Category Archives: healthcare

Tale of a fast, accurate home COVID test

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My son works at a company called Homodeus. It’s part of 4Catalyzer, an umbrella of seven medical biotechnology companies with a staff of 300 scientists and engineers. One of the Homodeus products, still waiting FDA guidance is a COVID-19, RNA self-tester called Homodeus Detect. It tests for COVID RNA directly, not for antibodies, with tests are much faster than hospital tests, taking 45 minutes, but more complex than the unreliable test strips. So far, the Detect tests have shown no false positives or false negatives. That would suggest 100% reliable, except but there are a fair number of invalid tests. The invalid tests are lares due to the complexity, and also to the fact that you are testing snot, essentially. There is no blood-taking involved, unlike with the test strips, but  just a nasal swab, and the cost is moderate, about $35 per test. However you have to do some lab work. After you swab your nose, you put the swab in a heated liquid bath where chemicals break up the snot and dissolve the shells on any viruses or pollen present. After 30 minutes, you pass the liquid onto a detector strip that contains a conjugate protein that binds to SARS-CoV-2 RNA. Your answer appears 15 minutes later as one of three lines: one for positive, one for negative, or one indicating an invalid test. Invalid tests show up more often than they like, about half the time, especially when the test is done by amateurs. 

Getting an invalid test result is a downside of the current product, but I don’t think it should prevent sales. You get better at doing the test, and speed and lack of false positives and negatives is a bigger plus. It seems worthwhile to fast-track offer this test for doctors offices and hospital admissions, at least. I’d also like to see it used for airplane boarding and interstate travel, so that a person traveling might avoid the two week quarantine that many states impose. I’d certainly pay $200 or more to avoid a two-week quarantine, and if I have to do a second or third test, I’d do that too. 

At least some people realize it’s a big advantage to know if you are currently infections.

Because this test measures virus RNA, and not antibodies, it indicates infection virtually as soon as you’re infected. That’s a benefit for those wishing to fly, or to meet with people, an advantage that is not lost on Elon Musk at least (see tweet). The test also shows negative as soon as the virus is gone, and that’s big. In recent months the FDA has fast-track approved an antibody indicating test from Abbott Labs, but that test has many false readings and only indicates infection several days afterward, and it does not indicate when you are no longer infectious. 

The FDA has not offered to fast track this test, or any other like it for approval. They have not even indicated what sort of reporting and privacy requirements they want, so things sit in limbo, both for Homodeus, and for competing companies. Here is a story in USA today: https://www.usatoday.com/story/news/2020/07/29/fda-opens-door-rapid-home-covid-19-tests/5536528002. One big issue that the FDA is contact tracing. The FDA would like to be able to trace all the contacts of anyone who tests positive, while maintaining privacy as demanded by the 4th Amendment.

One way around the 4th amendment concerns would be to require anyone who uses the test to sign a waiver allowing the government to trace their contacts. Alternately there could be a block-chain enabled app that would come with the test. An app coms already providing a timer for when to move to the next step, and it includes a machine-vision system to help analyze dim lines on the indicator. Perhaps the FDA would accept block chain as a way to allow full reporting while maintaining privacy The FDA has yet to provide guidance on what they want, though. Without guidance or fast-track approval, things sit in limbo. Here is a scathing legal analysis from the Yale Law Journal.

You can get a free test, but have to do it at Homodeus headquarters in Guilford, Connecticut. It’s free, and results appears in about 45 minutes.. Homodeus has been manufacturing the test in quantity; if you are interested, use the following link to sign up: https://www.homodeusinc.com/research. Healthcare providers are particularly welcome.

The Homodeus detect test kit. Picture from this article in the New Haven Register.

Why did the FDA fast-track approve Abott’s antigen/ antibody test. Maybe because the tests rethought to not lead to lower mask use. Alternately, Abott has more political pull. You can read the FDA’s explanation here. In my biassed opinion the Homodeus product is good enough to fast track especially for hospitals and healthcare providers. It could save lives while allowing the economy to reopen.

Robert Buxbaum, November 15, 2020 (with massive help from Aaron M. Buxbaum)

Pneumonia vaccine in the age of COVID

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A few days ago, I asked for and received the PCV-13 pneumonia vaccine, and a few days earlier, the flu shot. These vaccines are free if you are over 65, but you have to ask for them. PCV-13 is the milder of the pneumonia vaccines, providing moderate resistance to 12 common pneumonia strains, plus a strain of diphtheria. There is a stronger shot, with more side-effects. The main reason I got these vaccines was to cut my risk from COVID-19.

Some 230,00 people have died from COVID-19. Almost all none of them were under 20, and hardly any died from the virus itself. As with the common flu, they died from side infections and pneumonia. Though the vaccine I took is not 100% effective against event these 13 pneumonias, it is fairly effective, especially in the absence of co-morbidities, and has few side effects beyond stiffness in my arm. I felt it was a worthwhile protection, and further reading suggests it was more worthwhile than I’d thought at first.

It is far from clear there will be a working vaccine for SARS-CoV-2, the virus that causes COV-19. We’ve been trying for 40 years to make a vaccine against AIDS, without success. We have also failed to create a working vaccine for SARS, MERS, or the common cold. Why should SARS-CoV-2 be different? We do have a flu vaccine, and I took it, but it isn’t very effective, viruses mutate. Despite claims that we would have a vaccine for COVID-19 by early next year, I came to imagine it would not be a particularly good vaccine, and it might have side effects. On the other hand, there is a fair amount of evidence that the pneumonia vaccine works and does a lot more good than one might expected against COVID-19.

A colleague of mine from Michigan State, Robert Root Bernstein, analyzed the effectiveness of several vaccines in the fight against COVID-19 by comparing the impact of COVID-19 on two dozen countries as a function of all the major inoculations. He found a strong correlation only with pneumonia vaccine: “Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.” Root-Bernstein also looked at the effectiveness of adult inoculation and child inoculation. Both were effective, at about the same rate. This suggests that the the plots below are not statistical flukes. Here is a link to the scientific article, and here is a link to the more popular version.

