Improving COVID-19 pandemic response in distressed communities and a smarter, controlled approach to economic reopening.

Abstract


While some countries, nations, and peoples have fared quite well against the COVID-19 pandemic outbreak in their area, others have been much harder hit. The disparity between hospitalizations and fatalities highlights a lack of information sharing and knowledge about the most efficacious way to treat the disease. Also, for many, the economic consequences of lockdowns are dire and applying our best information to smart reopenings that do not cause renewed severe outbreaks is central to good public and economic health. This paper intends to share some recent discoveries about the prevention and minimization of the COVID-19 disease, treatment and recovery, and macro aspects that can be applied to assist in smart reopenings of some economic sectors. It has been shown that in instances where mask compliance was near 100%, the vast majority of cases of COVID-19 are asymptomatic to mild, that viral load (inoculum) is a massive component of COVID-19 severity and case outcome, and that a relationship between Vitamin D deficiency and the production of ACE2 receptors in the body leads to more severe COVID-19. Many of the most effective drugs for treatment are generic and affordable on a global scale. Still, they must be given in the appropriate doses, often early onset, and with supplements such as Zinc and Vitamin D as well as antibiotics such as Azithromycin. Several vital aspects in early detection, such as sniffer dogs and wastewater detection, could be used en masse to catch outbreaks before they spread, and contact tracing and isolation are effective methods to control and limit the spread.

A World in Chaos

The COVID-19 pandemic has ground the world economy to a halt, killed more than a million people so far, and affected many millions of lives. Still, the sadder reality is that it has not affected everyone equally. What’s more, the hard lessons, science, and research learned by early affected countries were not employed and shared properly to maximize effective treatment by later countries. Cynics have compared the global response to a line of lemmings watching each other plunge off a cliff one by one, but learning nothing and following each, exclaiming in surprise as they too are affected by gravity. The three strongest epidemic outbreaks surprised populations before any NPIs (non-pharmaceutical-interventions) were employed: Wuhan, Lombardy, Italy, and New York City, are evidence that an unaware civilian population will be devastated, specialists on the ground calling each epicenter equivalent to a battleground with impossible triage decisions being made of whom to treat and whom to euthanize. Most other places did not fare so badly, due to various measures such as masks, strict handwashing and mindfulness of surface contamination, lockdowns, and social distancing. Some places, such as Japan, had mainly asymptomatic cases and low death rates despite large, dense populations, with no lockdowns, evidence that a trained population in NPIs and ‘astronaut protocols’ will fare drastically better by every metric. Other countries such as Vietnam, Mongolia, and Uganda had great success with contact tracing and isolation. Until now, it has not been entirely clear which non-pharmaceutical-interventions (NPIs) are most effective, and why, while many countries have argued about the efficacies of each, namely do masks work and are lockdowns necessary.

Japan: Role Model for Mild COVID and No Lockdowns


In terms of minimizing hospitalizations, deaths, and the economic damage, we can look to Japan as a role model. Japan managed to do quite well without lockdowns, but high mask compliance and only minimal deaths: Tokyo, a megacity of over 37 million people, suffered only minor fatalities during their first wave. As of October 9, 2020, Tokyo has recorded 27320 COVID-19 cases, 1006 hospitalized, 21 with severe symptoms, and 421 deaths. (1)
New York City, the first American epicenter of the virus, with a population about half the size (18 million) had more than 243,975 cases,(2) 57,694 hospitalizations, and 19,237 confirmed deaths, and 4,642 probable deaths (23,879 total), even with lockdowns and attempting to use masks and distancing. The amount of people of color (Black and Indigenous people) affected by severe COVID-19 disease and fatality is much higher than that of Caucasian or Asian people; why is that? It might be important to examine several recent studies that shed light on COVID-19 infections and propose actionable and practical advice for distressed and at-risk populations worldwide. For example, a contact in the US Navajo Nation reported on October 10, 2020, 32 new COVID-19 cases, bringing the total to 10,582 positive cases (7,312 recoveries, 111,430 people tested). Five hundred sixty-three deaths have been recorded in that population – much higher per capita than that of Tokyo and many other nations and peoples. The earliest lockdowns in China were considered draconian and overly strong by many other countries yet after 8-10 weeks, much of China was able to reopen and might be the only country to actually show GDP growth in 2020(3). What we know is that pandemic lockdowns have kept millions from dying of COVID-19. A recent study from June 9 analyzed lockdowns in China, South Korea, Iran, France, Italy, and the USA. The lockdowns averted 62 million cases, averting more than 3.1 million deaths had those lockdowns not been put in place. (4)

