unaffected, etc. If political science was a science it would frame this situation as a hypothesis; to wit:
Based on our understanding of COVID-19 infectivity, we hypothesize that the states that did not restrict its citizen’s movements would have either a higher rate of infection (cases per week or month) or a higher number of infections (total cases cumulatively) or both.
For orientation what you are looking at are the individual states with their two letter abbreviation, a squiggly line for the three day moving average number of cases per 100,000 population and a color code of green, where cases are going down and red where cases are going up. I am purposely not going down into the weeds in each state because we are looking for BIG signals which should be visible at this level of looking at all the states as a group. For now, please ignore all those states in the big blue box.
The seven states with the red boxes around them are the seven states that did not lock their citizens at home. What jumps out at you about these seven states when you compare them to the other states is…nothing! What I mean is that they look pretty interchangeable with the states that completely shut down. Nebraska seems to have the biggest cumulative cases but it looks a lot like Minnesota, Illinois, and Michigan in total area under the curve. As you are well aware, those states really restricted their citizens.
So based on this data, you would have to conclude that your hypothesis is proven to be wrong.
Could the lack of cases in these states be due to factors like population density, lack of large public transportation systems (see below), or any one of a number of other factors. Sure, and if I was in a university we could sit around and have lively facility lounge debates on this for months. But if you are making public policy decisions that are weighing shutting down a state’s economy for months you should be absolutely sure of your facts because your actions effect millions of lives and livelihoods. This was a colossal mistake.
Should SARS-CoV-2 be renamed the ‘Acela Virus?’
Now let’s focus on the blue box. When I was studying this chart without the blue box which I put there I was puzzled about some of the state results. For example: New York and California have very similar demographics, big cities, etc. yet their COVID-19 cases on a population basis could not be different. One obvious difference is that Californians get around in their cars while New Yorkers us a lot of public transportation.
But other unexpected states jumped out. For example, what’s with Rhode Island seeming to be almost as bad as New Jersey? I love Rhode Island but it doesn’t have the ‘feel’ of New York or New Jersey for me, at least. And Delaware, the same question comes up.
And then it hit me, what is the Acela Train Route and which states does it go through?
Suddenly this corner of high COVID-19 incidence states made complete sense.
To help you see what I mean I have put a box around the states that the Acela train goes through (it includes Washington, DC). With this as an organizing principle it all comes together. This daily train service from Boston to Baltimore carried about 9600 passengers per day in 2016.1 If COVID-19 was in the US in January2 as some at the CDC think or even the end of December, as I published with a distinguished UCLA statistician before the CDC report in a blog,3 it would have been spreading for about two months until the Acela was closed, initially between New York and Washington on March 7th, and finally completely closed on March 23rd. That is close to 600,000 people in close contact inside a train for the first two months of COVID-19 spread in the US. I did go deep into each state and the peak you see is about 10 to 14 days after the Acela was closed.
Final thought. I know the virus doesn’t have a brain but if it did, and if its mission was to hit hardest all of the people in government, the media, and key academic centers that make decisions that affect the entire country, the entire United States, the Acela train would be the exact place it would want to go.
Suddenly what might look like an over-reaction (from the middle of the country) by the Federal government, the media, and even our academic centers looks more like a very human response to everyone having their riding buddy or friend, the folks they go back and forth with daily, getting COVID-19 or knowing someone with the virus.
If that was happening to you and when you got to the office you were pulling the levers of power all day…well you see where this ends up. Please start a new trend in social media by sending this blog to your friends with the hashtag #AcelaVirus
As I write this on June 8th in Taiwan it has been 13 days since the events in Minnesota led to daily nation- and world-wide protests and assembly in the streets. Videos of the public events show that, for the most part, facial masks are not being worn and certainly six-foot social distancing is being ignored.
Since COVID-19 has an average time from exposure to symptoms of five days that means that any exposure during these protests of hundreds in the streets from June 3rd or before should be showing up in the daily case rates. It also means that the remarkable, highly specific property of the SARS-CoV-2 to infect the cells that give us taste and smell and that lead people to go online and do searches for “can’t taste or can’t smell” can be an indicator of new cases, even for people that don’t go to the doctor.
In fact, I used this unusual taste/smell change by SARS-CoV-2 to determine when it first came to America.