An analysis of countries in terms of COVID rates and deaths versus pneumonia vaccination rates in children and adults. The US has a high child vaccination rate, but a low adult vaccination rate. Japan, Korea, etc. are much better. Italy, Belgium, Spain, Brazil, and Peru are worse. Similar correlations were found with child and adult inoculation, suggesting that these correlations are not flukes of statistics.

I decided to check up on Root-Bernstein’s finding by checking the state-by state differences in pneumonia vaccination rates — information available here — and found that the two US states that were hardest hit by COVID, NY and NJ, have among the lowest rates of inoculation. Of course there are other reasons at play. These states are uncommonly densely populated, and the governments of both made the unfortunate choice of sending infected patients to live in old age homes. At least half of the deaths were in these homes.

Pneumonia vaccination may also explain why the virus barely affected those under 20. Pneumonia vaccines was available only in 2000 or so. Many states then began to vaccinate about then and required it to attend school. The time of immunization could explain why those younger than 20 in the US do so well compared to older individuals, and compared to some other countries where inoculation was later. I note that China has near universal inoculation for pneumonia, and was very mildly hit.

I also took the flu shot, and had taken the MMR (measles) vaccine last year. The side effects, though bad, are less bad than the benefits, I thought, but there was another reason, and that’s mimicry. It is not uncommon that exposure to one virus or vaccine will excite the immune system to similar viruses, so-called B cells and T-cell immunity. A recent study from the Mayo Clinic, read it here, shows that other inoculations help you fight COVID-19. By simple logic, I had expected that the flu vaccine would help me this way. The following study (from Root-Bernstein again) shows little COVID benefit from flu vaccine, but evidence that MMR helps (R-squared of 0.118). Let men suggest it’s worth a shot, as it were. Similar to this, I saw just today, published September 24, 2020 in the journal, Vaccines, that the disease most molecularly similar to SARS-CoV-2 is pneumonia. If so, mimicry provides yet another reason for pneumonia vaccination, and yet another explanation for the high correlations shown above.

As a final comparison, I note that Sweden has a very high pneumonia inoculation rate, but seems to have a low mask use rate. Despite this, Sweden has done somewhat better than the US against COVID-19. Chile has a low inoculation rates, and though they strongly enforced masks and social distance, it was harder hit than we were. The correlation isn’t 100%, and masks clearly do some good, but it seems inoculation may be more effective than masks.

Robert Buxbaum, November 7, 2020.

Hand washing and masks help, just not that much.

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There are two main routes for catching flu. One is via your hands and your eyes and nose. Your hands pick up germs from the surfaces you touch, and when you touch your eyes or nose passages, the germs infect you. This was thought to be the main route for infection, and I still think it is. I’d been pushing iodine hand sanitizer for some time, the stuff used in hospitals, saying that that the alcohol hand sanitizer doesn’t work well, that it evaporates.

The other route, the one touted by the press these days is via direct cough droplets, breathing them in or getting them in your eyes. Masks and face shields are the preferred protection from this route, and the claim is that masks will stop 63% of the spread. The 63% number has an interesting history, it comes from this test with infected hamsters. Hamsters are 63% less likely to infect other hamsters when they wear a mask. Of course, the comparison has some weaknesses: hamsters don’t put their fingers in their noses, nor do they rub their eyes with their hands, and hamsters can be forced to keep the mask barrier all the time — read the study to see how.

A more realistic study, or more relevant to people, in my opinion showed a far lower effect for masks, about 20%. During the HiNi flu pandemic of 2009 a group of 1437 college students at a single university were divided into three randomized groups, see the original report here. Students at a few chosen residence halls were instructed to wash their hands regularly, use sanitizer, and wear masks. Students at other halls were either told to wear masks only, or told to go on as they pleased. This was the largest group, the control. They included students of the the largest residence hall on campus. The main results appear as the graph below, Figure 1 of the report. It shows a difference of 6% or 20%, depending on how you look at things, with the mask plus hand-health group, MPHH, doing the best.

After 6 weeks of monitoring, approximately 36% of the control group had gotten the flu or some collection of flu symptoms. The remaining 64% of the residents remained symptom free. This is he darkest line above.

Of the FM Only group, the medium line above, those instructed to wear face masks only. 30% of this group showed flu symptoms, with 70% remaining symptom free. Clearly masks do help with humans, but far less than what you’d expect from the news reports.

Sweden kept the primary schools open and allows people to wear masks and social distance at they see fit. The death toll to August 1 is identical to Michigan, or slightly bette Sweden’s top virologist recommends that the US follow suit. Open up and trust people.

The group that did best was FMHH, the group who both wore facemarks and used hand health, regular hand washing plus hand sanitizer. This group reported an average of 3.5 hours per day of mask use above the control group average. This is about as good or better than I see in Michigan. Adding the hand health provided an additional 1% improvement, or a 3% improvement, depending on how you look at these things. The press claims hand health is wasted effort, but I’m not so sure. I argue that the effect was significant, and that the hand sanitizer was bad. I argue that iodine hand wash would have done better at far less social cost.

I also note that doing nothing was not that much worse than mask use. This matches with the observation of COVID-19 in Sweden. With no enforced social distancing, Sweden did about the same as Michigan — slightly better, despite Michigan closing the schools and restaurants, and imposing some of the toughest requirements for social distancing and mask use.

Other things that affect how likely you are to get flu symptoms. I find these rustles more interesting than the main face-mask result.

There were other observations from the university study that i found isignificant. There are racial differences and social differences. The authors didn’t highlight these, but they are at least as large as the effect of mask use. Asians got the flu only 70% as often as others, while black students got it 8% more often. This matches what has been seen in the US with COVID-19. Also interesting, those with a recent flu shot got flu more often; those with physical activity 13% more often. Smokers got the flu less than non-smokers and women got it 22% more often than men. The last two are the reverse with COVID-19. I could speculate on the reasons, but clearly there is a lot going on.

Why did Asians do better than others? Perhaps Asians have had prior exposure to some similar virus, and are thus slightly immune, or perhaps they used the masks more, being more socially acceptable. Why were smokers protected? It’s likely that smoke kills germs; was that the cause. These are speculations, and as for the rest I don’t know.