Racial Inequality Among COVID Victims

A look at racial inequality of COVID-19 by the New York Times from July 5 shows that while the average number of cases is 38 per 100,000 of population, those identified as White report only 23, while Black and Latino report 62 and 73, respectively. This also acknowledged the disparity among Native Americans, and mentioned pockets in Arizona, such as the Navajo Nation, that “were far more likely to become infected than white people.“(5) A recent change.org email reported that many Indigenous peoples are suffering from serious outbreaks in the Amazon Rainforest, and the rate of serious disease and death is much higher again than in most metro areas. Without hospitals and access to modern medicine, it is wreaking havoc on their communities. What could be the reasons, and why?

Vitamin D Deficiency Key to Mild Outcome

Studies show that Vitamin D deficiency is central to a bad outcome of COVID-19. While many people, especially in the winter, will be vitamin D deficient, it is harder for those with melanin to receive the needed amount of vitamin D. Researchers released data (6) that tens of thousands of lives could be saved worldwide by boosting Vitamin D deficiencies into healthy ranges. Vitamin D is produced by a reaction in the skin to the UV rays in sunlight. Many people are low in Vitamin D, but those with darker skin are at a disadvantage because melanin protects the skin from burning in hot climates and inhibits Vitamin D production. An Indian-American might need twice the amount of time in the sun to generate the needed vitamin D levels, so they should take a daily dose of 5,000 international units as a daily supplement. Having low Vitamin D levels was studied and linked to increased symptomatic COVID-19 and respiratory distress and hospital admission to intensive care, whereas healthy Vitamin D levels were linked to mild COVID-19, says a new study from Italy. (7) A recent JAMA study showed that Vitamin D deficiency, even in an urban metro area, meant a patient was 77% more likely to be hospitalized for COVID-19. (8) Once hospitalized, a Reina Sofia University in Spain study showed that adding high doses of Vitamin D to the patient’s care resulted in much fewer admittance to the ICU. (9) None of the patients with their medicine + Vitamin D cocktail died. In contrast, 8% of the patients that didn’t receive the Vitamin D treatment did die. This is because when deficient in Vitamin D, the body creates ACE2 receptors in the lungs, and other organs and ACE2 receptors are the primary bonding vehicle COVID-19 uses to attack the body (10). The more ACE2 receptors you have, the more COVD-19 you can get and that has been proven to result in a stronger case of the disease.(11) How does one get enough vitamin D? Spend half the time in the sun every day it takes for you to burn, longer if you have darker skin. You can also eat the flesh of fatty fish (such as trout, salmon, tuna, and mackerel) and fish liver oils are among the best sources, as well as egg yolks, mushrooms, cow’s milk or soy milk (fortified), or orange juice or take supplements, such as a daily vitamin D intake of 1000–4000 IU, or 25–100 micrograms, 4000 IU is the safe upper limit according to the Institute of Medicine (IOM)(12), although the toxic dose of Vitamin D is more than 50,000 IU/day. (13) Selenium, Zinc and Vitamin C and E have also been shown to have an immune-boosting role in various studies, especially important for the elderly and immuno-compromised. (14) In a recent study in Barcelona, Zinc was shown to slow and inhibit COVID-19 virus replication and lower inflammation, delaying or disrupting acute respiratory distress syndrome (ARDS), a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs.