A week ago I published a manuscript with an esteemed statistics professor from UCLA that showed that COVID-19 probably was in America in late 2019 and was killing people, at least in California, in early January. You can read the article here. What this means is that many, many of us have been exposed to this virus and either had no symptoms or only mild symptoms. The implications of this are immense: in calculating the death rate from SARS-CoV-2 the top number in the fraction (the numerator) is the number of deaths, which we know pretty accurately. The denominator can be the harder number to come by, the total number of cases, especially if you miss the asymptomatic cases or miss the January and early community cases where people got a little sick and wrote it off to the seasonal influenza. This of course segues to the probably mistaken decision to close a country for a virus that might be no more deadly than the typical influenza.
But back to the topic of the potential flare-up from breaking the shelter-in-place and social distancing rules.
So what is happening in the US nation-wide right now? First, let’s look at the folks who don’t go to the doctor maybe but still have the loss of taste/smell symptom, meaning they are infected.
Above is the trend of Google searches1 for ‘can’t taste’ nationwide over the last 90 days. It peaked 23-25 March and has been steadily declining ever since. The slope of the line from before and after the events in Minnesota is unchanged. This suggests there is no spike or trend in new cases. So this provides no evidence that breaking the rules has caused a spike and suggests we can end the policies.
But what about people who actually show up in a clinical or hospital and get tallied into the official state or CDC database?
Below is a table of the states that are willing to share their data2 with the trend in new cases and deaths. Note: it usually takes longer than 14 days to die from COVID-19 so the trend in deaths has nothing to do with the recent spontaneous breaking of the ‘public health rules’ about COVID-19. I include it for its informational content value.
If your state is not on this list it is because they are not sharing their data on COVID-19 with the CDC or WHO. You should contact them and ask that they do so.
First the really good news. Deaths from COVID-19 are down everywhere except Louisiana, where they are flat. Again, this has no current relationship to the public assemblies going on but it is just a bit of good news for a change.
With respect to new cases, California, Florida, and Washington are seeing the caseload grow. It is a linear and not exponential growth like at the beginning but it is growing just the same. It does contradict the data I analyzed last week on cases decreasing as the temperature goes up; both California and Florida can be our warmest states so it looks like summer heat will not stop this villain.
So let’s look at California. The way to do this is to look at a smoothed moving average of the new cases before and after May 25th and look for an upward change in the slope.
Above are the daily cases and the blue line is the moving slope. For California (on the left) there is no upward change in slope of cases after May 25 and in fact there is a slight downward slope at the end. So no signal in California related to protests. Texas shows the opposite effect: a downward slope going into the time of the protests that is broken and now trending upward. It also has a one day drop but we should still assume there is a positive relationship here between the protests and the cases. This would support a hypothesis that the protests are increasing the cases of COVID-19 in Texas. But remember correlation (two things happening at the same time) is not the same as causation.
Washington State has the same kind of trend line as Texas with a change in slope around the time the protests began. So again, this is probably an example of the impact of stopping the COVID-19 policies: a measurable change if you look really hard at the data but certainly not something to continue to stop an economy for.
Conclusion. The nationwide protests has provided a useful experiment in whether it is time to end the shelter-in-place and social distancing policies of the last few months. The answer is that there is no evidence of an exponential growth in cases, any growth that is seen is minor, and so the policies should be ended.
Is there a recommendation for further COVID-19 policies after shelter-in-place is over? Yes, I recommend what I call the Taiwan policies. Remember, Taiwan has only seven COVID-19 deaths and about 1% of the cases per million population of anywhere else in the world.
Here is what is happening in Taiwan right now:
When you are outside there are no real restrictions or requirements. If you are of an age or have a medical condition to increase your risk, you will chose to wear a personal mask to protect yourself.
At the threshold of every building you must have your temperature taken with a non-contact thermometer and you will not be allowed to enter if you have a fever.
A small motion-detecting isopropyl alcohol dispenser is also at most entrances and you can uses in both coming and going. Again, customers indoors self-select to wear masks or not. It appears that masks might have become the new fashion accessary as the coordination of mask, scarf, purse, shoes, and jewelry are being seen, especially among the young.
In all commercial buildings, government buildings, etc. all employees where cloth masks at all times.
