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Comment by throwaway_pdp09 | Hacker News Reader

> but I will stop short of suggesting any conspiracy

But that's what you're doing.

> They held that there was no evidence of person-to-person transmission for far too long in the face of evidence out of China

Possibly true. Any pointers to that?

> They claimed for far to long that if you weren't showing symptoms you weren't contagious

If you make these claims, provide refrences please. This is new to me.

> They've been completely silent about ACE inhibitors and ARBs upregulating the expression of ACE2 receptors, and that available evidence strongly suggests that people on these medicines have much more severe reactions to the disease

Provide a link. If you're going to post stuff that sounds relevant and important, post references to it.

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> But that's what you're doing.

I don't think the WHO is trying to get people sick, or that China is doing this to the USA, or anything like that. I do think that something doesn't smell right, but I'm unwilling to make any kind of conclusion on what it might be.

As for the person-to-person thing, I lived through the storm of data and information and distinctly remember them claiming there was no evidence of person-to-person transmission after I had seen multiple bits of evidence out of China. To prove that, I'd have to do a lot of wayback machine work.

People have been contagious before symptoms and also without showing any symptoms. I thought this knowledge was widespread at this point. The 3rd case and 5th case in NZ were a couple where the 5th case (wife) travelled to Iran. The man got sick after she returned. She was not sick. They tested her and she was positive and became the 5th case. https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&object... https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&object... Probably sexual transmission, so not too suprising. But there are many other reports which the CDC acknowledges on this page: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-si...

The question on ACE/ACE2 has references itself: https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

I agree WRT china something stinks. My guess is it is just realpolitik. A lot of useful info was coming out of china (as well as lies) and maybe the WHO needed to bite its tongue to keep that channel open (China being... odd in its reactions to criticism).

I'll accept your point about no P2P transmission claim as I remember it too, and I suspect that was just parroted back from China early on - but they've not said that for a while.

The ACE stuff from your links just says 'we suspect'.

The WHO has indeed spoken on this recently (https://mobile.twitter.com/WHO/status/1240409217997189128):

"WHO is aware of concerns on the use of #ibuprofen for the treatment of fever for people with #COVID19. We are consulting with physicians treating the patients & are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations"

You're being unfair here, they have spoken and it's clear they don't feel enough to recommend for or against at this point. Getting clean yes/no info out of a filthy cloud of murk like this covid situation - I'm glad I'm not them.

Nonetheless, thank you for a civil and informative reply

Ibuprofen is one thing. ACEI and ARBs are another. I'm prescribed the maximum dose of an ACE inhibitor and I really want to know whether or not the scarcity of Angiotensin II has caused the ACE2 receptors to upregulate in compensation. It seems like it would, and studies on animals show it does at least in some contexts (https://www.bmj.com/content/368/bmj.m810/rr-2). I completely understand it would be dangerous to suggest publicly as people might suddenly stop their blood pressure medicines and we'd have a spate of heart attacks and strokes. But it might be equally dangerous to not phase them off, at least for a few months, and onto something else in the meantime.

Other links I have on this topic that might be relevant:

https://www.healio.com/cardiology/vascular-medicine/news/onl...

https://www.nature.com/articles/s41421-020-0147-1

https://www.bmj.com/content/368/bmj.m810/rr-2

https://www.eshonline.org/spotlights/esh-statement-on-covid-...

https://pubmed.ncbi.nlm.nih.gov/32064853/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829448/

I understood ibuprofen was relevant: "ibuprofen could increase the expression of ACE2 receptors that the virus uses to bind to cells" (https://www.popsugar.co.uk/fitness/should-you-avoid-taking-i...)

And you originally said

> upregulating the expression of ACE2 receptors

So ibuprofen is relevant.

And your first link says

“This speculation about the safety of ACE inhibitor or angiotensin receptor blockers treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it,” de Simone wrote in the ESC statement. “Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there are no data in humans. The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual antihypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACE inhibitors or angiotensin receptor blockers should be discontinued because of the COVID-19 infection.”

THEY DON'T HAVE THE INFO TO MAKE A DECISION ONE WAY OR ANOTHER.

STOP SPREADING YOUR NON-EXPERT OPINION AS IF IT WERE FACT.

WHO repeating CCP bullshit is one thing, but you are not being honest here. Stop this.

Now I'm going to stop because I have some work to do that is laterally related to covid and I need to get on with it.

A number of people have brought up ibuprofen in relation to the expression of ACE2 receptors. There was a long thread on reddit about it. My point is that any reliable information on ibuprofen does not necessarily allow us to make the same conclusions about ACE inhibitors and ARBs.

The bullet point about this topic was the final bullet point, and I put a clear warning in place on the bullet point (originally too, not as an edit). I did not pass off my opinion as if it were fact, nor did I claim to be an expert. I questioned why we still don't have better data on this, given how strong the coorelation is in people who have conditions that are treated with these medicines.

But I will concede one point: The list about the WHO was not the right place for me to bring up this topic, and putting it there was misleading.

I appreciate the way you've taken my criticisms. You acknowledge you're not an expert which is much to your credit, and haven't amended your posts or done the usual wankers trick of just downvoting someone who disagrees. I like that.

I can't speak for ACEs and ARBs.

Let's agree to disagree on why we don't have better data on these. I trust doctors and the WHO on this. You maybe feel they can do more. I can't take the time to look into it, nor if I did, to interpret what I found.

I repeat I appreciate your constructive attitude and have upvoted several of your posts and this one, because it's done in the right spirit. Good luck.

On asymptomatic spread:

https://www.nejm.org/doi/full/10.1056/NEJMc2001468 A woman from Shanghai traveled to Germany for a business trip between January 19 and January 22. She had no symptoms of coronavirus during this time and only became sick on her flight back to China. She was diagnosed with COVID-19 on January 26. But on January 24, a businessman who met with the woman on January 20 and 21 developed symptoms of coronavirus. He went back to work on January 27 and later tested positive for COVID-19. “We discovered that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection,” the report’s authors concluded.

https://www.nejm.org/doi/full/10.1056/NEJMc2001899 two individuals who had recently returned to Germany from Wuhan, China, appeared to be asymptomatic, but tested positive for COVID-19 when they were given a throat swab. "We discovered that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection,"

https://science.sciencemag.org/content/early/2020/03/13/scie... A majority of cases in China were transmitted by “undocumented infections” in the period before the country placed travel restrictions on Hubei province on January 23. “This high proportion of undocumented infections, many of whom were likely not severely symptomatic, appears to have facilitated the rapid spread of the virus throughout China"

https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v... a significant number of infections can be attributed to people who had not yet developed symptoms

https://www.nejm.org/doi/full/10.1056/NEJMp2003762 Bill Gates "COVID-19 is transmitted quite efficiently," he wrote. "There is also strong evidence that it can be transmitted by people who are just mildly ill or even pre-symptomatic. That means COVID-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people."

These - that I've scanned - don't back up your point. They say that P2P transmission is happening (no argument with that these days), but your claim was that the WHO was silent for too long on this. I don't know what 'too long' is.

However, quick dig in wikipedia: (https://en.wikipedia.org/wiki/2019%E2%80%9320_outbreak_of_no...)

<<< On 12 January, based on additional information from the Chinese National Health Commission, WHO stated that "at this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission." >>>

So, fuck.

(you provided references in good faith, which I really appreciate).

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