Introduction to COVID-19 pandemic

The wildfire of the COVID-19 pandemic is spreading through the world. The arsonists, all while hiding the matches, are offering their help to clean up the burned places by providing some essential protective necessities – all while being praised by the media which has always been in awe of autocratic regimes, starting with German and Italian fascists and their variants. The local Wuhan, China epidemic became a pandemic. The world has to handle this very much self-inflicted wound.

The tragic death count is on display, and the economic losses are well known, the current quarantine restrictions have changed the lives of people around/throughout the world. However, the unaccounted for result of COVID-19 is apparently a pandemic of fear. As a normal protective mechanism of living species, fear becomes damaging in excess for individuals, and is dangerous for politicians who are operating in the public eye of the masses.

These introductory words preclude my presentation of some issues pertaining predominately to safety in anatomic pathology laboratories under COVID-19 conditions. However, the observations and recommendations can be extrapolated to other individual and collective safety issues. They are written from the perspective of my experience as a Chief of Sanitary-Epidemiological Station back in Karelia, Russia, an experimental immunologist (PhD program), a clinical and anatomic pathologist (Leningrad-St. Petersburg), a pathologists’ assistant (including morgue attendant) and grossing technologist (Chicago).

As an epidemiologist, I was obliged to manage all ranges of actions during local epidemics including dysentery, hepatitis, and some sporadic cases of anthrax, tularemia, and others. While working in anatomic pathology, I tried to follow the safety rule, although I managed to accidentally stick my finger during an autopsy of a deceased acute HIV patient. The variability of conditions in individuals’ lives and work across different countries are incomparable. Every experience is limited and personal biases are inevitable, but the common denominator remains to be the rationality of actions under current circumstances.A different perspective might be useful for current COVID-19 and epidemics in the future.

This blog is focusing on “hot” topics. Three buzz words are dominating during current COVID-19 epidemic: hand washing, mask, social distancing with testing inside this triangle.

Hand washing, as a variant of disinfection, is self-explanatory action rooted in history of fighting epidemics. A mask is a natural instinct of locking the door before an intruder breaks in. Social distancing is a relatively new notion. Separation between potentially ill people at the voluntary chosen distance of 6 feet is relatively benign and acceptable by the frightened society. Are not self-destructive for humans prolonged social quarantines of healthy millions who want to work, go for shoping, come together for sport, entertainment, political, religious and other events?

The blog is going to address these issues in detail. They are not challenged in public and even science discourse. Surprisingly, the world entered the pandemic without reliable scientific data regarding these basic premises.

Please, come back to the Blog’s COVID-19 categories. I’m often placing new and periodically updating some previous posts.

ICD-10 code for COVID-19

The correct medical statistics is crucial during an epidemic. The mortality data are particularly significant during COVID-19 because it is one of the unusual signs of this epidemic.           

National Vital Statistic System (NVSS) issues COVID-19 Alert No. 2 letter on March 24, 2020 that “a newly-introduced ICD code has been implemented to accurately capture mortality data for Coronavirus Disease 2019 (COVID-19) on death certificates.” “The new ICD code for Coronavirus Disease 2019 (COVID-19) is U07.1.”

The letter includes also a puzzling paragraph: “The WHO [World Health Organization] has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically reported on death certificates in the U.S., NCHS [National Center for Health Statistics] is not planning to implement U07.2 for mortality statistics”. (Bold and [ ] brackets added).

Epidemiological diagnosis exists only in WHO’s heads. There are clinical and post mortem/autopsy diagnoses. The latter is not mentioned at all. Clinical and autopsy diagnoses can be a source for the epidemiological assessment but not otherwise. So called, epidemiological diagnosis makes mortality rate more discretional and to some degree inflate the numbers of death during COVID-19. The last thing that we need in this coronavirus pandemic which is accompanied by an epidemic of fear.

The World Health Organization allowed China (the second after USA donor) to hide real the COVID-19 outbreak’s numbers in December-January. The cavalierly approach to death statistics is not helpful, moreover counterproductive.

Excerpt from Center for Disease Control and Prevention (CDC) official document on COVID-19

https://www.cdc.gov/coronavirus/2019-nCoV/lab/index.html

The CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel is a real-time RT-PCR test intended for the qualitative detection of nucleic acid from the 2019-nCoV in upper and lower respiratory specimens (such as nasopharyngeal or oropharyngeal swabs, sputum, lower respiratory tract aspirates, bronchoalveolar lavage, and nasopharyngeal wash/aspirate or nasal aspirate) collected from individuals who meet 2019-nCoV clinical and/or epidemiological criteria (for example, clinical signs and symptoms (the difference between signs and symptoms?) associated with 2019-nCoV infection, contact with a probable or confirmed 2019-nCoV case, history of travel to geographic locations where 2019-nCoV cases were detected (except Antarctica and Arctica in the pandemia?) , or other epidemiologic links (couple examples ?) for which 2019-nCoV testing may be indicated as part of a public health investigation). Testing in the United States is limited to laboratories certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), 42 U.S.C. § 263a, to perform high complexity tests. Results are for the identification of 2019-nCoV RNA. The 2019-nCoV RNA is generally detectable in upper and lower respiratory specimens during infection. Positive results are indicative of active infection with 2019-nCoV but do not rule out bacterial infection or co-infection with other viruses. The agent detected may not be the definite cause of disease. Laboratories within the United States and its territories are required to report all positive results to the appropriate public health authorities. Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information.

Bold, italics, and question mark are mine.

Many question marks are in the CDC official document. When the notion of testing, testing, testing became one of the main ways of solving the COVID-19 epidemic, the information of positive or negative 2019-nCoV tests reliability is essential. CDC ought to provide this information without hiding behind general statement.

Lungs infection and lipid metabolism

With many apologies for the intrusion in the internal medicine realm, a reminiscence from my PhD program old days. This is somehow related to COVID-19 outbreak. It is obvious that the main problem is lung damage due to virus itself or a bacterial pneumonia which is followed.

My teacher, professor L. R. Perelman, an extraordinary pathophysiologist, always repeated that lungs are one of the main lipid metabolism places. Chylomicron’s catabolism plays a significant role in activation of alveolar macrophages and the phospholipids synthesis of the pulmonary surfactant. He insisted that diets that are rich in fat are advised in lung infection. The folks medicine used bear or dog lard for tuberculosis treatment. And indigenous Arctic circle people’s diet is rich in fat.

Perhaps, this is well known to the internists in charge for treatment. Again, my apology for these remarks on the subject that is not area of my expertise.