I am not that bothered that the students probably didn’t wear their masks 100% of the time. Better would be better, but even with mask use 100% of the time, there are other known routes that are almost impossible to remove: clothing, food, touching your face. I still think there is a big advantage to iodine hand wash, and I suspect we would be better off opening up a bit too.

Robert Buxbaum August 7, 2020.

Sweden v Michigan: different approaches, same outcome.

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Sweden has scientists; Michigan has scientists. Sweden’s scientists said to trust people to social distance and let the COVID-19 disease run its course. It was a highly controversial take, but Sweden didn’t close the schools, didn’t enforce masks, and let people social distance as they would. Michigan’s scientists said to wear masks and close everything, and the governor enforced just that. She closed the schools, the restaurants, the golf courses, and even the parks for a while. In Michigan you can not attend a baseball game, and you can be fined for not wearing a mask in public. The net result: Michigan and Sweden had almost the same death totals and rates, as the graphs below show. As of July 28, 2020: Sweden had 5,702 dead of COVID-19, Michigan had 6,402. That’s 13 more dead for a population that’s 20% smaller.

Sweden’s deaths pre day. There are 5,702 COVID dead since the start, out of a population of 10.63 million. There are 79,494 confirmed COVID cases, but likely a lot more infected.

Sweden and Michigan are equally industrial, with populations in a few dense cities and a rural back-country. Both banned large-scale use of hydroxy-chloroquine. Given the large difference in social distance laws, you’d expect a vastly different death rate, with Michigan’s, presumably lower, but there is hardly any difference at all, and it’s worthwhile to consider what we might learn from this.

Michigan’s deaths pre day. There are 6,426 COVID dead since the start, out of a population of 9.99 million. There are 88,025 confirmed COVID cases, but likely a lot more infected.

What I learn from this is not that social distance is unimportant, and not that hand washing and masks don’t work, but rather it seems to me that people are more likely to social distance if they themselves are in control of the rules. This is something I also notice comparing freezer economies to communist or controlled ones: people work harder when they have more of a say in what they do. Some call this self -exploitation, but it seems to be a universal lesson.

Both Sweden and the US began the epidemic with some moderate testing of a drug called hydroxychloroquine (HCQ)and both mostly stopped in April when the drug became a political football. President Trump recommended it based on studies in France and China, but the response was many publications showing the didn’t work and was even deadly. Virtually ever western country cut back use of the drug. Brazil’s scientists objected — see here where they claim that those studies were crooked. It seems that countries that continued to use the drug had fewer COVID deaths, see graph, but it’s hard to say. The Brazilians claim that the anti HCQ studies were politically motivated, but doctors in both Sweden and the US largely stopped prescribing the drug. This seems to have been a mistake.

US hospitals stopped using HCQ in early April almost as soon as Trump recommended it. Sweden did the same.

In July, Henry Ford hospitals published this large-scale study showing a strong benefit: for HCQ: out of 2,541 patients in six hospitals, the death rate for those treated with HCQ was 13%. For those not treated with HCQ, the death rate was more than double: 26.4%. It’s not clear that this is cause and effect. It’s suggestive, but there is room for unconscious bias in who got the drug. Similarly, last week, a Yale researcher this week used epidemiological evidence to say HCQ works. This might be proof, or not. Since epidemiology is not double-blind, there is more than common room for confounding variables. By and large the newspaper experts are unconvinced by epidemiology and say there is no real evidence of HCQ benefit. In Michigan and Sweden the politicians strongly recommend continuing their approaches, by and large avoiding HCQ. In Brazil, India and much of the mideast, HCQ is popular. The countries that use HCQ claim it works. The countries that don’t claim it does not. The countries with strict lock-down say that science shows this is what’s working. The countries without, claim they are right to go without. All claim SCIENCE to support their behaviors, and likely that’s faulty logic.

Hydroxychloroquine and COVID-19 fatality rates in different countries as of early June 2020. This isn’t enough to prove HCQ effectiveness, but it’s promising, and suggests that increased use is warranted, at least among those without heart problems.

Given my choice, I’d like to see more use of HCQ. I’m not sure it works, but I’m ,sure there’s enough evidence to put it into the top tier of testing. I’d also prefer the Sweden method, of nor enforced lockdown, or a very moderate lockdown, but I live I’m Michigan where the governor claims she knows science, and I’m willing to live within the governor’s lockdown.There is good, scientific evidence that, if you don’t you get fined or go to jail.

Robert Buxbaum, July 29, 2020. As I side issue, I think iodine hand wash is a good thing. I may be wrong, but here’s my case.

Brazilian scientists speak out for hydroxychloroquine

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Brazil has decided to go its own route in response to the Corona virus pandemic. They’re using minimal social distancing with a heavy reliance on hydroxychloroquine (HCQ), a cheap drug that they claim is effective (as has our president). Brazil has been widely criticized for this, despite so far having lower death rate per million than the US, Canada, or most of Europe. In an open letter, copied in part below, 25 Brazilian scientists speak out against the politicalization of science, and in favor of their approach to COVID-19. The full letter (here). The whole letter is very worth reading, IMHO, but especially worthwhile is their section on hydroxychloroquine (HCQ), copied below.

….. Numerous countries such as the USA, Spain, France, Italy, India, Israel, Russia, Costa Rica and Senegal use the drug (HCQ) to fight covid-19, whereas other countries refrain from using HCQ as one of the strategies to contain the pandemic, betting on other controversial tactics.

Who then speaks here in the name of “science”? Which group has a monopoly on reason and its exclusive authorization to be the spokesperson of “science”? Where is such authorization found?One can choose an opinion, and base his strategy on it, this is fine, but no one should commit the sacrilege of protecting his decision risking to tarnish with it the “sacred mantle of science”.

Outraged, every day I hear mayors and governors saying at the top of their lungs that they “have followed science”. Presidents of councils and some of their advisers, and of academies and deans in their offices write letters on behalf of their entire community, as if they reflect everyone’s consensual position. Nothing could be more false.Have they followed science? Not at all! They have followed the science wing which they like, and the scientists who they chose to place around them. They ignore the other wing of science, since there are also hundreds of scientists and articles that oppose their positions and measures.