Viral Load Critical To Avoiding Serious Cases

How much SARSCOV2 you are exposed to does matter. According to many studies(15) when exposed to large doses of the virus, your body does not have time to mount a defense and becomes quickly overwhelmed. This is why we sometimes see young and healthy doctors succumb to fatal cases of COVD-19 because, as health care workers, they simply were exposed to too much of the virus and possibly not properly protected with the right mask, eye gear or somehow otherwise exposed to toxic doses.
Masks have been shown to be the best form of protection. When we look back to Japan, we see a large, very dense population that did not go into lockdown but almost uniformly complied with voluntary mask usage in all public situations. A recent study(16) shows that 95% of the cases were asymptomatic. We now understand that receiving a low innocuous of the virus (a low viral load, low dose) either might not infect you with the virus or, even if hitting that threshold, is much more likely to present as an asymptomatic case. When the general population is effectively using masks in situations, there is a huge decrease in virus transmission, and when it is being passed, because we know masks are not 100% effective, we see the weak form of the virus being spread through a masked carrier to a masked patient results 95% of the time in a very weak, mild or asymptomatic COVID-19 case, where serious complications and fatalities are very rare. So we now have proof that while the transmission may occur with or without masks, when two unmasked people (a carrier and a patient) transmit the virus in an enclosed indoor, poorly ventilated space, there is a much higher chance the virus will be transmitted in huge doses, leading to very strong, and often toxic or fatal cases of COVID-19. When the virus spreads in outdoor, well-ventilated areas from masked person to person, the virus is overwhelmingly of a mild or asymptomatic nature. Some evidence has come out that wearing masks can even create some immunity (17), by exposing people gradually to sub-toxic levels of the SARSCOV2 virus so that the COVID-19 disease does not present itself, but the body creates a natural B or T cell response or produces antibodies that would fight off a potentially larger exposure in the future. So we now understand the true power of masks in protecting the population. The results are incredibly important: both for public health and in understanding what sectors of the economy can be reopened and which should be closed and subsided. One can not eat or drink in public without removing a mask, so restaurants and bars are huge vectors of serious COVID transmission and should be avoided, for example.

Politiciciation and Profit in a Pandemic 

When dealing with serious cases of COVID-19 when they occur, we should look at developing nations rather than the west for the lead of effective treatments. While Oxford and the WHO found HCQ was a dangerous treatment for COVID-19 (18), it was revealed in the study they were using toxic daily doses, often 400% of the textbook guidelines within 24 hours and at late stages where antivirals in high doses might do more harm than good. According to the FDA, “The recommended adult dosage is 200 to 400 mg (155 to 310 mg base) daily, administered as a single daily dose or in two divided doses. Doses above 400 mg” are considered toxic and dangerous. In contrast, a Bangladesh study,(19) showed that when used early and with an appropriate textbook dose, HCQ combined with antibiotics such as AZ and Vitamin D and Zinc proved very effective, reducing fatalities by 30% and reducing hospital stay times. (20) Another incredible and multipurpose/broadband antiviral is Ivermectin,
recently showed (21) that reducing hospital stays to an average of 7 days and fatalities by 30% also. These medicines are generic and less than $1 a pill and accessible around the world for the treatment of serious COVID and prevention of unneeded case fatalities. Ivermectin has been shown to be an efficacious broad-band antiviral for a very low cost that may prove not only instrumental to ending this pandemic but possibly a future one as well. In a recent Indian study, Ivermectin is being used both as preventative prophylactic medicine as well as an effective treatment for serious onset of COVID-19. Dr. Manikappa said that 93 % of primary contacts who received Ivermectin did not develop any symptoms and 58 % of primary contacts who did not receive Ivermectin did progress to have symptoms of the pandemic. “Quadruple Therapy includes Ivermectin 12 mg one dose, Doxycycline 100 mg once a day for four days, Zinc 50 mg once a day for four days and Vitamin D3 once a week. Ivermectin, Doxycycline and Zinc are to be repeated every 14 days and Vitamin D3 every week with blood levels monitored. The synergistic effect of these medicine acts to prevent viral multiplication and also stop the virus from entering human cells. Thomas Borody, an Australian gastroenterologist who is known for curing peptic ulcers with triple antibiotic therapy, has revealed that one block in South America that received Ivermectin combination prophylaxis did not contract coronavirus infection while others did,” he said.

