Notes From All Over, Part 1 -- Sunday, October 4, 2020

First things first: Talledaga, today, 1:00 p.m. central. NASCAR. NBC. 

Veklury.

Cost of production? Link here. It used to be given away to hospitals for free. Source.

Sunday morning: wow, I'm in a great mood. I was very concerned Friday night when President Trump was transferred to Walter Reed National Military Medical Center. I wonder if they should make the name a bit longer, perhaps, The Walter (NMI) Reed National Joint Medical Center Bethesda Maryland Site 1.

Amazing: I am still in awe how flawlessly this all seemed to go. One thing one does not like to do, if one enjoys, sausage, is to watch sausage being made. 

The same is true for medicine. It's not pretty. It's chaotic. Very, very chaotic. Changes are made on the fly. Many great minds making recommendations, fast and furious, and in some cases there really is not a lot of time to make a decision. And decisions are made with incomplete data. One rolls the dice and takes one's chances. No two human bodies would be expected to respond exactly the same. 

One wonders if Walter Reed had a plan in place to treat the president if he tested positive? My hunch: they did. 

One thing all military organizations are very, very good at: making checklists. One thing the US military is very, very good at: executing those checklists. 

We will never know, but one wonders how the president would have done without any medical treatment. Right now, it doesn't appear he even came down with much of a "cold." But it is also alarming how quickly this virus can lower one's oxygen levels. 

Wow, the press is certainly fixated on oxygen levels; supplemental oxygen, etc. Makes me think how influential the new  Watch is / has become. If this doesn't help sell the new watch, I don't know what will.

Disappointed: I was disappointed in the lead story in the WSJ. 

Wow, could they have made this story any more complicated? The president tested positive -- by the way, that's why the number of tests for coronavirus across the nation is such a meaningless metric. Athletes are being tested daily. Some folks are being tested multiple times a day. Which, based on the total number of tests accomplished, suggests that 99.99% of Americans have never been tested. 

And those that have tested positive have been tested multiple times, probably an average of five times. 

However the decision was made, taking him to the hospital early was exactly the right decision, and I believe exactly what the "press"  has been advising folks to do all along. 

However the decision was made, it appears the physicians and the president made the decision to hit hard, hit fast: plasma and an anti-viral medication. 

That was it. How much more complicated could the writers make it? All the other stuff -- steroids, for example -- were available if necessary. 

Caps: MarketWatch did remind me of one thing. Remdesivir is not a brand name. When used, it is not "capitalized," except at the beginning of a sentence. Gilead's name for the drug is "Veklury." A review of its discovery and development can be found here. How it works:

• enters the cell;
• inhibits RdRp:

That was easy.

RdRp should not be confused with R2-D2. 

Great article: by the way, that NIH review is very, very, very good. The coronaviruses were discovered in the 1960s.

Coronaviruses primarily cause respiratory and intestinal infections in animals and humans.2 Discovered in the 1960s, they were originally thought to be only responsible for mild disease, with strains such as HCoV 229E and HCoV OC43 responsible for the common cold. 

That changed in 2003 with the SARS pandemic and in 2012 with the outbreak of MERS, both zoonotic infections that resulted in mortality rates greater than 10% and 35%, respectively. 

Both coronaviruses likely emerged from native bat populations, which maintain a broad diversity of coronaviruses, and were transmitted through an intermediate host to humans. Loss of natural habitat and increased exposure to new hosts are likely responsible for the increased frequency of zoonotic infections originating from bats. 

Evidence also supports that the novel coronavirus which emerged in the Wuhan region of China in late 2019 also originated from bats. 

This novel coronavirus, SARS-CoV-2, resulted in an outbreak of pathogenic viral pneumonia in Wuhan, Hubei Province, China, as reported to the World Health Organization  in December 2019. Subsequent spread has led to a global pandemic, officially declared by the WHO on March 11, 2020).

Manufactured pathogen: I guess if Covid-19 is a manufactured pathogen, the Chinese (and others) have been manufacturing lethal strains since 2003. The earlier strains were more lethal but not as long-lasting. Most didn't last very long; most died out pretty quickly. Looks like they found the "trick" with Covid-19. Lasted much, much longer, but not particularly infectious or dangerous as pathogenic viruses go. Especially for a manufactured virus.

Scott Adams was able to cut to the chase in one short tweet.  

Gilead: is getting all the credit but remdesivir (GS-5734) was the result of a collaborative study by Gilead and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). I did not know that. That's amazing. I've long forgotten the history but USAMRIID; it can trace its genealogy all the way back to the 1950s. For me, as a USAF medical commander in remote regions of Turkey, practicing medicine in Turkey and Iraq, I occasionally had contact with folks from USAMRIID. They were incredibly helpful. Talk about a great organization that gets little press (but perhaps that's good). 

Toxicity: by the way, some consider remdesivir to be quite toxic, and even the NIH paper linked above suggests how toxic it can be. The president, appears, will be getting five daily IV doses of the medication (treatment regimen can be extended for a full ten days) and toxicity from the drug could be worse than the underlying disease itself. That's why they physicians say the president is not yet "out of the woods." In fact, I bet there's a lot of discussion about the continued use of the drug, especially if side effects worsen. The drug appears to have very similar side effects as seen in chemotherapeutic drugs used to treat and that makes sense: in both cases, drugs are being used to act at the level of DNA and RNA. 

Pretty cool photo: I wonder what device President Trump uses to tweet -- smart phone or laptop or desk top? What make? Android or Apple? Remember how we used to see all those photos (and stories, by the way) of President Obama and wanna-be Hillary using their cell phones). I don't recall seeing similar photos of President Trump using a cell phone. He has people that do those things. It seems the more successful someone is, the less time they spend looking at their phones. I don't know; just a random thought.

Beautiful weather. Wow, what a great time of the year in north Texas. The weather is incredibly beautiful. I score every day, one to ten, based on parameters that affect biking: temperature, humidity/precipitation, wind. We start with a ten, and then take off, in increments of a half point, high or low temperatures; degree of humidity / precipitation; wind; and, then a fudge factor. Sometimes, the number comes out to 8 before the fudge factor but the day seems so much better than an "8," I raise it to "9" using the fudge factor. These past few days, I have to score off the scale -- giving most of this past week an "11." That's how nice it's been.

Movie theaters: the end is coming. The second-largest US cinema chain may shut down. Apparently also in the UK. Regal Cinemas. Going the way of the silent movies. Story easily found; one link here. My wife loves going to the movies; I lost interest in movie theaters -- but not movies -- a long time ago. I love movies but better options for viewing now exist.