Monthly Archives: November 2020

Aspirin protection from heart attack and COVID-19 death.

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Most people know that aspirin can reduce blood clots and thus the risk heart attack, as shown famously in the 1989 “Physicians’ Health Study” where 22,000 male physicians were randomly assigned to either a regular aspirin (325 mg) every other day or an identical looking placebo. The results are shown in the table below, where “Myocardial Infarction” or “MI” is doctor-speak for heart attack.

TreatmentMyocardial InfarctionsNo InfarctionTotalfraction with MI
Aspirin13910,89811,037139/11,037 = 0.0126
Placebo23910,79511,034239/11,034 = 0.0217

Over the 5 years of the study, the physicians had 378 MI events, but mostly in the group that didn’t take aspirin: 1.28% of the doctors who took aspirin had a heart attack as opposed to 2.17% for those with the placebo. The ratio 1.28/2.17 = 0.58 is called the risk ratio. Apparently, aspirin in this dose reduces your MI risk to 58% of what it was otherwise — at least in white males of a certain age.

A blood clot showing red cells held together by fibrin fibers. Clots can cause heart attack, stroke, and breathing problems. photo: Steve Gschmeissner.

Further study showed aspirin benefits with women and other ethnicities, and benefits beyond hear attack, in any disease that induces disseminated intravascular coagulopathy. That’s doctor speak for excessive blood clots. Aspirin produced a reduction in stroke and in some cancers (Leukemia among them) and now it now seems likely that aspirin reduces the deadliness of COVID-19. Data from Wuhan showed that excessive blood clots were present in 71% of deaths vs. 0.4% of survivors. In the US, some 30% of those with serious COVID symptoms and death show excessive blood clots, particularly in the lungs. Aspirin and Vitamin D seem to help.

.The down-side of aspirin use is a reduction in wound healing and some intestinal bleeding. The intestinal bleeding is known as aspirin burn. Because of these side-effects it is common to give a lower dose today, just one baby aspirin per day, 81 mg. While this does does some good, It is not clear that it is ideal for all people. This recent study in the Lanset (2018) shows a strong relationship between body weight and aspirin response. Based on 117,279 patients, male and female, the Lanset study found that the low dose, baby aspirin provides MI benefits only in thin people, those who weigh less than about 60 kg (130 lb). If you weigh more than that, you need a higher dose, perhaps two baby aspirin per day, or a single adult aspirin every other day, the dose of the original doctors study.

In this study of COVID patients, published in July, those who had been taking aspirin fared far better than those who did not A followup study will examine the benefits of one baby aspirin (81 mg) with and without Vitamin D, read about it here. I should note that other pain medications do not have this blood-thinning effect, and would not be expected to have the same benefit.

While it seems likely that 2 baby aspirins might be better in fat people, or one full aspirin every other day, taking a lot more than this is deadly. During the Spanish flu some patients were given as much as 80 adult aspirins per day. It likely killed them. As Paracelsus noted, the difference between a cure and a poison is the dose.

Robert Buxbaum, November 27, 2020.

Locked down so long, it’s looking up: the up-side of COVID-19.

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I’m not crazy about the COVID isolation, but there are up-sides that I’ve come to appreciate. You might too. Out of boredom, I was finally got into meditation. It was better than just sitting around and doing nothing.

It’s best not to look at isolation as a problem, but an opportunity. I’ve developed a serious drinking opportunity.

And it’s an opportunity to talk to myself. I told myself I’ should quit drinking. Then I figured, why should I listen to a drunk who talks to himself.

A friend of mine was on drugs, but then quit. Everyone in his house is happy, except for the lamp. The lamp won’t talk to him anymore.

The movies are closed, and the bars, and the gyms. It gives me another reason not to go to the gym.

Did you know that, before the crowbar was invented, crows used to drink at home.

The real reason dogs aren’t allowed in bars: lots of guys can’t handle their licker.

There’s time to spend with my children. And they look like me.

I like that I don’t commute. Family events are over zoom, funerals (lots of funerals), meetings, lectures. They come in via the computer, and I don’t have to dress or attend. No jacket, no pants… no travel …. no job.

My children are spending more time with us at home. We have virtual meals together. I discovered that I have a son named Tok. He seems to like my dad-jokes.

My wife is finding it particularly tough. Most every day I see her standing by the window, staring, wondering. One of these days, I’ll let her in.

I asked wife why she married me. Was it for my looks, or my income, or my smarts. She smiled and said it was my sense of humor. 🙂

My wife is an elementary school teacher. She teaches these days with a smart board. If the board were any smarter, it would go work for someone else. It’s necessary, I guess. If you can’t beat them, you might as well let the smart board teach. I think the smart board stole the election. It began by auto-correcting my spelling. Then it moved to auto correct my voting. The board is smarter and better than me (Hey, who wrote this?)

some mask humor
I’ve learned to love masks, though some of them are hot.

You’d think they’d reduce the number of administrators in the schools, given that it’s all remote. Or reduce the price of college. It would be nice if they’d up the number of folks who can attend. So far no. Today the Princeton alumni of Michigan is sponsoring video-talk by Princeton alumnus, George Will. I wanted to attend, but found there was limited seating, so I’m on the waiting list (true story). By keeping people out, they show they are exclusive. Tuition is $40,000 / year, and they keep telling us that the college is in service of humanity. If they were in the service of humanity, they’d charge less, and stream the talk to whoever wants to listen in. I have to hope this will change sooner or later.

Shopping for toilet paper was a big issue at the beginning of the pandemic, but I’ve now got a dog to do it for me. He goes to the store, brings it back. Brings back toothpaste too. He’s a lavatory retriever. (I got this joke from Steve Feldman; the crowbar joke too.)

I don’t mind that there are few new movies. There are plenty of old movies that I have not seen, and old TV shows too.

This fellow is the new head of Biden’s COVID-19 task force. He’s got a science-based plan for over-population and the disease.

I like that people are leaving New York and LA. It’s healthy, and saves on rent. Folks still travel there, mostly for the rioting, but lockdowns are nicer in Michigan.

More people are hunting, and hiking, and canoeing. These are active activities that you can do on lockdown. The old activities were passive, or going out to eat. Passive activities are almost a contradiction in terms.

We’re cooking more at home, which is healthier. And squirrel doesn’t taste half bad. If I live through this, I’ll be healthy.

I’m reading more, and have joined goodreads.com. I’ve developed a superpower: I find can melt ice cubes, just by looking at them. It takes a while but they melt.

A lot more folks have dogs. And folks have gotten into religion. Wouldn’t it be great, if after death we fond that dyslexic folks were right. There really is a dog.

Let’s love the virus. If we don’t, the next crisis will be worse.

There was an election last week. My uncles voted for Biden, which really surprised me. They were staunch Republicans when they were alive. My aunt got the ballot and convinced them. She was a Democrat when she was alive.

I got pneumonia vaccine shot, and a flu shot. That wasn’t a joke. I think it’s a good idea. Here’s why. People mostly die from pneumonia not the virus.

Before COVID, the other big crisis was global warming. Al Gore and Greta Thunberg claimed we had to shutter production and stop driving to save the planet. COVID-19 has done it. The next crisis is over-population. COVID is already curing that problem — not so much in China, but in the US, Europe, and South America.

Just As a final thought, let’s look at the bright side of the virus. If we don’t, the next crisis will be worse. Take Monty Python’s advice and Always look at the bright side of life.

Robert Buxbaum, November 20, 2020.

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.