We thought it was just a respiratory virus
ucsf.edu
ucsf.edu
A lot of the early part of the article rehashes basics, like how viruses replicate. If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
I have been reading less about the virus of late, but this fits with everything I know. It causes blood clots. Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).
Later in the article, it talks about impacts on the feet suspected to be a side effect. Feet issues are commonly associated with blood/circulation issues. This is why diabetes can lead to feet being amputated.
The blood issues are well established and this has been known for some time. I'm somewhat aghast to see this article talking like we don't already know that detail.
Not everyone has done as much research as you, and the public perception and debate is still awash with "just a bad flu" disinformation, so its really important a clearer and more accurate picture is put out as widely as possible.
The stuff about blood clots began coming out about the time I concluded I probably had it and had been mostly asymptomatic and about that same time I ran into a researcher on HN who said something about the blood that I didn't follow and I asked questions and that went weird places and then they said something else about zinc.
And that led to an epiphany for me and I turned to my son and kind or recounted the exchange with the researcher and then I said "We've been eating a lot of zinc-rich foods. I am going to go get a cheese pizza because cheese has zinc." So I got a pizza and then he felt vastly better.
So the whole blood angle is cemented in my mind like "Clearly, this is a hard fact and everyone knows it." But it's probably just me in my little bubble and that's it.
I'm still aghast. But what you say makes sense.
For example, yes there is some research suggesting zinc (and related, vitamin D) may be very relevant with covid-19, but there isn't yet definitive understanding among experts yet alone us HN commenters.
Anecdotally: I often feel better after eating a pizza, dating back to before covid-19 existed, and despite my zinc levels being fine. I just really fucking love pizza.
All of us, whether we are trying to read every research paper released or not following anything except newspaper headlines, need to keep reminding ourselves that just as the experts will keep revising their beliefs to fit new findings, we need to keep checking if our own knowledge is correct, or if it might be either outdated and/or based on cognitive biases.
Personally I'm recommending friends/family to make sure that they are getting enough of various vitamins/minerals, while being very clear that my suggestion is a "can't do any harm to have the right levels of whatever" rather than "I'm sure this will help with covid".
I'm well aware of that. I'm just trying to say that it made an especially big impression on me because of my personal experience, not that my anecdote makes it scientific fact.
I'm still appalled that they know it causes blood issues and are not connecting the dots between that and the feet issues. The article doesn't explicitly say that feet issues of that sort are consistent with blood issues, though that is an extremely well-established scientific fact.
I paid accident claims for five years. As part of that job, I read medical records all day. I paid for foot amputations and we had to sometimes try to decide "Was this really an accident? Or was this really a complication of diabetes?"
So I'm not just talking out my ass here. I completed a Certified Life and Health Insurance Specialist certificate. I also just do a lot of reading of medical stuff because of my own health issues.
I'm pretty confident the blood issues are very well established at this point and have been for some time.
Not because I specifically agree (or disagree) with them. Personally, I also consider myself in a pretty good position to judge this stuff, however I decided a while back that even when I think I'm sure I'm not going to tell it as a fact, especially online where other readers can't easily tell if corin_ or doreenmichele are making great points or deluded idiots. (A quick edit here: I didn't mean that to imply one or both of us are deluded or idiots. Just that neither of us are coming into this thread with "here are my qualifications and/or research to make me more than a random commenter".)
My reply wasn't that you were wrong in your beliefs, however this part in particular:
"And that led to an epiphany for me [...] So I got a pizza and then he felt vastly better. So the whole blood angle is cemented in my mind like "Clearly, this is a hard fact and..."
My point is that even if you are 100% correct about the blood issues and zinc, you have literally described a one day process of epiphany to pizza to fact proven. Whether you're right or wrong overall, that's not how people should be forming opinions on fighting covid.
You are wildly misreading my comment.
A professional researcher stated their opinion that there was something blood related -- that I didn't understand so I asked for clarification -- and then said something about zinc. I then went over our consumption habits, realized that we were eating a lot of zinc-rich foods we don't normally eat in large quantities and felt it was worth betting on "It's the zinc, like the researcher said." And that bet paid off for us -- though me and my oldest son both have a genetic disorder, so I'm absolutely not inclined to generalize from that.