Worse, scientists are not angels. Scientists are people, and people have likes and dislikes, passions and political party preferences. Or wouldn’t they? There are many scientists, therefore, who do good without looking at whom, I know and admire many of them. But there are also pseudoscientists who use science to defend their opinion, their own pocket, or their passion. Scientists have worked and still work hard and detached to contribute to the good of humanity, many of whom are now in their laboratories, risking their lives to develop new methods of detecting coronavirus, drugs and vaccines, when they could stay “safe at home”. But, to illustrate my point, I know scientists who have published articles, some even in major journals such as “Science” or “Nature”, with data they have manufactured “during the night”; others who have removed points from their curves, or used other similar strategies. Many scientists were at Hitler’s side, weren’t they? Did they act in the name of “science”? Others have developed atom bombs. Others still develop chemical and biological weapons and illicit drugs, by design.

The Manaus’ study with chloroquine (CQ) performed here in Brazil and published in the Journal of the American Medical Association (JAMA) [1], is emblematic to this discussion of “science”. Scientists there used, the manuscript reveals, lethal doses in debilitated patients, many in severe conditions and with comorbidities. The profiles of the groups do not seem to have been “randomized”, since a clear “preference” in the HIGH DOSE group for risk factors is noted. Chloroquine, which is more toxic than HCQ, was used, and it seems that they even made “childish mistakes” in simple stoichiometric calculations, doubling the dosage with the error. I’m incapable of judging intentions, but justice will do it. The former Brazilian Health Minister Luiz Henrique Mandetta quoted this study, supported it, and based on it, categorically stated: “I do not approve HCQ because I am based on ‘science, science, science’!”.

Another study published by Chinese researchers in the British Medical Journal (BMJ) and which is still persistently used against HCQ was also at least revolting [2]. In it, the authors declared: “we administer 1,200 mg for 3 days, followed by 800 mg for 12 to 21 days, in patients with moderate to severe symptoms”. In other words, they gave a huge dosage of the drug that could reach the absurdity of 20 grams in the end, and it given was too late to patients (HCQ should be administered in the first symptoms or even earlier). And even worse, overdosing on HCQ or any other drug for severe cases is poisonous. What do you think, was it good science? The recommended dosage in Brazil, since May 20th, 2020, by the new Ministry of Health, for mild symptoms is 2 times 400 mg in the first day (every 12 hours) and 400 mg for 5 days for a total of 2.8 grams.

In other published studies, also in these internationally renowned journals such as The New England Journal of Medicine, JAMA and BMJ [3-5], once again, “problems” are clearly noted, since or the patients were randomized in irregular ways, placing older, more susceptible or most severe and hypoxemic patients in the higher (lethal) dose groups, or more men (almost 3 times more deadly by covid than women), or more black people (in the USA, black people have displayed higher mortality) and more smokers, and where most of the deaths occurred in the first days of the studies (signs that were deaths of critically ill patients, who at this stage would be more “intoxicated” than “treated” with HCQ), or they administered HCQ isolated, when it is known that it is necessary to associate HCQ at least with azithromycin. One of these studies [5] administered HCQ only on the sixteenth day of symptoms (for really early treatment, HCQ administration should be started up to fifth day), in other words, at the end of the disease, when the drug can do little good or nothing to the patient.

These studies indicate that some scientists either forgot how “science” is done or that there is a huge effort to disprove, whatever it takes, that HCQ works. How can someone or even Councils and Academies of Medicine cite such studies as the “science” of their decisions? How can that be?

On the contrary, the study published – and today with more than 3 thousand patients tested – and carried out by Dr. Didier Raoult in France [6], using the correct dosage and at the right time, with a very low mortality rate (0.4%), and the Prevent Senior’s clinical experience in Brazil – also quite encouraging – are disqualified with very “futile” arguments such as: “Didier Raoult is a controversial and unworthy researcher”, “At Prevent Senior Clinic they were not sure of the diagnosis” (but none of the hospitalized patients with clear COVID symptoms died), “Placebo effect” (what a supernatural power of inducing our mind that reduces mortality from 40% to zero, I want this placebo!), “Study performed by a health plan company” (I do not doubt that this people indeed want to save lives, because the patients were their customers who pay their bills), and similar ephemeral arguments.…

The Brazilian scents who signed the letter. Read the whole letter here.

I admire the spunk of these fellows going agains the doctors, WHO. Beyond being a critique of bad research on a particular drug, it is a defense of science. Science is a discussion, a striving for truth. It is not supposed to demand blind allegiance to a few politically appointed experts. They’ve convinced me that the tests sponsored by the world health organization seem designed to show failure, and reminded me that there is rarely a one-size-fits-all for problems and all times.

I also find striking the highly critical response of my local newspapers and TV reporters. While they both like to highlight efforts by South America as they try entering the first world, with help from Bill gates and leftist politicians, they have been uniformly condemned Brazil for its non-left approach and now for use of HCQ. They want Sous Americans to think, but only if their conclusions are no different from those of their favorite, liberal thinkers.

Robert Buxbaum, May 28, 2020. Check out my notes on how to do science right. And by the way, you might want to use iodine hand wash to minimize your chance of getting or spreading COVID and other diseases.

Iodine is far better than soap or alcohol sanitizer.

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I’m a fan of iodine both as a hand sanitizer, and as a sanitizer for surfaces. II’ve made gallons of the stuff for my own use and to give away. Perhaps I’ll come to sell it too. Unlike soap washing or alcohol sanitizer, iodine stays on your hands for hours after you use it. Alcohol evaporates in a few seconds, and soap washes off. The result is that iodine retains killing power after you use it. The iodine that I make and use is 0.1%, a concentration that is non-toxic to humans but very toxic to viruses. Here is an article about the effectiveness of iodine against viruses and bacteria Iodine works both on external surfaces, and internally, e.g. when used as a mouthwash. Iodine kills germs in all environments, and has been used for this purpose for a century.

