9 April 2020 – Thursday – #25

The BCG vaccine may be the phoenix rising from the ashes of the unfolding hydroxychloroquine debacle. French and Swedish hospitals have stopped administering hydorxychloroquine due to risk of cardiac arrest. On the other hand, promising statistic on BCG vaccine are emerging. “BCG, or Bacillus Calmette-Guérin, is a vaccine for tuberculosis and is administered at birth in countries that have historically suffered from the disease, such as India.” Researchers are finding that countries with BCG immunization programs have 10 times lower Covid-19 mortality rates compared to countries that don’t. Yes, ten times. Not a typo.

I always warn people that correlation is not causation, and I’m issuing that warning again. However, these BCG numbers look good to me. It’s hard to imagine another factor besides BCG vaccines that explains the vast difference in the Covid-19 mortality.

Other countries that have universal BCG vaccination include Japan, Brazil, Iran, and Portugal. Wait, Portugal?!? BCG vaccine may explain why Portugal has about 200 Covid-19 deaths while neighboring Spain has over 14,000. But wait! It turns out the Basque Country in Spain had a BCG vaccine program until 2013, too. It’s the only region in Spain that has a recent BCG program. So, are Covid-19 mortality numbers better in Basque Country than the rest of Spain?

Spanish Covid-19 mortality by region (partial list).

On a per-capita basis, I calculate that Basque Country has roughly three times lower mortality than Madrid and 20% – 25% lower mortality than Catalonia, the two hardest hit regions in Spain. So, yes, Basque Country appears to have lower Covid-19 mortality than the rest of Spain. But wait, why is Catalonia mortality so much lower than Madrid? Well, it turns out Catalonia had BCN immunization until 1974. Spanish reporting isn’t great, so take my analysis with a grain of salt. At the very least, it doesn’t contradict the BCG story. [Update 13:53 CET – BCG World Atlas says Spain adopted BCG in 1961 and stopped use in 1981, so my analysis may be incorrect. I’m checking with Spanish sources.]

Germany, which has had a mysteriously low Covid-19 mortality rate compared to Spain and Italy, also has a BCG story. The parts of Germany that were formerly in the USSR received BCG vaccinations and, as the map below shows, Covid-19 mortality is lower in those parts of Germany (lighter colors indicate lower Covid-19 mortality).

Covid-19 mortality in Germany by region (darker colors indicate higher mortality).

Covid-19 mortality varies significantly in countries that have BCG vaccination programs. This variation may be explained in part by start dates for BCG vaccine programs. Iran, which started BCG vaccinations in 1984, has a higher Covid-19 mortality than Japan, which started in 1947. Since Covid-19 mortality skews towards older people, Japan’s older population should be better protected than Iran’s, assuming boosters aren’t needed.

About 4,000 Australian hospital workers will participate in the clinical trial that will seek to determine if the tuberculosis vaccine can reduce symptoms of COVID-19, researchers at the Murdoch Institute in Melbourne said.

Euronews, 7 April 2020

The statistics for BCG vaccine look more meaningful to me than for hydroxychloroquine (there aren’t any good statistics for hydroxychloroquine, really), and it’s a lot easier to type, too. Still, it’s important for the experts to weigh in and, even if they gave the green light today, it would be months to ramp up production and work out distribution. Herd immunity for 7 billion people is a big task. BCG is too late for the first wave of Covid-19 infections, except where it’s already in use. Luckily, BCG is in use in some of the world’s most populous poor countries. If BCG pans out, it may ramp up in time to attenuate further Covid-19 mortality as people go back to work and before a vaccine is available. This would make Covid-19 look statistically more like the flu.

There are other interesting developments to track. One close in effort is to find treatments with existing statins, ARBs, and diabetes drugs. The thinking is that given the short time frame to react to a pandemic, looking for existing drugs that help a human body survive a virus like Covid-19 can improve outcomes and mortality in the relevant time frame. Hydroxychloroquine is, of course, a candidate in this vein. For reasons that aren’t clear, it is getting promoted to the detriment of other treatments that have fewer side effects without showing any clear benefit.

One long term effort is from Arrakis Therapeutics, which is working with Roche to develop medicines that target RNA. This presumably includes viruses like Covid-19.

A mid-March survey of clinical trials tracked by the US government shows that over a dozen therapies are under study. As of today, the database has 388 studies, of which 10 are complete and the rest are in various stages.

At the end of the day, it will take a Covid-19 vaccine to eradicate the virus. In the meantime, I expect to see different treatments emerge with varying degrees of effectiveness. With luck, the BCG vaccine will reduce Covid-19 mortality by 90% after the first wave of Covid-19 infections and before a Covid-19 vaccine.

So, this arrived in my inbox yesterday from the US Department of State:

Location: Spain – Level 4: Do Not Travel
Event: The U.S. Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA) warns individuals to remain vigilant for scams related to Coronavirus Disease 2019 (COVID-19). Cyber actors may send emails with malicious attachments or links to fraudulent websites to trick victims into revealing sensitive information or donating to fraudulent charities or causes. Exercise caution in handling any email with a COVID-19 related subject line, attachment, or hyperlink, and be wary of social media pleas, texts, or calls related to COVID-19. For more information regarding scams related to COVID-19, see https://www.cisa.gov/coronavirus.

People take advantage of pandemics in many ways.

One way is scam artists calling or emaiing to offer a Covid-19 testing kit. If you get a call from someone asking you to give a credit card number, that’s a clear sign you’re talking to a scammer. Even if the call sounds like it’s free, be careful.

“The coronavirus has caused the US to declare a national emergency. The Families First Coronavirus Response Act has made coronavirus testing more accessible immediately. If you want to receive a free testing kit delivered overnight to your home, press one.”

Recording of a Covid-19 scam call.

One thing I never respond to is a chain-letter because chain-letters feel like a scam to me. But then I got a Poem Exchange email from my friend Laura. I almost deleted it. Another chain letter. But I thought about it and I thought to myself, fuck it, what’s wrong with passing around a little poetry? We’re in the middle of a goddam pandemic.

I followed the directions to send a poem to one person and then forward the Poem Exchange email to a bunch of other people. I was hesitant. It wasn’t like I had a lot of other things to do with my time, but I felt a little slimy doing it. Then I thought, hey, I’m not asking for my friends’ credit cards, and pressed the Send button.

My friend Donna wrote back to thank me for the chain email, but explained she got a whole lot of these Poem Exchange emails and she didn’t like participating in chain emails. I thought to myself, wow, I got one of these Poem Exchange emails and Donna gets a whole lot of them. Maybe I have the wrong friends? But then I found out from people to whom I forwarded the Poem Exchange chain email that they, too, got a lot these emails. I don’t know how I avoided the Poem Exchange chain email for so long. I take showers. I brush my teeth.

Well, anyway, after a bit, I got a bunch of nice poetry in my inbox. Lots of poems and poets I didn’t know. I had to wait to read them, though. Poetry is not one of those things you breeze through like an email from the US State Department warning of Covid-19 scams. Poetry is a serious endeavor. It’s serious business. People spend their whole life writing this shit. So, I found a time where I could clear my mind.

Here’s the one I like best. It seemed right for the pandemic at hand and it made my eyes tear up a bit. It’s by Mary Oliver. Take a deep breath and clear your mind.

Wild Geese

You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting –
over and over announcing your place
in the family of things.

Mary Oliver

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