So I'm not recommending anything about how to fight covid. It's a personal anecdote about how this got cemented in my mind so clearly. That's it. Nothing more.
We all have cognitive biases, including the most intelligent, accomplished people anywhere.
Plenty of research shows that the placebo effect is a very real phenomenon (even when we are told we're being given a placebo pill it can still help!)
I wasn't trying to change your mind on anything covid related; just about how we all let anecdotes convince us of pre-existing beliefs.
And even if you personally didn't need that lesson, I still think it needed to be explained for anyone reading your comments considering their implication that a one off pizza event was enough to impact your views (even if that's not how you intended the comment to mean).
Edit to add: of course, the mechanisms behind cognitive biases can be helpful! If a doctor says X will help and then X does help, it's good that our brains automatically process that as being more likely true than if it hadn't worked. But they can be unhelpful, too.
You don't know that, since you don't know that you have Covid-19, nor do you know that your zinc consumption had anything to do with whether or not you had it, or recovery from it.
I know that because it wasn't a one time incident. We continued to consciously and intentionally consume zinc-rich foods at a greater rate than normal and it successfully alleviated symptoms that had us concerned. It did so consistently for some period of time until those symptoms finally resolved. We pay very close attention to our diets because of the medical situation. So I know we were consuming abnormally high levels of zinc for some weeks.
Your framing seems to suggest you think I am saying zinc helped "cure" us of the infection. That's not what I'm saying. I'm saying it helped mitigate the worst of our symptoms, which is a completely different claim.
You are correct that I don't know for absolute certain that we had Covid-19 because that was never verified by testing. I've already made that clear and also made it clear that I'm not suggesting treatment to anyone else.
I'm aware there are people promoting zinc as a means to cure Covid-19. I'm not remotely suggesting that.
Even if you accept that I'm correct about having it and I'm correct about zinc helping us, the only takeaway here is that zinc may mitigate some symptoms in some populations, especially populations prone to nutrient deficiencies.
If you have any reason to believe you are zinc deficient, zinc is a good thing to take to treat your deficiency. If you aren't deficient, I'm not recommending it for any purpose.
This is a consistent stance of mine and has been for many years: It's a good thing to determine if you have deficiencies and redress those deficiencies. Otherwise, I absolutely don't recommend any kind of supplement at all. I think it's a dangerous practice to take supplements if you aren't deficient.
Again, you don't know that. You can't establish causation, particularly when N=2, and even more so when you do not know whether or not you had Covid-19.
Yes, I understand you fully acknowledge you may not have had it, but that acknowledgement contradicts that claim that zinc consumption alleviated its effects. What you can say is that you may have had Covid-19, and increased zinc consumption may have helped.
I have a genetic disorder. My son has a genetic disorder. We use diet to mitigate health issues regularly.
I do know for an absolute fact what I have stated as clearly as I can figure out how to state: that increased zinc consumption mitigated the unusual problems we were having that aren't typical for us and which we firmly believe were due to Covid-19.
I have stated clearly that we were never tested, so, no, I can't prove we had it. I can still believe we had it and I don't think it should be anywhere near this much drama to say I believe we had it when I've stated clearly that this is a belief unverified by testing, so I certainly cannot prove it.
I have stated clearly -- and repeatedly -- that my anecdote isn't a recommendation for treatment.
I think it did mitigate symptoms from Covid-19. I admit I can't prove it was Covid-19. I've stated that repeatedly.
And whatever was wrong with us, zinc helped.
You are entirely free to think it's worthless data because we were never tested. I've done everything in my power to distinguish as clearly as I can my opinion from verifiable fact. I am telling you "zinc helped" is in the category of fact in my mind and what it helped with was "probably Covid-19" is my opinion.
I'm planning to walk away at this point. It never ceases to amaze me how much other people have some big problem with me having opinions about my own health status like me thinking about my own health is some kind of serious crime on the order of impersonating a surgeon.
That's not a reasonable position.
I get that you disagree. I expect people to not be convinced that I'm right. Skepticism is warranted.