With normal soap or sanitizer it’s almost impossible to keep from reinfecting your hands almost as soon as you wash. I’ve embedded a video showing why that is. It should play below, but here’s the link to the video on youtube, just in case it does not.

The problem with washing your hands after you receive an item, like food, is that you’re likely to infect the sink faucet and the door knob, and the place where you set the food. Even after you wash, you’re likely to re-infect yourself almost immediately and then infect the towel. Because iodine lasts on your hands for hours, killing germs, you have a good chance of not infecting yourself. If you live locally, come by for a free bottle of sanitizer.

For those who’d like more clinical data to back up the effectiveness of iodine, here’s a link to a study, I also made a video on the chemistry of iodine relevant to why it kills germs. You might find it interesting. It appears below, but if it does not play right, Here’s a link.

The video shows two possible virus fighting interactions, including my own version of the clock reaction. The first of these is the iodine starch interaction, where iodine bonds forms an I<sub>3</sub><sup>-</sup> complex, I then show that vitamin C unbinds the iodine, somewhat, by reducing the iodine to iodide, I<sup>-</sup>. I then add hydrogen peroxide to deoxidize the iodine, remove an electron. The interaction of vitamin C and hydrogen peroxide creates my version of the clock reaction. Fun stuff.

The actual virus fighting mechanism of iodine is not known, though the data we have suggests the mechanism is a binding with the fatty starches of the viral shell, the oleo-polysaccharides. Backing this mechanism is the observation that the shape of the virus does not change when attacked by iodine, and that the iodine is somewhat removable, as in the video. It is also possible that iodine works by direct oxidation, as does hydrogen peroxide or chlorine. Finally, I’ve seen a paper showing that internal iodine, more properly called iodide works too. My best guess about how that would work is that the iodide is oxidized to iodine once it is in the body.

There is one more item that is called iodine, that one might confuse with the “metallic” iodine solutions that I made, or that are sold as a tincture. These are the iodine compounds used for CAT-scan contrast. These are not iodine itself, but complex try-iodo-benzine compounds. Perhaps the simplest of these is diatrizoate. Many people are allergic to this, particularly those who are allergic to sea food. If you are allergic to this dye, that does not mean that you will be allergic to a simple iodine solution as made below.

The solution I made is essentially 0.1% iodine in water, a concentration that has been shown to be particularly effective. I add potassium iodide, plus isopropyl alcohol, 1%, 1% glycerine and 0.5% mild soap. The glycerine and soap are there to maintain the pH and to make the mix easier on your hands when it dries. I apply 5-10 ml to my hands and let the liquid dry in place.

Robert Buxbaum April 27, 2020; I’m running for water commissioner again. Wishing you a safe and happy lockdown,

Virus and cancer treatment by your immune system

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There are two standard treatments for a disease. One is through a chemical, pill or shot, often using a patented antibiotic or antiviral molecule, sometimes a radioactive chemical or anti-inflammatory. There have been quite a lot of success with these molecules especially against bacterial disease. E.g. penicillin, a molecule found in cheese, was quite effective against infection, syphilis, and even the viral disease, rabies. Still, in surprisingly many cases, a molecule that you’d expect should cure a disease does not. For this reason, recent research has looked into the other approach to a cure — use your own immune system.

In the most basic version of this approach, that of Paracelcius, is to give the patient nothing beyond sunshine, a clean dressing, and good food. In surprisingly many cases, this is enough to allow the patient’s own immune system will fight the disease successfully. Currently, this seems like our best option to fight COVID-19, the new Wuhan coronavirus.; antivirals seem to have no particular effect on COVID-19, as with rabies, but patients do get better on their own with time, and there is some indication that sunlight helps too, at least in fighting the disease spread, and perhaps in effecting a cure.

Your immune system is remarkably flexible. When it is up to the task, as in the video below white blood cells multiply enormously around the invader and attack. The white cells do not harm your body cells nor those of friendly bacteria, but rally to kill nearly any invader, even one the cells have never seen before. There is a minimum of side effects (fever, tiredness) but these go away after the invader is gone. The immune system then keeps the memory of the invader alive via “Memory T cells” so that it can attack more quickly if the same invader is seen again. This is what we call immunity, and it’s a type of protection that you generally don’t get from pills.

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Unfortunately, not every disease is fought well by the immune system alone. Measles, for example, or smallpox. For several of these diseases we’ve found we can activate the patient’s immune system with a vaccination, even after the patient contacts the disease. An injection of a weaker form of the disease seems to help kick-start the patients own immune system. Vaccination tends to have bad side-effects, but for many diseases, e.g. measles, the bad is outweighed by the good. Interestingly we’ve begun to use this approach on some cancers, too, and it seems to work. Immune therapy, it’s called.

Immune therapy is not generally the first line approach to cancer, but it might be the best for slow cancers, like prostate. Generally, in the fight against cancer, the preferred method is to removes as much of cancer cells as possible, and treat any missed cells using a mix of radiation and chemicals. This works but there are a lot of side-effects. Immune therapy is sort of similar, in a way. Instead of irradiating the bad cells inside the body, one takes the cancer cells outside of the body (or the virus molecules) and uses radiation and chemicals to knock off bits. These bits, a weakened form of the cancer or of the virus, are then cultured and re-injected into the body. Sometimes it works, sometimes not. For melanoma, skin cancer, immune therapy is found to works about 1/4 of the time. Why not more? It seems that sometimes the immune system gets “exhausted” fighting a foe that’s to much for it. And sometimes the activated immune system starts attacking the host body. This is an auto-immune response.

Dr. Robert E. Buxbaum, February 21, 2020

COVID-19 is worse than SARS, especially for China.

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The corona virus, COVID-19 is already a lot worse than SARS, and it’s likely to get even worse. As of today, there are 78,993 known cases and 2,444 deaths. By comparison, from the first appearance of SARS about December 1 2002, there have been a total of 8439 cases and 813 deaths. It seems the first COVID-19 patient was also about December 1, but the COVID-19 infection moved much faster. Both are viral infections, but it seems the COVID virus is infectious for more days, including days when the patient is asymptomatic. Quarantine is being used to stop COVID-19; it was successful with SARS. As shown below, by July 2003 SARS had stopped, essentially. I don’t think COVID-19 will stop so easily.