Physician-Scientist Dr. Steven Quay, MD, PhD vows to make the book available through his website, with proceeds supporting military veterans performing COVID-19 relief work in their communities
SEATTLE, June 5, 2020 (GLOBE NEWSWIRE) – Dr. Steven Quay, MD, PhD, author and physician-scientist, announces the availability of his 158-page book, “Your COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond,” in paperback and eBook format on his website, www.DrQuay.com, beginning Monday, June 8, 2020. Proceeds from the book will go to military veterans performing COVID-19 relief work in their communities.
The book had been made available in pre-launch mode in the Amazon Kindle website for only a matter of hours when it was pulled down with no notice. Later Dr. Quay received an email stating: “Due to the rapidly changing nature of information around the COVID-19 virus, we are referring customers to official sources for health information about the virus.” No method to appeal the decision was provided.
During the hours Your COVID-19 Survival Manual was available and before any promotional activity, the eBook became:
The #1 New Release in Immunology
The #1 New Release in Respiratory Diseases
The #1 New Release in Microbiological Diseases
Received a Five Star Review, stating: “Easy to read and understand as well as being based on History and Science. Would highly recommend to anyone. Be safe and secure and follow the recommendations which are cleanly documented and shared.”
“I was really surprised to have this important information on how to keep you and your family safe during this pandemic banned from the largest eBook platform in the world,” stated Dr. Quay. “As a physician-scientist, inventor of seven FDA-approved pharmaceuticals that have helped over 80 million people worldwide, and with 9800 citations from other researchers to my contributions to medicine over a 30+ year career, it feels wrong that I cannot share the hours of work I have done since January to understand this new virus and help people fight it off. Despite this temporary setback, my team has done an incredible job working 24/7 to pivot away from this problem and make ‘Your COVID-19 Survival Manual’ available on my website beginning on Monday, June 8th, 2020.”
“Since January when official sources for health information said there was no evidence of human-to-human spread, to February when face masks were said to be useless, to March when schools were closed with no evidence of pediatric spread and threats of keeping them closed until a vaccine is available were made, to April when hydroxychloroquine was said to increase death, only to have that paper retracted after I and others showed it was simply bad science, to May when the CDC and WHO can’t agree on the value of face masks, I have tried to provide evidence-based solutions for getting through this pandemic,” continued Dr. Quay. “I will continue to use my website and book to help as many people as I can and hope the proceeds from the sale of the book can be used to make a difference in communities hard hit by COVID-19.”
About Your COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond
This 158-page eBook is chock-full of lifesaving tips you can’t find anywhere else to help you and your family stay safe while sheltering-in-place, as well as how to get back to life in the coming weeks and months.
Some highlights:
One 2-minute step you can take every time you come home to kill Coronavirus before it enters your lungs
A, quick, free home test for COVID-19 that is as good as the FDA-approved nasal swab
The one exercise you won’t learn in the gym that can save your life
How NOT to die of COVID-19 (Make your lungs younger)
What to do if you have early stage COVID-19 so that you can stay out of the hospital
The #1 most effective way to prevent the spread of coronavirus as we reopen society (Hint: it’s the one thing the CDC said was “NOT effective” when coronavirus hit the U.S.)
Why a vaccine won’t be the solution, and what YOU can do to protect yourself, now and in the future
What to eat and drink (and what to avoid) so you can prevent and beat this coronavirus
The best supplements I have found from clinical trial research for immune health during this pandemic
The coronavirus’ “Diabolic Trait” and how it helped the virus spread so fast
An easy DIY step that takes your face mask from a viral barrier to a virus killer, giving you over 100-times the protection of an untreated mask
The one blood test to ask for if you are hospitalized that can keep you off a ventilator
Three steps to take to thrive during the next epidemic
Learn about gain-of-function research and why we must ban it to prevent future pandemics
About Steven Quay, M.D., PhD.
Steven Quay is the founder, Chairman, and CEO of Seattle-based Atossa Therapeutics, Inc. (Nasdaq: ATOS), a clinical-stage biopharmaceutical company seeking to discover and develop innovative medicines in areas of significant unmet medical need. Atossa’s current focus is on breast cancer and COVID-19, with the recent announcement of the COVID-19 HOPE drug development program.
Dr. Quay received his M.D., M.A. and Ph.D. from The University of Michigan, was a postdoctoral fellow at MIT with Nobel Laureate H. Gobind Khorana, a resident at the Harvard-Massachusetts General Hospital, and was on the faculty of Stanford University School of Medicine for almost a decade. He has over 300 published contributions to medicine which have been cited over 9,800 times.