What's not warranted is harassment.
Repeatedly insisting that I cannot possibly know what I believe to be true when I have already agreed with you that my statements are opinion, inference, etc and unverified by testing is harassment.
I have my reasons why I am confident in my conclusions. No one cares to hear those reasons. They just want me to capitulate, admit defeat and announce that I'm wrong and stupid -- both factually and morally -- for engaging in the same behavior many other people engage in on a regular basis without being similarly mistreated. (That behavior being telling an anecdote about my health and stating a personal opinion about my own experience.)
I'm not capitulating. No one is required to agree with me or be at all interested in what I think about my own health or about health generally. But, like any other human, I am entitled to have an opinion about my own health. I'm not going to pretend that I think you are right when I don't think you are right just because you insist over and over again that my opinion is, in your opinion, factually wrong.
You are not more right than me. Just as I cannot prove I had Covid-19, you cannot prove I did not. Thus you cannot prove my opinion is factually wrong anymore than I can prove it is factually right, yet you feel some strange compulsion to try to insist that your unprovable opinion about my life is somehow more right than my unprovable opinion about my own life.
I feel like you're jumping to conclusions prematurely. If you as health insurance specialist can connect these dots, you can be sure that researchers did, too. However, having a hunch is only the first step of a thorough scientific investigation, and those take time. Until we have collected and analyzed the evidence, this remains speculation, and scientists shouldn't go off spouting half-researched speculations. That leads to only more fake news. If you look through the Lancet or JAMA, you might find first articles on this connection (if there is one). But until there are peer reviewed papers about this, most researchers know that it's better not to speculate when talking to the press.
Source: am researcher
I honestly don't think I am. I am currently a freelance writer by trade. I sometimes write health articles. I'm familiar with protocols for how to carefully qualify things to keep them factual and avoid wild speculation and suggest confidence levels for various tidbits while being informative.
I am not super impressed with the quality of the medical information in the piece.
But given that thanking someone for their remark and saying "Oh, that makes sense to me" is getting me so much flak, it's probably best for me to bow out of this discussion at this point.
But if you sometimes write health articles, I feel it worth saying: health articles should be written having understood the proven science and convey it to people in an easy to understand way of what is or isn't proven, not by people who assume their connecting the dots is right before the research shows that.
I haven't read any of your articles, for all I know you're a fantastic writer on those subjects. But your HN comments specifically have not been written in the way that health articles should be, which is why people are giving you flak. And on that subject, sorry that you feel attacked here - it certainly wasn't my intention, nor I think the others', we just aren't in agreement.
But, it's not like there hasn't been additional coverage on covid-19 as a circulatory disease rather than a respiratory-first one.
https://news.weill.cornell.edu/news/2020/07/what-is-known-ab... and https://health.clevelandclinic.org/should-you-be-worried-abo... and https://www.the-scientist.com/news-opinion/autopsies-indicat... for consumer-oriented overviews.
A recent covid-19 study here: https://pubmed.ncbi.nlm.nih.gov/32291094/
And this from a post-SARS study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178621/
There's plenty of primary and secondary research out there. The problem, I think, is that mainstream media headlines have been -- and continue to -- present covid-19 as a respiratory virus.
Perhaps like Doreen, my family have been tracking the circulatory effects more closely than most, given we have a toddler with a heart condition and family with diabetes.
Additionally... the article submitted that we're all commenting in response to specifically makes the case that this virus is affecting more than the respiratory system.
I don't disagree with anything in your comment, but I also don't see how any of your comment disagrees with anything I said or with the original article.
How long has it been since you last worked in insurance?
Recently, there’s been speculation that some of COVID-19’s seemingly disparate symptoms may stem from trouble in the blood. Blood clots, for example, are showing up in cases of COVID-19 frequently enough for clinicians to take notice. “There’s something unique about the coagulation system in these patients,” says nephrologist Kathleen Liu, MD ’99, PhD ’97, MAS ’07, a UCSF professor of medicine. In caring for COVID-19 patients on dialysis machines, she’s been surprised to see blood clots block dialysis tubes more than usual. Clotted tubes are common, she says, “but this is extreme.”