The process of SARS, worldwide; a dramatic rise and it’s over by July 2003. Source: Int J Health Geogr. 2004; 3: 2. Published online 2004 Jan 28. doi: 10.1186/1476-072X-3-2.

We see that COVID-19 started in November, like SARS, but we already have 10 times more cases than the SARS total, and 150 times more than we had at this time during the SARS epidemic. If the disease stops in July, as with SARS, we should expect to see about a total of 150 times the current number of cases: about 12 million cases by July 2020. Assuming a death rate of 2.5%, that suggests 1/4 million dead. This is a best case scenario, and it’s not good. It’s about as bad as the Hong Kong flu pandemic of 1968-69, a pandemic that killed 60,000 approximately in the US, and which remains with us, somewhat today. By the summer of 69, the spreading rate R° (R-naught) fell below 1 for and the disease began to die out, a process I discussed previously regarding measles and the atom bomb, but the disease re-emerged, less infectious the next winter and the next. A good quarantine is essential to make this best option happen, but I don’t believe the Chinese have a good-enough quarantine.

Several things suggest that the Chinese will not be able to stop this disease, and thus that the spread of COVID-19 will be worse than that of the HK flu and much worse than SARS. For one, both those disease centered in Hong Kong, a free, modern country, with resources to spend, and a willingness to trust its citizens. In fighting SARS, HK passed out germ masks — as many as anyone needed, and posted maps of infection showing places where you can go safely and where you should only go with caution. China is a closed, autocratic country, and it has not treated quarantine this way. Little information is available, and there are not enough masks. The few good masks in China go to the police. Health workers are dying. China has rounded up anyone who talks about the disease, or who they think may have the disease. These infected people are locked up with the uninfected in giant dorms, see below. In rooms like this, most of the uninfected will become infected. And, since the disease is deadly, many people try to hide their exposure to avoid being rounded up. In over 80% of COVID cases the symptoms are mild, and somewhat over 1% are asymptomatic, so a lot of people will be able to hide. The more people do this, the poorer the chance that the quarantine will work. Given this, I believe that over 10% of Hubei province is already infected, some 1.5 million people, not the 79,000 that China reports.

Wuhan quarantine “living room”. It’s guaranteed to spread the disease as much as it protects the neighbors.

Also making me think that quarantine will not work as well here as with SARS, there is a big difference in R°, the transmission rate. SARS infected some 2000 people over the first 120 days, Dec. 1 to April 1. Assuming a typical infection time of 15 days, that’s 8 cycles. We calculate R° for this stage as the 8th root of 2000, 8√2000 = 2.58. This is, more or less the number in the literature, and it is not that far above 1. To be successful, the SARS quarantine had to reduce the person’s contacts by a factor of 3. With COVID-19, it’s clear that the transmission rate is higher. Assuming the first case was December 1, we see that there were 73,437 cases in only 80. R° is calculated as the 5 1/3 root of 73,437. Based on this, R° = 8.17. It will take a far higher level of quarantine to decrease R° below 1. The only good news here is that COVID-19 appears to be less deadly than SARS. Based on Chinese numbers the death rate appears to be about 2000/73,437, or about 3%, varying with age (see table), but these numbers are overly high. I believe there are a lot more cases. Meanwhile the death rate for SARS was over 9%. For most people infected with COVID-19, the symptoms are mild, like a cold; for another 18% it’s like the flu. A better estimate for the death rate of COVID-19 is 0.5-1%, less deadly than the Spanish flu of 1918. The death rate on the Diamond Princess was 3/600 = 0.5%, with 24% infected.

The elderly are particularly vulnerable. It’s not clear why.

Backing up my value of R°, consider the case of the first Briton to contact the disease. As reported by CNN, he got it at conference in Singapore in late January. He left the conference, asymptomatic on January 24, and spent the next 4 days at a French ski resort where he infected one person, a child. On January 28, he flew to England where he infected 8 more before checking himself into a hospital with mild symptoms. That’s nine people infected over 3 weeks. We can expect that schools, factories, and prisons will be even more hospitable to transmission since everyone sits together and eats together. As a worst case extrapolation, assume that 20% of the world population gets this disease. That’s 1.5 billion people including 70 million Americans. A 1% death rate suggests we’ll see 700,000 US deaths, and 15 million world-wide this year. That’s almost as bad as the Spanish flu of 1918. I don’t think things will be that bad, but it might be. The again, it could be worse.

If COVID-19 follows the 1918 flu model, the disease will go into semi-remission in the summer, and will re-emerge in the fall to kill another few hundred thousand Americans in the next fall and winter, and the next after that. Woodrow Wilson got the Spanish Flu in the fall of 1918, after it had passed through much of the US, and it nearly killed him. COVID-19 could continue to rampage every year until a sufficient fraction of the population is immune or a vaccine is developed. In this scenario, quarantine will have no long-term effect. My sense is that quarantine and vaccine will work enough in the US to reduce the effect of COVID-19 to that of the Hong Kong flu (1968), so that the death rate will be only 0.1 – 0.2%. In this scenario, the one I think most likely, the US will experience some 100,000 deaths, that is 0.15% of 20% of the population, mostly among the elderly. Without good quarantine or vaccines, China will lose at least 1% of 20% = about 3 million people. In terms of economics, I expect a slowdown in the US and a major problem in China, North Korea, and related closed societies.

Robert Buxbaum, February 18, 2020. (Updated, Feb. 23, I raised the US death totals, and lowered the totals for China).

