Eight plus months into the Global Pandemic known as COVID-19 with over 700,000 resultant deaths, the people and policy makers of the world are as confused as before. There are continuous debates on lock-down measures, mask/no mask, emergency use of certain drugs, etc. Everyone from politicians to celebrities to news personalities speak with scientific authority regardless of their background and training. And within the medical and scientific community, the “privileged” can speak freely without data justification while others who speak with data are criticized endlessly. Now social media platforms with no apparent “chief medical officer” are removing COVID-19 discussions that they deem invalid. So the world is exactly where it—in confusion and in fear—because it is not following the science that is clear and present. The only solution to reaching a better COVID-19 outcome is simple: listen to the science!
THESIS: The COVID-19 virus, SARS-CoV-2, behaves like the “common cold” for the young & healthy and “SARS” for the vulnerable.
**This position is supported by the known scientific facts below and the human data observed with COVID-19.**
FACT1: The biological construct for SARS-CoV-2 is known and published. In 2003, SARS arrived in the world and its receptor was found to be ACE2 (Angiotensin-Converting-Enzyme-2). In subsequent years, 2004 and 2005, two new common cold coronaviruses appeared in the form of NL63 and HKU1, respectively. The receptors for NL63 and HKU1 were found to be ACE2 and sialic acid, respectively. Yes, we know ACE2 serves as the receptor (site-of-action) for two coronaviruses with drastic outcomes (SARS with possible acute death and NL63 with coughing and sneezing). Their main difference is the higher ACE2 down-regulation (decreased production) for SARS and this is the established path (mechanism-of-action) for acute death with SARS. SARS-CoV-2 (“SARS2”) was also found to bind ACE2 as its receptor. In addition, there is evidence suggesting a “promoter” effect of neighboring sialic acid next to ACE2 to facilitate the binding of SARS2 to ACE2.[i] In essence, SARS2 is a hybrid of the endemic human coronaviruses that cause common cold and the deadly SARS.
ACTION1: There are estimates of up to 1 billion cases of common cold in US each year with adults averaging 2-3 common colds and children averaging more (from CDC). There are estimates of up to 45 million cases of influenza in US each year (from CDC). If we use the “influenza” cases as the conservative bottom estimate for COVID-19, we are working with a number that is too large for testing and contact tracing preventive measures to be effective. The proper use of testing is upon the first appearance of COVID-19-like symptoms.
FACT2: There are two dominant strains of SARS2 circulating in the world—East Asian and European—with different levels of infectivity and mortality. Yes, different levels of infectivity and mortality as measured within one month of new outbreak in respective countries. This is a precise measure given that countries have adopted different mitigation and treatment protocols several months into their respective combat against COVID-19. The different approaches could influence the infectivity and mortality rates. Deep-dive this subject at: https://sciencebetold.com/the-pandemic-box/ and https://www.cato.org/blog/two-supertypes-coronavirus-east-asian-european.
ACTION2: It is imperative that we obtain representative samples from defined geographical areas and sequence those samples for exact strain of COVID-19. We need to aggressively monitor for presence of new mutant strains with potential for greater virulence and more severe outcomes. We need to know precisely the strain(s) of COVID-19 to effectively set health policies, deploy medical resources, and execute treatment plans at the local level.
FACT3: The mechanism-of-action for COVID-19 death corroborates with observed human data. As known from SARS, upon ACE2 binding by the virus, ACE2 is down-regulated and this down-regulation leads to the main causes of acute death—respiratory failure, heart failure, and multi organ failure. ACE2 plays a critical protective role in the Renin-Angiotensin-System (RAS) that is vital for cardio-pulmonary health as well as vascular health. With its decreased presence, down-stream damages such as vasoconstriction, hypoxia, thrombosis, and excess inflammation occur potentially leading to death. For young and healthy people, their strong RAS balance buffers any ACE2 down-regulation by COVID-19 infection and their immune system is able to clear away the virus. For the elderly and people with pre-existing conditions, their weak RAS balance is susceptible to further deterioration from ACE2 down-regulation by COVID-19 infection. They are vulnerable to severe COVID-19 outcome including acute death as their immune system attempts to clear away the virus. Deep-dive this subject at: https://sciencebetold.com/covid-19-science-be-told/.
ACTION3: We have to categorize the general population into two groups—“young & healthy” and “people with pre-existing conditions”. The vulnerable group are the “people with pre-existing conditions” which most elderly fall into. These are the people that needs protection. For the “young & healthy”, their experience with COVID-19 will be no worse than influenza. We can re-open America NOW by protecting the vulnerable and returning to NORMAL with the rest.
FACT4: Children are especially protected from COVID-19 because of their pristine RAS balance and lower levels of ACE2 and TMPRSS2 in their nasal passage, barring genetic abnormalities. In a recent study, lower levels of ACE2 were found in the nasal passage—point of first contact between the virus and the human body—of children compared with adults.[ii] So there are less receptors to bind with the virus in children. In addition, another key component to the viral entry process is TMPRSS2 and the TMPRSS2 levels in children are found to be less than those in adults.[iii] The lower levels of TMPRSS2 in children temper viral replication and damage. These scientific findings are consistent with the empirical evidence of 30 children deaths from COVID-19 compared with 166 children deaths from influenza (from CDC). Deep-dive this subject at: https://sciencebetold.com/covid-19-back-to-school/.
ACTION4: We can re-open our schools NOW.