That may be because, as growing evidence suggests, SARS-CoV-2 can infect cells in the walls of blood vessels that help regulate blood flow and coagulation, or clotting. If true, this behavior could explain some of the virus’s weirder (and rarer) manifestations, such as heart attacks, strokes, and even “COVID toes.”
https://www.cleveland.com/coronavirus/2020/05/taking-daily-a...
But while they may need to think about their license, I need to think about my survival. And here I'm talking about my own survival. I'm not advising anyone else to do the same. I'm not a doctor, and even if I claimed I were one, nobody should just take a random guy's advice over the internet.
That said, my thought process is this: it is aspirin we are talking about, not cyanide. I have taken aspirin many times in my life, including several times recently. The benefit is not proven because doing medical trials is expensive. But the benefit is plausible enough that someone started just such a trial [1]. Separately, the benefits of other blood thinners are considered so great that they are part of the standard of care for Covid19 patients in some hospitals, such as MassGeneral [2]. So, my own assessment of that taking aspirin has for me a higher potential benefit than the potential risk.
But again, this is just for me, not offering advice to other people.
[1] https://clinicaltrials.gov/ct2/show/NCT04365309
[2] https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/...
If you are alluding however that I'm committing the base rate fallacy, then I'm not. My argument is not statistical in nature.
My argument is this: I know more about my body than the FDA. The FDA makes decisions that affects hundreds of millions of people and cannot know how each will respond to a drug (like aspirin). I however know how my body responds to aspirin because I have taken it and I know I tolerate it well.
So, although both the FDA and I are making a risk-reward analysis, my problem is much more narrow and I have a lot more information about it. I do not need to employ double-blind clinical trials or know anything about t-statistics and p-values.
If I were to start recommending aspirin to HN readers, then I'd start becoming a bit like the FDA, and I would need to resort to statistical arguments. But I'm not recommending aspirin to anyone. I'm just showing people the way I'm carrying my personal risk-reward analysis. This could be useful.
The Cleveland Clinic is a fairly big name, respected clinic. I think of it as a reliable source. I was just trying to sum up a lengthy piece briefly, which is always fraught with potential problems.
I do a lot of making my own health decisions of that sort. I'm routinely attacked for saying anything at all about my thinking about my own health. I wish it were easier to have meaningful discourse of that sort in a responsible fashion without people acting like "You are evil incarnate and practicing medicine without a license for leaving comments on the internet." I have no idea how we get there from here.
It says don't do it because there are risks of gastrointestinal and brain bleeding, which would be a bad thing to risk if you don't currently have an illness.
It even links to the following article from the Mayo Clinic, which goes over the pros and cons of taking aspirin daily to prevent blood clots and heart attacks, and has recommendations for classes of people that they recommend should take aspirin every day. so I'd think if you have an active illness known to cause blood clots, it's probably worth risking the bleeding risks from the other.
https://www.mayoclinic.org/diseases-conditions/heart-disease...
From the article: "Guidelines are varied between organizations, but they're evolving as more research is done. The benefits of daily aspirin therapy don't outweigh the risk of bleeding in people with a low risk of heart attacks. The higher your risk of heart attack, the more likely it is that the benefits of daily aspirin outweigh the risk of bleeding."
Anecdote is not data, but for awhile in my 20s I used to take aspirin pretty much every day just because I had constant issues with headaches. I think I did get an ulcer during that time, but it healed in time, once I stopped taking aspirin so often. Better than dying of a blood clot from a virus that still doesn't have a solid treatment, especially if you have to stay home and self-treat it.
https://link.springer.com/article/10.1007/s40265-020-01365-1
Has been speculated on since as early as March (that I've seen) with more evidence in support since then that this strain of human coronavirus is behaving like that.
Explains the majority of symptoms. Low pulse ox, feet, brain, lung, kidney, etc etc.
It's an article, not a news story or a scientific paper. So it's neither about breaking news nor innovative research results.
So, they don't presume what the public knows at any substantial level (heck, many still don't know/believe the virus is not real).