Dr. Quay has founded six pharmaceutical startups, invented seven FDA-approved medicines, and holds 87 U.S. patents. Over 80 million people have benefited from the drugs he has invented. His current passion is the prevention of the two million yearly breast cancer cases worldwide. A TEDx talk he delivered on breast cancer prevention, “How to Be Smart If You’re Dense,” has been viewed over 200,000 times. His website is: www.DrQuay.com
The short answer is yes, it will be very safe. Why? The beach has wind, sun, the salty spray in the air, and people spread out. Let’s consider each of these separately.
Wind.Because the water of the ocean and the adjacent land have very different responses to the warming effect of the sun there is an almost constant wind at the beach. Is that good or bad for spreading SARS-CoV-2? A nice study 1 (not peer-reviewed however) looked at the rate of COVID-19 cases and various weather conditions in four cities in China and five locations in Italy. They then plotted wind speed versus the number of cases (because of the average five day incubation period they correlated cases and weather with a five day interval). In eight of the nine cities the higher the wind speed the lower the rate of cases. The effect was not huge but in the vast majority of the time, the more wind the fewer cases. So given that effect, being at a windy beach versus a still air part of town away from the beach, will have fewer cases.
Sun and temperature. Previous results on the relationship between respiratory-borne infectious diseases and temperature have indicated that both SARS and influenza need to survive under certain temperature conditions, and increasing temperature can reduce their ability to spread. The underlying hypothesis as to why warmer seasons tend to decrease the spread of viruses include: higher vitamin D levels, resulting in better immune responses; increased UV radiation; and no school in the summer (when children are clustered together, transmission rates of flu and measles increase). Reports of UV and respiratory diseases have also been considered, and previous studies have shown that high levels of UV exposure can reduce the spread of SARS-CoV virus.
However, in this study of UV exposure and COVID-192 which had a six-fold difference in UV radiation there was no effect of increasing UV. With respect to temperature, the first study1 showed a positive effect, with each increase in temperature of one degree having a 1% decrease in COVID-19 incidence. The second study, however, saw no temperature effect.
Salty spray. The spray from the ocean, the aerosol, contains water, salt, and lots of ocean microbes.3 Importantly, they also contain a large and diverse collection of fatty acids, those long carbon chain chemicals we all know commonly as soaps. If a human sneeze/cough/breath droplet were to merge with a sea aerosol and then it began to float on the wind two things would happen: as it ‘dried’ in the air the salt concentration would increase, and the fatty acids would attack the membrane of the envelope virus, SARS-CoV-2. Both of these actions would quickly destroy the virus! This will not happen with fresh water lakes, by the way.
Public bathrooms.Even before COVID-19 the public facility situation at the beach is far from ideal. Nothing special for COVID-19 here. Just wash your hands after and if you are really talented, hold your breath if you can!
Get even more tips on staying safe with COVID-19 by following my blogs at ElevatorMedicine or get my new book on Amazon Kindle, Your COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond.
My COVID-19 Book Publishes June 5, 2020 on Amazon Kindle!
A paper entitled, “Respiratory virus shedding in exhaled breath and efficacy of face masks” (1) published in April 2020 is a good study of just how effective face masks are; and the key limitation they have. It was a big study with 246 patients. They took a nasal swab, a throat culture, and then an exhaled breath sample and looked for seasonal coronavirus (not CoV-2 but the common colds cousin), influenza virus, and the true common cold virus, the rhinovirus (Rhino is “Greek to me” for nose). The results are encouraging.
The percent of patients with any of the three viruses decreased with a mask for both the big droplets that don’t travel too far as well as the small aerosols that travel a great distance. To pay my dues to the statistician, only the situations in bold were “significant,” meaning that if I did this experiment twenty times it would come out this way 19 times. But when I see a number go down (and because I am an optimist) I simply tell myself if I had just studied more patients these numbers would be significant as well.
Now look at that common cold virus, the rhinovirus; what do you think is going on there? Well if you guessed it was a super small virus you would be right! If I told you that SARS-CoV-2 was suddenly the size of a soccer ball how big do you think is the common cold virus? About the size of a tennis ball. So the next time you see some toddler walking around crying, with a red nose pouring like a firehose, just imagine its tennis balls flowing out and stand clear!
