The Morning Jolt

World

How Much of a Risk Do Our Children Face?

Descending to the subway in Beijing, China, March 10, 2020 (Thomas Peter/Reuters)

On the menu today: the new multisystem inflammatory syndrome in children and questions about what China knew — and how much we should trust any medical data out of China; the World Health Organization accepts watered-down semi-accountability; the president tells the country he’s embracing better living through chemistry; and a new study pours a bit more cold water on the “wet market” theory of the virus’s emergence.

We Need More Information from China, and Quickly

Late last week, the Centers for Disease Control and Prevention issued a health alert about a “recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).” The syndrome is described as “severe inflammatory responses with Kawasaki disease-like features” — a high fever that lasts, abdominal pain so serious some parents initially think it’s a burst appendix, and for many kids, diffuse rashes.

The good news is that this inflammatory response is still pretty rare — a couple hundred cases in a country with about 50 million kids under age twelve — and fatal reactions are rare among those who catch this syndrome. Most of the kids seem to heal just fine. But one of the few silver linings of this virus in the early months of this pandemic had been the belief that children were not vulnerable to it. This inflammatory syndrome is the sort of factor that greatly complicates decisions about reopening schools in the fall and whether to go ahead with any summer programs.

A couple of days ago, the Washington Post’s Josh Rogin offered one of the most disturbing and unnerving thoughts since the beginning of this crisis: “Either the Chinese government knew nothing about the delayed effects COVID19 has on children (which seems unlikely) or they knew about it but didn’t tell us. We must find out which of these is true.”

It is possible that all data about the coronavirus we get out of China will be suspect. There’s simply too much distrust, driven in large part by the fact that Wuhan authorities and Chinese government insisted the virus could not be spread from person to person until January 20, weeks after doctors on the ground knew it was contagious.

But there are other odd incongruencies between the public conclusions of Chinese doctors and ones elsewhere. Back on April 23, Chinese doctors “inadvertently posted” a “draft manuscript” of a clinical study in that country declaring that the drug remdesivir was “not associated with a difference in time to clinical improvement” among coronavirus patients.

But a week later, White House health advisor Dr. Anthony Fauci announced that data from trial testing of remdesivir showed “quite good news” and sets a new standard of care for COVID-19 patients. He said that while the mortality rate wasn’t dramatic — 8 percent for the group receiving remdesivir versus 11.6 percent for the placebo group — the study revealed a “clear-cut positive effect in diminishing time to recover.”

Did the Chinese study just have different results from the luck of the draw of the patients they studied? Or did some people in China want to downplay the effectiveness of a drug manufactured by Gilead in La Verne, Calif.?

This is a big question that will only get bigger in the months ahead. Doctors at the University of Beijing’s Advanced Innovation Center for Genomics think they have isolated, identified, and developed antibodies that will work as both a treatment and temporary vaccine. (Researchers at the American pharmaceutical company Sorrento Therapeutics think they’ve made a comparable breakthrough.)

At some point soon, the Chinese government is going to declare that they have a vaccine. Does the world embrace it? Or do other countries regard a Chinese vaccine warily, wondering if it’s as unreliable as the 10 million defective tests, masks, and medical equipment that China shipped in the opening months of the pandemic?

Then there’s this study of Wuhan residents, suggesting that achieving “herd immunity” would take a long, long time to complete:

While strict lockdown measures in China’s outbreak epicentre Hubei province helped break the chain of local transmission, people in cities like Wuhan could be vulnerable to a second wave of infections because there is a low level of antibodies in the population. A study of 11,000 residents of Wuhan in April found that 5 to 6 per cent tested positive for coronavirus antibodies, Caixin reported last week.

“Lots of people in China have no background immunity and would be at risk if there is a second wave,” Mr Hui said.

Five months after the outbreak, the initial epicenter has just 5 or 6 percent exposure?

If there’s any spot in the world you would think people would have high levels of antibodies, it would be a hospital in Wuhan, right? Apparently not: “Wuhan’s Zhongnan Hospital found that 2.4 percent of its employees and 2 percent to 3 percent of recent patients and other visitors, including people tested before returning to work, had developed antibodies, according to senior doctors there.”

Why do so many studies that come out of China make so little sense?

We Know WHO Can’t Be Trusted

Today at the World Health Assembly — the meeting of member nations of the World Health Organization — a majority of member states are expected pass a somewhat watered-down resolution introduced by Australia calling for an “impartial, independent and comprehensive evaluation, including using existing mechanisms, as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to Covid-19.” The resolution does not specifically mention China and should proceed “at the earliest appropriate moment.”