I, on the other hand, am more aghast for the use of the word aghast for such a trivial matter :-)
That's not right. It causes cytokine storms just like any other major repiratory virus. Ventilators do help, lots of people survive on them. They are a critically important piece of the treatment puzzle.
I don't think statements like that are very helpful. It's on the spectrum toward conspiracy nonsense.
> I'm somewhat aghast to see this article talking like we don't already know that detail.
It's not a scientific study, it's a review piece for general readers.
Well maybe you skimmed a little too much, because the article clearly talks about the negative effects of an overactive immune system response being characteristic in some patients, and there was plenty of evidence of that in some people's wrecked lungs. Part of the therapy is to guide and even suppress the complex immune system response to keep people's bodies from destroying themselves.
Your comment didn't mention any of that and might be read by some as a "move along, nothing to see here." I think this is definitely not the case and people would be better served to read the article itself instead of your comment dismissing it and instructing them to skip over the section about immune system response.
> If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
I replied to your comment because I read the article first and actually did learn this bit about the immune system response which is in the first half. If I had read your comment first I would likely would have skimmed the article (or even skipped it altogether) and missed it. In that situation your comment would have directed me away from learning something new. I'll continue to try to read articles before comments in the future.
This is IMO the other important reason why it’s important to stop the spread, besides overloading hospitals.
All the co-morbidities are essentially unknown and are likely to stay that way for a while. These side effects take time to suss out; more than the nine months we've had with covid.
With the unknown and potentially unbounded risks we are staring at, Taleb says that over-reaction is the best strategy. He and Russ Roberts go on to talk about the basic issues with statistics in these cases, a good trip back to the first week of any stats course that everyone promptly ignores.
[0] https://www.econtalk.org/nassim-nicholas-taleb-on-the-pandem...
"Morality rate", hmmm...I like it, but maybe for another article!8-))
From the OC:
Marcus plans to also start collecting data from wearable devices, including Fitbits and Zio patches, which wirelessly monitor heart rhythms. “There may be large numbers of people who are suffering from cardiovascular effects of COVID-19 in the absence of other symptoms,” Marcus says. “I’m worried we’re missing those cases.”
I have no idea what it means to regard COVID-19 in cardiovascular vs respiratory terms. I'm just repeating what I think I've read. I really don't understand this stuff.
edit: good citation provided by twic below
I wasn't the one who asked for citation, and didn't mean to imply that you were wrong at all in my comment just that one patient's example isn't a good way of proving something about a disease.
I've edited out the quick CDC quote of my last comment since your citation is much better.
And what you cite can’t be proof that the flu is more deadly than people think. If what you say is true, those deaths are in the numbers used for the death rate of the flu.
The point of that article is that perhaps our algorithms for estimating flu deaths are wrong.
Edit: Can someone explain the downvotes? Any error in my reasoning is not obvious to me. The claim above was that:
1. Heart attacks are included in flu death estimations
2. This should make the public think the flu is more deadly than they believe
That seems contradictory, as the public’s belief about the deadliness of the flu comes in stats from point #1. As for the article, the author made no real attempt to rebut its central claim.
Is this true? An anecdote, but both times I and/or my partner had fever and flu-like symptoms, a flu test was the first thing performed by the doctor.
Sorry for AMP link, canonical url is paywalled: https://www.google.com/amp/s/www.washingtonpost.com/business...
The CDC explains its methodology here. There are valid reasons to assume influenza deaths are higher than confirmed tested deaths. But many of these apply to coronavirus as well: https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm
"Clinicians, too, were seeing surprising numbers of COVID-19 patients develop heart problems – muscle weakness, inflammation, arrhythmias, even heart attacks. “We’re not used to respiratory viruses having such dire consequences on the heart in such apparently high numbers,” says cardiologist Gregory Marcus, MD. Many patients whose hearts acted up also had failing lungs. But others had no other symptoms or, like Dowd, only mild ones."
> Gut specialists are finding that 20% to 40% of people with the disease experience diarrhea, nausea, or vomiting before other symptoms, says gastroenterologist Michael Kattah, MD, PhD, a UCSF assistant professor. If you swallow virus particles, he says, there’s a good chance they will infect cells lining your stomach, small intestine, or colon. As in the lungs and heart, these cells are studded with vulnerable ACE2 portals.