The above information is a yes/no is it found or is it not kind of experiment. But these good scientists went further. They also measured the actual number of virus particles, to get a sense of just how good a mask can be, with numbers. The Text=Table below shows the results of the experiment.
First, the nose and throat swab give you a sense of what is going on. The difference in the nose virus load and the throat is partly a timing issue, since the infection starts in the nose and only later as it spreads does it get into the throat. But there is a filtering effect and a defensive effect going on as well. Here’s an unsettling statistic: you make about 1.5 liters (50 ounces) of nasal mucous per day. Why? Because it is like the lava field in one of the Ice Age movies, where Sid, the sloth, is floating toward a cliff where the lava falls off into oblivion. In our nose, the virus is Sid and the cliff is our throat and esophagus. Very few viruses survive getting swept off the back of the nose and dropped into the hydrochloric acid bath of the stomach!
So hat’s off to the nose for getting the numbers down by a factor of 1,000 or more. The next numbers are from the air we breathe out. Repeating, these are not sneezes, where in the right light you can actually see the droplets and aerosol! This is just quiet breathing. The kind people do in restaurants, movie theatres, church, and the mall.
Without masks there are a lot of virus particles that go a few feet (droplets) or up to 27 feet (an aerosol under perfect conditions). Now, the black line shows what a simple surgical face mask (nothing fancy) does in this same setting. Seasonal coronavirus; nothing, not in droplets, and importantly, in aerosols. For clarity, this is a cousin of CoV-2 which is about the same overall size!
No wonder the CDC wanted to be sure we didn’t run out of face masks for the doctors and medical staff during the early phase of the pandemic. For influenza and that pesky rhinovirus, it isn’t perfect but it is still really good. And it is still way better than no mask at all.
The aerosol data for the rhinovirus was weird. For half of the patients there were no, zero, rhinoviruses. And for the other half it seemed to be useless compared with the no mask folks. My untested theory is that the patients with high virus loads to begin with (those with 100 million in the nasal swab, for example) in their exhaled breathe were the ones who were breaking through.
So in this one experiment, a simple surgical face mask could start with a patient with 100 million virus particle on a simple swab (I have no idea what getting 100 million virus particles on a swab means in terms of the total virus load a patient has) and over 1,000 in every exhaled breath of air, and “sterilize” their breath.
My COVID-19 Book Publishes June 5, 2020 on Amazon Kindle!
My book entitled, Your COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond, will be published as an Amazon Kindle book on June 5, 2020, and will provide my blueprint for how to move beyond this pandemic safely for you and your family. Before anyone decides to return to life outside the shelter, please read my book. It might save your life!
Your COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy during the Pandemic and Beyond
This book is chock-full of lifesaving tips you can’t find anywhere else to help you and your family stay safe while sheltering-in-place, as well as how to get back to life in the coming weeks and months.
Some highlights:
• One 2-minute step you can take every time you come home to kill Coronavirus before it enters your lungs
• A, quick, free home test for COVID-19 that is as good as the FDA-approved nasal swab
• The one exercise you won’t learn in the gym that can save your life
• How NOT to die of COVID-19 (Make your lungs younger)
• What to do if you have early stage COVID-19 so that you can stay out of the hospital
• The #1 most effective way to prevent the spread of coronavirus as we reopen society (Hint: it’s the one thing the CDC said was “NOT effective” when coronavirus hit the U.S.)
• Why a vaccine won’t be the solution, and what YOU can do to protect yourself, now and in the future
• What to eat and drink (and what to avoid) so you can prevent and beat this coronavirus
• The best supplements I have found from clinical trial research for immune health during this pandemic
• The coronavirus’ “Diabolic Trait” and how it helped the virus spread so fast
• An easy DIY step that takes your face mask from a viral barrier to a virus killer, giving you over 100-times the protection of an untreated mask
• The one blood test to ask for if you are hospitalized that can keep you off a ventilator
• Three steps to take to thrive during the next epidemic
• What is gain-of-function research and why we must ban it to prevent future pandemics
It will be available on Amazon Kindle for $4.99 starting June 5. The proceeds will be shared with Team Rubicon, a non-profit organization that serves communities by mobilizing veterans to continue their service, leveraging their skills and experience to help people prepare, respond, and recover from disasters and humanitarian crises.