Kindness and Cholera in California

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California likely leads the nation in socially activist government kindness. It also leads the nation in homelessness, chronic homelessness, and homeless veterans. The US Council on Homelessnesses estimates that, on any given day, 129,972 Californians are homeless, including 6,702 family households, and 10,836 veterans; 34,332 people are listed among “the chronic homeless”. That is, Californians with a disability who have been continuously homeless for one year or cumulatively homeless for 12 months in the past three years. No other state comes close to these numbers. The vast majority of these homeless are in the richer areas of two rich California cities: Los Angeles and San Francisco (mostly Los Angeles). Along with the homeless in these cities, there’s been a rise in 3rd world diseases: cholera, typhoid, typhus, etc. I’d like to explore the relationship between the policies of these cities and the rise of homelessness and disease. And I’d like to suggest a few cures, mostly involving sanitation. 

A homeless encampment in LosAngeles

Most of the US homeless do not live in camps or on the streets. The better off US homelessness find it is a temporary situation. They survive living in hotels or homeless shelters, or they “couch-serf,” with family or friends. They tend to take part time jobs, or collect unemployment, and they eventually find a permanent residence. For the chronic homeless things are a lot grimmer, especially in California. The chronic unemployed do not get unemployment insurance, and California’s work rules tend to mean there are no part time jobs, and there is not even a viable can and bottle return system in California, so the homeless are denied even this source of income*. There is welfare and SSI, but you have to be somewhat stable to sign up and collect. The result is that California’s chronic homeless tend to live in squalor strewn tent cities, supported by food handouts.

Californians provide generous food handouts, but there is inadequate sewage, or trash collection, and limited access to clean water. Many of the chronic homeless are drug-dependent or mentally ill, and though they might  benefit from religion-based missions, Los Angeles has pushed the missions to the edges of the cities, away from the homeless. The excess food and lack of trash collection tends to breed rats and disease, and as in the middle ages, the rats help spread the diseases. 

Total homelessness by state, 2018; California leads the nation. The better off among these individuals do not live on the streets, but in hotels or homeless shelters. For most, this is a short term situation. The rest, about 20%, are chronically homeless. About half of these live on the streets without adequate sewage and water. Many are drug-dependent.

The first major outbreaks of the homeless camps appeared in Los Angeles in August and September of 2017. They reappeared in 2018, and by late summer, rates were roughly double 2017’s. This year, 2019, looks like it could be a real disaster. The first case of a typhoid infected police officer showed up in May. By June there were six police officers with typhoid, and that suggests record numbers are brewing among the homeless.

To see why sanitation is an important part of the cure, it’s worth noting that typhoid is a disease of unclean hands, and a relative of botulism. It is spread by people who go to the bathroom and then handle food without washing their hands first. The homeless camps do not, by and large, have hand washing stations. and forced hygiene is prohibited. Los Angeles has set up porta-potties, with no easy hand washing. The result is typhoid epidemic that’s even affecting the police (six policemen in June!).

rate od disease spread.
R-naught, reproduction number for some diseases, CDC.

Historically, the worst outbreaks of typhoid were spread by food workers. This was the case with “typhoid Mary of the early 20th century.” My guess is that some of the police who got typhoid, got it while trying to feed the needy. If so, this fellow could become another Typhoid Mary. Ideally, you’d want shelters and washing stations where the homeless are. You’d also want to pickup the dirtier among the homeless for forced washing and an occasional night in a homeless shelter. This is considered inhumane in Los Angeles, but they do things like this in New York, or they did.

Typhus is another major disease of the California homeless camps. It is related to typhoid but spread by rodents and their fleas. Infected rodents are attracted to the homeless camps by the excess food. When the rodents die, their infected fleas jump to the nearest warm body. Sometimes that’s a person, sometimes another animal. In a nastier city, like New York, the police come by and take away old food, dead animals, and dirty clothing; in Los Angeles they don’t. They believe the homeless have significant squatters rights. California’s kindness here results in typhus.

Reproduction number and generation time for some diseases.

The last of the major diseases of the homeless camps is cholera. It’s different from the others in that it is not dependent on squalor, just poor health. Cholera is an airborne disease, spread by coughing and sneezing. In California’s camps, the crazy and sick dwell close to each other and close to healthy tourists. Cholera outbreaks are a predictable result. And they can easily spread beyond the camps to your home town, and if that happens a national plague could spread really fast.

I’d discussed R-naught as a measure of contagiousness some months ago, comparing it to the reproductive number of an atom bomb design, but there is more to understanding a disease outbreak. R-naught refers merely to the number of people that each infected person will infect before getting cured or dying. An R-naught greater than one means the disease will spread, but to understand the rate of spread you also need the generation time. That’s the average time between when the host becomes infected, and when he or she infects others. The chart above shows that, for cholera, r-naught is about 10, and the latency period is short, about 9 days. Without a serious change in California’s treatment of the homeless, each cholera case in June will result in over 100 cases in July, and well over 10,000 in August. Cholera is somewhat contained in the camps, but once an outbreak leaves the camps, we could have a pandemic. Cholera is currently 80% curable by antibiotics, so a pandemic would be deadly.

Hygiene is the normal way to prevent all these outbreaks. To stop typhoid, make bathrooms available, with washing stations, and temporary shelters, ideally these should be run by the religious groups: the Salvation Army, the Catholic Church, “Loaveser and Fishes”, etc. To prevent typhus, clean the encampments on a regular basis, removing food, clothing, feces and moving squatters. For cholera, provide healthcare and temporary shelters where people will get clean water, clean food, and a bed. Allow the homeless to work at menial jobs by relaxing worker hiring and pay requirements. A high minimum wage is a killer that nearly destroyed Detroit. Allow a business to hire the homeless to sweep the street for $2/hour or for a sandwich, but make a condition that they wash their hands, and throw out the leftovers. I suspect that a lot of the problems of Puerto Rico are caused by a too-high minimum wage by the way. There will always be poor among you, says the Bible, but there doesn’t have to be typhoid among the poor, says Dr. Robert Buxbaum.

*California has a very strict can and bottle return law where — everything is supposed to be recycled– but there are very few recycling centers, and most stores refuse to take returns. This is a problem in big government states: it’s so much easier to mandate things than to achieve them.

July 30, 2019. I ran for water commissioner in Oakland county, Michigan, 2016. If there is interest, I’ll run again. One of my big issues is clean water. Oakland could use some help in this regard.