Unfortunately, the American NIH does not recommend either of these medicines to treat COVID-19, instead suggesting Remdisivir by Gilead (20). Remdisivir has been found to reduce the hospital stay from 15 days to 11 days (compared to 7) and shows no significant reduction in case fatalities. It’s also $3000 a pill, an amount not available to many Americans, let alone many countries worldwide. More than 1 billion people survive on less than $2 a day, and half the world is living on less than $5.50 a day. (23) This is a puzzling recommendation and might have something to do with 19/40 people on the NIH board reporting conflicts of interest and 10/40 of them being sponsored by Remdisivir’s pharmaceutical giant, Gilead. (24) If this is not the reason for this recommendation, none other is obvious or apparent.

Applying Best Case Outcomes Across the Board

What does this mean for distressed communities being ravaged by COVID-19? Suppose we look at countries and populations that have managed the better/best outcomes. In that case, we see that certain procedures and protocols will allow for the most freedom and least serious cases, hospitalization a and fatalities, and in rural areas such as the Amazon populations where some people are days from the nearest field hospital, not requiring hospitalization might be a life-saving factor. In the west and Europe, we saw 10-15 % of cases requiring hospitalization and 1-4% fatalities (25). In places without access to hospitals, this could be 10-15% of cases resulting in serious illness and death.
By using masks, supplements such as Vitamin D3 and Zinc, we can minimize the amount of a population that will suffer COVID-19 severe cases and fatalities by a factor of 95%. By using cheap, generic, and effective medications such as HCQ, AZ, Ivermectin, and Zinc/Vitamin D, we can again minimize the number of patients who suffer severe and life-threatening illnesses or deaths.
These measures are not cost-prohibitive, thus, almost universally accessible (at least with some assistance), and can level the playing field, so we do not see whole swaths of the population, be in countries, nations, or people’s that are drastically and negatively impacted by COVID-19 while other populations manage to dodge the worst of it, seemingly barely affected by the pandemic.
This can be incredibly helpful in terms of implications for the public and lockdowns. China saw a heavy lockdown for eight weeks and almost universal mask compliance and now is mostly back to normal with vigilant protocols. Japan did not enforce a lockdown and instead relied strictly on mask use ventilation and social distancing (26). By examining their successes, other countries can manage to reopen certain sectors of the economy/society, subsidize/protect the restaurants and bars, etc. that they have to keep closed. For example, on recent cruise ships, when all staff and customers received masks the moment an outbreak occurred, a majority of infections were stopped or became milder and more asymptomatic, and this kind of proactive adaptation can protect the cruise industry from a complete shutdown (27). What is clear is that the priority should be a population masked at all times in public to attempt to recreate the Japanese results of 1) reduced infections and 2) the majority of asymptomatic or mild disease for the infected. This means that all efforts should be made to outlaw and deter anti-maskers, mask enforcement, and the education and work sectors that can operate masked and safely monitored and opened. Sectors where masking is impossible (sit down public eating halls, private rooms with shared ventilation, or bars, since eating and drinking with a mask on is not feasible or possible) should be closed and efforts made to subsidize those businesses to convert to take out or give rent and insurance break government-mandated, so they will be possible after the pandemic is over or community spread is terminated, under close supervision. This clearer mandate should be implemented everywhere, as it is more focused and will give leaders clear directives from which to operate safely and effectively.

Novel Detection Methods for the Novel Virus: Stopping Outbreaks Before They Start

More effort should be put into finding and preventing outbreaks before they blow up. In Helsinki, sniffer dogs are able to detect COVID at almost 100% accuracy (28), and testing sewage wastewater can detect outbreaks ten days before they become symptomatic and problematic (29), both of these should be looked into on a larger scale as they could be the key to “smart reopening a and controlled lockdowns” when needed, preserving businesses and the economy. The WHO says, “Ventilation is an important factor in preventing the virus that causes COVID-19 from spreading indoors.” They advise to consider using natural ventilation such as opening windows, increasing airflow supply to outdoor areas, improve filters on central air, using air purifiers and making sure exhaust fans in bathrooms are at full capacity.


Please share this information as far and wide as possible to community leaders, health directors, and fundraisers capable of both sharing the information and providing the masks, supplements, and medicines needed to save lives and support affected communities.

Thank you kindly and dearly for your time and your heroic efforts in this matter,

Jorah Kai
Editor, iChongqing, Chongqing Daily News, and special COVID-19 correspondent (blogger) to CTV News Canada, journalist, and author of The Invisible War (Pandemic Diary).