I have spoken many times about the role of a clinical diagnosis of COVID-19 (cough, fever, sweats, and changes in taste or smell) which is free, repeatable, does not require a doctor’s order, can be done by a third-grader versus the expensive, one-time, slow nasal swab test for viral genetic material.
A group of scientists from none other than Johns Hopkins have confirmed my suspicions and, in fact, the test is worse than I thought. The key parameter that this test needs to have to beat my simple clinical test is a low false negative rate. After all, what some people say they need is a test that works very soon after an infection begins and then is positive for as long as a patient is shedding virus and can potentially infect others. This parameter is called the ‘False Negative’ rate and is the percent of patients who really have an infection with SARS-CoV-2 but who test negative with the nasal swab test.
The results are below and, as I said, are worse than I suspected. The graph starts at 100% False Negative on the day of infection. After all it is just the moment a person is in a room, train, plane, bar, etc. and takes a breath just as someone with COVID-19 sneezes. And for the next three days, as the infection silently builds in the nose and throat, the nasal swab test stays almost completely negative, but falsely so since the person here is really infected. Day 4 and 5 show us the test is finally working, with the False Negative rate dropping to about 70% and 40%, respectively.
But wait! What is that big red arrow on Day 5? That is the clinical symptoms of fever, cough, sweats, and changes in taste or smell finally showing up. Great you say: I have this high tech test that is no better than a third grader would do. Once the symptoms set in the test runs about a 20% False Negative Rate for the rest of the infection. Isn’t it interesting that the clinical symptom test also shows about 20% asymptomatic patients? So don’t let someone tell you that we need tests to pick up all the asymptomatic cases. (Although I suspect if you had infinite dollars you could do both and probably get the False Negative rate down to 4% or so; thinking 0.2 times 0.2 equals 0.04 if they are independent but since they probably both happen in patients with low virus loads, they will be connected and miss the same patients, so maybe 10% False Negatives).
If this summary isn’t enough for you and you want to dig in deep, the full article can be found at this link. (1)
My COVID-19 Book Publishes June 5, 2020 on Amazon Kindle!
My book entitled, COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond, will be published as an Amazon Kindle book on June 5, 2020, and will provide my blueprint for how to move beyond this pandemic safely for you and your family. Before anyone decides to return to life outside the shelter, please read my book. It might save your life!
COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy during the Pandemic and Beyond
This book is chock-full of lifesaving tips you can’t find anywhere else to help you and your family stay safe while sheltering-in-place, as well as how to get back to life in the coming weeks and months.
Some highlights:
• One 2-minute step you can take every time you come home to kill Coronavirus before it enters your lungs
• A, quick, free home test for COVID-19 that is as good as the FDA-approved nasal swab
• The one exercise you won’t learn in the gym that can save your life
• How NOT to die of COVID-19 (Make your lungs younger)
• What to do if you have early stage COVID-19 so that you can stay out of the hospital
• The #1 most effective way to prevent the spread of coronavirus as we reopen society (Hint: it’s the one thing the CDC said was “NOT effective” when coronavirus hit the U.S.)
• Why a vaccine won’t be the solution, and what YOU can do to protect yourself, now and in the future
• What to eat and drink (and what to avoid) so you can prevent and beat this coronavirus
• The best supplements I have found from clinical trial research for immune health during this pandemic
• The coronavirus’ “Diabolic Trait” and how it helped the virus spread so fast
• An easy DIY step that takes your face mask from a viral barrier to a virus killer, giving you over 100-times the protection of an untreated mask
• The one blood test to ask for if you are hospitalized that can keep you off a ventilator
• Three steps to take to thrive during the next epidemic
• What is gain-of-function research and why we must ban it to prevent future pandemics
It will be available on Amazon Kindle for $4.99 starting June 5. The proceeds will be shared with Team Rubicon, a non-profit organization that serves communities by mobilizing veterans to continue their service, leveraging their skills and experience to help people prepare, respond, and recover from disasters and humanitarian crises.
Dr. Quay announces availability of his COVID-19 Survival Manual on June 5th
Seattle, WA. Dr. Steven Quay, MD, PhD, physician-scientist and CEO of Atossa Therapeutics, Inc. (NASDAQ: ATOS) announced today that he and Dr. Martin Lee, PhD, Adjunct Professor of Statistics, UCLA Fielding School of Public Health, UCLA, Los Angeles, CA have published a manuscript entitled, “SARS-CoV-2 was spreading in the United States in late December 2019 and may have killed over 440 patients in California and 980 nationwide by mid-January.”