In that case, is the info about not getting it from eating as thoughtless and parroting as saying masks don’t work, or is this article fake news? It makes a huge life changing difference to know for high risk people
1. Does the virus remain infectious in food? In particular, does hot or reheated food affect it?
2. The digestive process produces more acid. Will that kill the virus?
3. Will the virus even touch the wall of the stomach? It may be in food after chewing, rather than directly on the stomach wall
There are some reasons to think that swallowing virus replicating in your throat is different than having some inside a chewed up piece of food surrounded by saliva.
We don’t know of course, and someone super high risk should perhaps avoid takeout salads. But as of yet we haven’t had any case cluster reports where a superspreader cook spread the virus to their colleagues + customers via food. No country has reported a single instance of a traced infection via takeout.
This doesn’t mean it’s impossible, as contact tracing is not perfect. But the lack of any evidence so far is suggestive.
> Fattahi’s team has found evidence suggesting that male sex hormones such as testosterone may increase the number of ACE2 receptors that cells produce, which could help explain why SARS-CoV-2 seems to wreak greater havoc on men than on women and why kids rarely get sick.
(https://www.nytimes.com/2020/07/18/health/coronavirus-childr...)
However, Sweden did not close school for children through 14 years of age.
https://www.sciencemag.org/news/2020/05/how-sweden-wasted-ra...
And their excess mortality rates for that age group are indistinguishable from other European countries:
https://euromomo.eu/graphs-and-maps
When you go to that link, near the bottom select graphs by age and see that Sweden ages 0-14 looks like all the other countries shown there. I think that is a pretty good indication. We have a country that kept their schools open and a number of countries that did not, and the results look the same.
EDIT: in fact, the excess mortality for that age group looks indistinguishable from other years.
In the Netherlands they found out by coincidence that some people who have a broken TLR7 gene don't fight the virus so the virus hits them very hard.
So there may be multiple reasons.
I think the idea is that younger, healthier people with better immune systems are able to prevent the virus from replicating as much, whereas sluggish immune systems and bodies that are highly inflamed like overweight ppl, diabetics, etc. (high leptin, also related to il-6) get overwhelmed.
T-cell immunity/cross-reactivity meaning that most people have the ability to fight the virus from exposure to other coronaviruses.
I think a major component of the death toll from the pandemic is basically a consequence of obesity. I'm suspicious that govt interventions, planning, etc make that much difference when the US is an order of magnitude more obese than Japan, for example.
Source: https://www.google.dk/amp/s/www.washingtonpost.com/health/el...
I do hope that more attention will be focused on telling that this virus is both causing respiratory issues and heart issues. The leading comorbidities data from New York says it very clearly.
Source: https://www.the-hospitalist.org/hospitalist/article/220457/c...
The article even says "By June, clinicians were swapping journal papers, news stories, and tweets describing more than three dozen ways that COVID-19, the disease the coronavirus causes, appears to manifest itself."
Think of it this way. If there were a giant asteroid heading towards earth and we have a limited time to solve this problem, would I want 500 teams all operating by themselves and using the incredibly slow process of sharing data via NIH / NIST and other research paper repositories, or would I want them all in a war room (virtual or physical) and someone coordinating the effort to risk rank all the solutions and quickly form action plans? My vote is the latter. It feels like the scientific community may have artificially painted themselves into a corner because of something like the banana ladder conundrum. [1] meaning, doing it that way because that is the way it has always been done.
[1] - https://security.stackexchange.com/questions/33470/what-tech...
Some lists of symptoms don't include anosmia or diarrhoea, so people have symptoms but don't think these are covid-19 symptoms.
But cruise ship cases seem to indicate people with no true visible symptoms. There was a cruise ship with universal masking and a 80+% asymptomatic rate after 28 days.
Now, these patients may well have symptoms such as ground glass opacities in the lungs. But you can’t exactly feel that, so that’s some of the ambiguity.
Wow that’s incredible. 200 million Americans could have the virus.