Measles, anti-vaxers, and the pious lies of the CDC.

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Measles is a horrible disease that contributed to the downfall that had been declared dead in the US, wiped out by immunization, but it has reappeared. A lot of the blame goes to folks who refuse to vaccinate: anti-vaxers in the popular press. The Center for Disease Control is doing its best to promote to stop the anti-vaxers, and promote vaccination for all, but in doing so, I find they present the risks of measles worse than they are. While I’m sympathetic to the goal, I’m not a fan of bending the truth. Lies hurt the people who speak them and the ones who believe them, and they can hurt the health of immune-compromized children who are pushed to vaccinate. You will see my arguments below.

The CDC’s most-used value for the mortality rate for measles is 0.3%. It appears, for example, in line two of the following table from Orenstein et al., 2004. This table also includes measles-caused complications, broken down by type and patient age; read the full article here.

Measles complications, death rates, US, 1987-2000, CDC.

Measles complications, death rates, US, 1987-2000, CDC, Orenstein et. al. 2004.

The 0.3% average mortality rate seems more in tune with the 1800s than today. Similarly, note that the risk of measles-associated encephalitis is given as 10.1%, higher than the risk of measles-diarrhea, 8.2%. Do 10.1% of measles cases today produce encephalitis, a horrible, brain-swelling disease that often causes death. Basically everyone in the 1950s and early 60s got measles (I got it twice), but there were only 1000 cases of encephalitis per year. None of my classmates got encephalitis, and none died. How is this possible; it was the era before antibiotics. Even Orenstein et. al comment that their measles mortality rates appear to be far higher today than in the 1940s and 50s. The article explains that the increase to 3 per thousand, “is most likely due to more complete reporting of measles as a cause of death, HIV infections, and a higher proportion of cases among preschool-aged children and adults.”

A far more likely explanation is that the CDC value is wrong. That the measles cases that were reported and certified as such are the ones that are the most severe. There were about 450 measles deaths per year in the 1940s and 1950s, and 408 in 1962, the last year before the MMR vaccine was developed and by Dr. Hilleman of Merck (a great man of science, forgotten). In the last two decades there were some 2000 measles cases reported US cases but only one measles death. A significant decline in cases, but the ratio does not support the CDC’s death rate. For a better estimate, I propose to divide the total number of measles deaths in 1962 by the average birth rate in the late 1950s. That is to say, I propose to divide 408 by the 4.3 million births per year. From this, I calculate a mortality rate just under 0.01% in 1962, That’s 1/30th the CDC number, and medicine has improved since 1962.

I suspect that the CDC inflates the mortality numbers, in part by cherry-picking its years. It inflates them further by treating “reported measles cases.” as if they were all measles cases. I suspect that the reported cases in these years were mainly the very severe ones. Mild case measles clears up before being reported or certified as measles. This seems the only normal explanation for why 10.1% of cases include encephalitis, and only 8.2% diarrhea. It’s why the CDC’s mortality numbers suggest that, despite antibiotics, our death rate has gone up by a factor of 30 since 1962.

Consider the experience of people who lived in the early 60s. Most children of my era went to public elementary schools with some 1000 other students, all of whom got measles. By the CDC’s mortality number, we should have seen three measles deaths per school, and 101 cases of encephalitis. In reality, if there had been one death in my school it would have been big news, and it’s impossible that 10% of my classmates got encephalitis. Instead, in those years, only 48,000 people were hospitalized per year for measles, and 1,000 of these suffered encephalitis (CDC numbers, reported here).

To see if vaccination is a good idea, lets now consider the risk of vaccination. The CDC reports their vaccine “is virtually risk free”, but what does risk-free mean? A British study finds vaccination-caused neurological damage in 1/365,000 MMR vaccinations, a rate of 0.00027%, with a small fraction leading to death. These problems are mostly found in immunocompromised patients. I will now estimate the neurological risk for actual measles based on the ratio of encephalitis to births, as before using the average birth rate as my estimate for measles cases; 1000/4,300,000 = 0.023%. This is far lower than the risk the CDC reports, and more in line with experience.

The risk for neurological damage from measles that I calculate is 86 times higher risk than the neurological risk from vaccination, suggesting vaccination is a very good thing, on average: The vast majority of people should get vaccinated. But for people with a weakened immune system, my calculations suggest it is worthwhile to not immunize at 12 months as doctors recommend. The main cause of vaccination death is encephalitis, but this only happens in patients with weakened immune systems. If your child’s immune system is weakened, even by a cold, I’d suggest you wait 1-3 months, and would hope that your doctor would concur. If your child has AIDS, ALS, Lupus, or any other, long-term immune problem, you should not vaccinate at all. Not vaccinating your immune-weakened child will weaken the herd immunity, but will protect your child.

We live in a country with significant herd immunity: Even if there were a measles outbreak, it is unlikely there would be 500 cases at one time, and your child’s chance of running into one of them in the next month is very small assuming that you don’t take your child to Disneyland, or to visit relatives from abroad. Also, don’t hang out with anti-vaxers if you are not vaccinated. Associating with anti-vaxers will dramatically increase your child’s risk of infection.

As for autism: there appears to be no autism advantage to pushing off vaccination. Signs of autism typically appear around 12 months, the same age that most children receive their first-stage MMR shot, so some people came to associate the two. Parents who push-off vaccination do not push-off the child’s chance of developing autism, they just increase the chance their child will get measles, and that their child will infect others. Schools are right to bar such children, IMHO.

I’ve noticed that, with health care in, particular, there is a tendency for researchers to mangle statistics so that good things seem better than they are. Health food: is not necessarily so healthy as they say; nor is weight loss. Bicycle helmets: ditto. Sometimes this bleeds over to outright lies. Generic modified grains were branded as cancer-causing based on outright lies and  missionary zeal. I feel that I help a bit, in part by countering individual white lies; in part by teaching folks how to better read statistic arguments. If you are a researcher, I strongly suggest you do not set up your research with a hypothesis so that only one outcome will be publishable or acceptable. Here’s how.

Robert E. Buxbaum, December 9, 2018.