The study identifies a well-accepted epidemiology signal of COVID-19, internet searches for the loss of smell and/or taste, spiking in California the first two weeks of 2020, clearly indicating symptomatic patients in California at that time. The study also identifies about 980 deaths nationwide and 440 deaths in California in early January that were attributed to pneumonia and/or influenza but are likely to have been incorrectly diagnosed and are, with high probability, the first deaths from COVID-19 in the U.S.
“This study arose when I considered the origin of SARS-CoV-2 in Wuhan, China in early December, the rate and ease of human-to-human spread, especially in crowded indoor locations, and the expected annual year-end glut of holiday travel that the world experiences. From the perspective of the virus, there is no difference between spending 13 hours spreading from human to human in a traditional market in Wuhan or spending 13 hours traveling to LAX in California and spreading in Beverly Hills,” stated Dr. Quay. “This pandemic has provided a stark example of the unprecedented perils we have created by our modern world.”
Dr. Quay continued, “My book entitled, COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy During the Pandemic and Beyond, will be published as an Amazon Kindle book on June 5, 2020, and will provide my blueprint for how to move beyond this pandemic safely for you and your family. Before anyone decides to return to life outside the shelter, please read my book. It might save your life!”
COVID-19 Survival Manual: A Physician’s Guide to Keep You and Your Family Healthy during the Pandemic and Beyond
This book is chock-full of lifesaving tips you can’t find anywhere else to help you and your family stay safe while sheltering-in-place, as well as how to get back to life in the coming weeks and months.
Some highlights:
One 2-minute step you can take every time you come home to kill Coronavirus before it enters your lungs
A, quick, free home test for COVID-19 that is as good as the FDA-approved nasal swab
The one exercise you won’t learn in the gym that can save your life
How NOT to die of COVID-19 (Make your lungs younger)
What to do if you have early stage COVID-19 so that you can stay out of the hospital
The #1 most effective way to prevent the spread of coronavirus as we reopen society (Hint: it’s the one thing the CDC said was “NOT effective” when coronavirus hit the U.S.)
Why a vaccine won’t be the solution, and what YOU can do to protect yourself, now and in the future
What to eat and drink (and what to avoid) so you can prevent and beat this coronavirus
The best supplements I have found from clinical trial research for immune health during this pandemic
The coronavirus’ “Diabolic Trait” and how it helped the virus spread so fast
An easy DIY step that takes your face mask from a viral barrier to a virus killer, giving you over 100-times the protection of an untreated mask
The one blood test to ask for if you are hospitalized that can keep you off a ventilator
Three steps to take to thrive during the next epidemic
What is gain-of-function research and why we must ban it to prevent future pandemics
It will be available on Amazon Kindle for $4.99 starting June 5. The proceeds will be shared with Team Rubicon, a non-profit organization that serves communities by mobilizing veterans to continue their service, leveraging their skills and experience to help people prepare, respond, and recover from disasters and humanitarian crises.
About Steven Quay, M.D., PhD.
Steven Quay is the founder, Chairman, and CEO of Seattle-based Atossa Therapeutics, Inc. (NASDAQ: ATOS), a clinical-stage biopharmaceutical company developing novel therapeutics and delivery methods for breast cancer and other breast conditions.
Dr. Quay received his M.D., M.A. and Ph.D. from The University of Michigan, was a postdoctoral fellow at MIT with Nobel Laureate H. Gobind Khorana, a resident at the Harvard-Massachusetts General Hospital, and was on the faculty of Stanford University School of Medicine for almost a decade. He has over 300 published contributions to medicine which have been cited over 9,700 times.
Dr. Quay has founded six pharmaceutical startups, invented seven FDA-approved medicines, and holds 87 U.S. patents. Over 80 million people have benefited from the drugs he has invented. His current passion is the prevention of the two million yearly breast cancer cases worldwide. A TEDx talk he delivered on breast cancer prevention, “How to Be Smart If You’re Dense,” has been viewed over 200,000 times.