Some corners of the Australian press are taking a victory lap: “While the wording of the draft resolution did not specifically refer to China or to Wuhan, it was broadly in line with what [Prime Minister] Scott Morrison and others have been advocating.

It is difficult to get too excited. WHO’s director-general, Tedros Adhanom Ghebreyesus, will still be the one ultimately responsible for overseeing the investigation that will review his own actions. If any of our progressive friends wonder why so many Americans have so little faith in international organizations, a World Health Organization that prioritizes keeping Beijing happy over, you know, world health is as powerful an example as you can find. All coalitions face internal conflicts and pressures; effective ones manage to remember and prioritize the original priority of the coalition in the face of internal disagreement. Ineffective coalitions let “maintaining the coalition” turn into the primary activity and priority of the coalition.

The fact that there appears to be no serious talk of replacing Tedros is a clear sign that despite the weekend’s leaks of internal criticism, too many people within the World Health Organization see their institutional reputation as inseparable from Tedros’s reputation. If the director-general announced he intended to step down once the pandemic was under control, we could at least hope that the next director-general would have the right priorities and be willing to stand up to China when circumstances warrant.

The assembly kicked the can down the road on the question of whether to allow a delegation from Taiwan attend as an observer. You could make the argument that Taiwan has handled the pandemic better than anyone: “Despite its proximity to China, Taiwan has only reported 440 coronavirus cases and seven deaths so far even without a large-scale lockdown.

You may recall James Griffiths, a producer and commentator at CNN, writing at the end of April that China had handled the outbreak better than the United States, earning him plenty of criticism. Griffith’s latest on the WHO meeting at least acknowledges that “the pandemic has left China in one of its most vulnerable positions in terms of global influence, with criticism from multiple directions, not just traditional rivals like the US, but also countries with which Beijing has had strong ties in the past. One only need look at the never before seen levels of public support for Taiwan around the world to see how China’s clout is considerably weakened.”

We Pay More Attention to What Trump Says Than to What Trump Does

I guess we’re all arguing about hydroxychloroquine again, huh?

Even though the letter from Sean Conley, physician to the president, only says “we concluded the potential benefit of the treatment outweighed the relative risks” and doesn’t actually say that Conley prescribed or that the president is taking it. Or when the president started taking the medication.

I’ve read the medical journal articles; one of the central takeaways, which I relayed in an article earlier this month, is that chloroquine and hydroxychloroquine actually slow down parts of a patient’s immune system by making the cells not work as well together. This is actually desirable if the patient is in a “cytokine storm” — when the body’s immune system kicks into overdrive and starts attacking healthy cells in important organs.

Yes, I’ve seen the arguments that hydroxychloroquine helps the body absorb zinc, resulting in a stronger immune system; you can read a not-yet-peer-reviewed paper here, about an ongoing clinical trial here, a new NIH clinical trial here, and an encouraging study from NYU here. All of these studies are on people who have already caught COVID-19, not as a preventative treatment.

From a WebMD article last month:

“My concern about the drug in the pre-infection state or the infected state is that they block the innate immune pathways that may allow the immune system to detect virus and to start a response against it,” says Art Krieg, who has spent decades studying this process. He sees both drugs as likely to be more useful to treat late stages of the disease, as has been done in China and elsewhere.

Krieg, founder and chief scientific officer of Checkmate Pharmaceuticals, a Cambridge, MA-based startup developing immune treatments for cancer, says he’s particularly worried about health care workers and others who may try these drugs outside of clinical trial. Without a trial, he says, they won’t know if the drug is actually increasing their risk of severe infection.

One of the extraordinarily frustrating aspects of this public argument is the number of people who insist chloroquine or hydroxychloroquine must be either a wonder drug or absolutely useless; a disturbing number of people cannot seem to grasp that a treatment could work for certain patients in certain circumstances and not others.

I suspect my readership is far too smart to ever take an unacceptable risk, but just in case you know anyone who’s a quart low in the common-sense department, do not ingest prescription medication without consulting a doctor. Even if the President of the United States insists a drug is super-duper terrific and he’s taking it himself.

ADDENDUM: An intriguing new study, spotlighted by the Daily Mail:Phylogenetic tracking suggests that SARS-CoV-2 had been imported into the market by humans.” The short version is that samples of the virus taken from the market in January 2020 look more like SARS at the latter stages of the 2003-2004 outbreak than the viruses at the beginning of the outbreak. In other words, the viruses at the market early on looked like they had already adapted to beat a human being’s immune system.

This doesn’t completely eliminate the possibility of the virus emerging from the wet market . . . but it’s another piece of counter-evidence. This study points in the direction of a human being who had the virus coming to the market and spreading it, not some undercooked bat or pangolin.

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