FACT5: The SARS2 infection follows the seasonal infection pattern of the common cold and influenza. As described in FACT1, some elements of SARS2 are derived from the common cold coronaviruses. It is expected that SARS2 follows a seasonal infection pattern shown in the below scheme. The seminal work on seasonal influenza transmission was done by Dr. Robert Edgar Hope-Simpson. In the Hope-Simpson model (right chart in the scheme), influenza infection is concentrated in Oct-Mar for N. temperate areas. This phenomenon is off-set six months for S. temperate areas. In the N. and S. tropical areas, the infection is more evenly spread throughout the year.
Representative cluster countries in the N. temperate region (UK, Germany, France, Italy, Spain, and Sweden) follow the Hope-Simpson model. Sweden is the no “lock-down” country (control group).
Representative cluster countries in the S. tropical region (Peru and Brazil) also follow the Hope-Simpson model. Brazil is the no “lock-down” country (control group).
Within US, key illustrative examples such as New York and Michigan follow the N. temperate pattern; Florida and Texas follow the N. tropical pattern.
The COVID-19 infection pattern is consistent with established seasonal pattern for coronaviruses and influenza.
ACTION5: Our health policies should be based on well-established, predictive infectious disease models such as Hope-Simpson’s. Local authorities do not need to be alarmed to see increases in infection that follow the seasonal patterns. In addition, “lock-down” mitigation strategies do not show any significant benefit in reducing deaths within representative cluster countries and should be avoided in future consideration.
FACT6: Therapeutic options are available with demonstrated benefits in COVID-19 patients at different stages. For patients with mild symptoms (non-hospitalized), hydroxychloroquine- and ivermectin-based cocktails have been used with success. The mechanism-of-action for hydroxychloroquine cocktails includes: 1) alkalinization to inhibit endosome entry,[iv] 2) inhibition of viral replication,[v] and 3) inhibition of sialic acid binding by SARS2 spike proteins.[vi] The mechanism-of-action for ivermectin cocktails includes: 1) inhibition of transport of viral proteins from cytoplasm to nucleus that impairs immune response[vii] and 2) inhibition of ACE2 binding by SARS2 spike proteins.[viii] For patients with severe symptoms (requiring ventilation), dexamethasone has shown efficacy in reducing mortality because of its anti-inflammatory benefits.[ix] Summary of these findings at: https://sciencebetold.com/covid-19-the-good-the-bad-the-ugly/ (first part, “The Good”). This subject is of prime importance to doctors and patients and there are new findings released regularly. Recently, reports of successful use of hydroxychloroquine cocktails and ivermectin cocktails as a prophylactic against COVID-19 have emerged. The high interest in hydroxychloroquine and ivermectin, especially among populous and developing countries, stems from their cost-effectiveness and long-history safety records. Both hydroxychloroquine and ivermectin, along with dexamethasone, are on the WHO Model List of Essential Medicines. Deep-dive hydroxychloroquine clinical use at: www.hcqtrial.com, www.c19study.com, and www.americasfrontlinedoctorsummit.com. Deep-dive ivermectin clinical use at: www.thecompleteguidetohealth.com/ivermectin.html.
ACTION6: The use of generic medicines has generated large polarization in the political and medical spheres with novel medicines rolling out. For the singular interest of patients, frontline doctors should be empowered and protected to use therapeutic options at their discretion without any interference from any institutions. In addition, we have siloed valuable treatment information at local hospitals and other care centers. We need to create an open and objective platform to share the best practices from frontline doctors on treating COVID-19.
FACT7: All of us possess the innate solution to COVID-19. As discussed previously, the culprit in COVID-19 disease progression to death is ACE2 down-regulation. From a recent publication, it was found that exercise increases ACE2 production.[x] Yes, an activity that is within our control that we could do regularly (unless there are stringent lock-down measures in place). We know from various studies the benefits of exercise—reducing the risk of cardiovascular disease by up to 35%, the risk of type 2 diabetes by up to 40%, the risk of dementia by up to 30%, and the risk of cancer up to 30%.[xi] These pre-existing conditions are the exact ones that exacerbate the outcome of COVID-19. In addition, recent publications found SARS2 reactive T cells in COVID-19 patients were also present in a significant percentage of healthy, non-COVID-19 exposed people.[xii] This suggests a select number of people have “borrowed” immunity from exposure to the endemic common cold coronaviruses; elements of common cold coronaviruses are also present in SARS2.
ACTION7: Choose to exercise regularly for protection against COVID-19 and other diseases. We should view gyms and other fitness centers in our society as “essential services” and ensure these services are not closed.
Like the seven “seals” in the Book of Revelation, unlocking these seven scientific “truths” will bring an end to the COVID-19 apocalypse. SCIENCE LEADS TO VICTORY!
[i] doi: 10.3389/fimmu.2020.01480
[ii] doi:10.1001/jama.2020.8707
[iii] doi: 10.1101/2020.04.12.037580
[iv] doi:10.3390/v8120322
[v] doi: 10.1371/journal.ppat.1001176
[vi] doi: 10.1016/j.ijantimicag.2020.105960
[vii] doi:10.1016/j.antiviral.2020.104787
[viii] doi: 10.1101/2020.06.06.20124461
[ix] doi: 10.1101/2020.06.22.20137273
[x] doi: 10.1016/j.heliyon.2020.e03208
[xi] https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day
[xii] doi: 10.1038/s41586-020-2598-9; doi: 10.1126/sciimmunol.abd2071