In February a study was published out of France that the very old malaria drug, hydroxychloroquine (HCQ), could inhibit the infection of cell cultures in the laboratory with the SARS-CoV-2 virus. I did an analysis of the data within 24 hours and posted a note on social media that the concentration needed for it to work in the test tube was not reached by the drug when given in normal doses. I was skeptical of it working.
But the drug developed a life of its own. It eventually received an Emergency Use Authorization from the FDA and it is likely many people are taking HCQ either to prevent the disease or to treat it if they have COVID-19. It became, the first drug in history to become a political pawn. But it is still a drug and I am still interested in the risk-benefit of treatments for important diseases, including COVID-19. So I continue to examine the benefit-risk balance of HCQ.
As a reminder, the risks of HCQ are well known as it is a very old drug. The most important risk is a dangerous, sudden heart pattern that can kill you if you are not defibrillated with the heart paddles in short order. While there is an algorithm for knowing how likely you are to have these arrhythmias (my upcoming book has a detailed discussion of how to calculate your risk) for the most part, anyone over about 65 years with a serious COVID-19 infection will be at moderate to high risk.
Today, four Harvard Medical School medical scientists stepped in to try to settle the matter but their analysis is patently wrong and because I assume they are reasonably smart I am wondering how they came to their conclusion except by the process of starting with the end in mind. That is a great way to plan a trip but a lousy way to study unknown science.
In an article published in the British Journal, The Lancet1, they pooled data from over 96,000 hospitalized patients with COVID-19 located in 671 hospitals in six continents. If I remember my geography lessons correctly this means hospitals from everywhere in the world except Antarctica! They compared the rate of heart arrhythmias and deaths for patients that were taking HCQ or its cousin drug, chloroquine (the Treatment Group) to those who were not (the Control Group).
Their results are shown here in this Text-Table.
The safety findings are very clear and damning for HCQ. The treated group had between two- and five-times more heart rhythm problems than the control group. The range of numbers is because the scientists tried to help HCQ ‘win’ by doing subgroup analyses of HCQ alone or with other drugs, etc. But it didn’t work. Any combination that included HCQ or chloroquine had more arrhythmias. The false result rate for the study was set so that the chance that this result is not correct is one out of twenty times.
As expected, when you have so many more heart arrhythmias you also have increased deaths. Can I make the picture clear? The patient is in the hospital with COVID-19, is very sick, probably on a ventilator, is taking HCQ, and suddenly their heart monitor goes off telling the ‘crash cart staff’ they need to rush to the bedside of the patient because they have about four minutes to get the heart problem corrected or the patient dies. But everyone is wearing PPE and nervous and doing a rescue takes even a little longer than it would under normal circumstances. I think you see where this ends up.
So does that settle it that HCQ doesn’t work? No! The last column above in my Table is why.
Buried in one of the tables in the paper, without any real comment by the authors, is this remarkable data point in the column titled mechanical ventilator: the patients who got HCQ or chloroquine were much more likely to be on ventilators than the control group. With this single observation, their whole paper suddenly heats to 454 Fahrenheit and burns up.
Why? Bad science. Two input variables with one output variable means you can’t say which input variable caused the output.
If you look at an outcome like arrhythmias or death and you have two input variables, one variable is being on a ventilator and the other is taking HCQ, you have no way to know which caused the outcomes. Said simply, the results also could be concluded that ventilation leads to more deaths. But writing a paper that says that patients with COVID-19 who are on mechanical ventilation die more often is hardly worthy of publication in The Lancet. But ignore that confounder and come out and say HCQ kills people and suddenly you get top billing. Strange indeed!
I am actually kind of embarrassed for them because this is a college level experimental design error although I was pleased to see that none of them were from either The University of Michigan or The Massachusetts General Hospital.
Could they have salvaged the study with the data they have? Absolutely.
All they had to do was perform what is called a Case Matched Control Study, where they use preset features to match the controls to the treated group and then redo the analysis. So here, instead of having a control group with 7.7% mechanical ventilation they make a control group with 23-25% mechanical ventilation, the rate in the HCQ treatment group, and then repeat their analysis.
I did a back of the envelope analysis myself and my take is that if you control for ventilation HCQ is either neutral or maybe a little helpful to patients. That might not get as many internet clicks but it would at least be descent science.
I still lean out on whether HCQ is beneficial for COVID-19 (if I were betting I would conclude no). But this study gets us no closer to the truth and mucks up things for true science.
