Corona Daily 333: Tooth fractures

An interactive chart ranks professions according to the coronavirus risk they face. Measured against two parameters, “exposure to diseases” and “physical proximity to others”, dentists are identified as carrying the highest risk.

In March, most dentists around the world shut their clinics. In April, YouTube posted some horrible clips about how to extract teeth by the DIY method.

Last month, WHO once again recommended delaying all “routine” dental care. American dental association vehemently disagreed with the advice.  It argued oral conditions are related to overall health. Routine visits can find diabetes, cancer or liver illnesses. Gum disease is linked to increased risk of stroke, respiratory disease, heart disease, diabetes, ulcers and arthritis. At the global level, an estimated 3.5 billion are affected by oral disease. Untreated dental caries in permanent teeth is the most common health condition in human beings.

And most of those 3.5 billion humans have not visited the dentist for the past six months. Increased intake of sweets and fizzy drinks have made our mouths dirtier.

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Dental associations argue many dentists have been wearing Personal Protective Equipment, masks, gloves, goggles since 1980s, after the HIV/AIDS epidemic. Now additional precautions are practiced. Fewer patients are given appointments, aerosols in the room are given time to settle before taking another patient, patients are spaced in the waiting rooms. Some dentists use rubber dams to cover the patient’s mouth, only exposing teeth that require work. Clinic ventilation is improved; expensive PPEs are bought for assistants. A 45 page document that recommends a re-opening plan for dentists worldwide is worth reading for any dentist, as well as for patients who need reassurance.

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In yesterday’s NYT, Dr Tammy Chen raises a new issue from her practice. She talks about an epidemic of tooth fractures. In the past six weeks, she has seen more tooth fractures than in the last six years. She gives two main reasons.

One is the stress. The pandemic related anxiety or coronaphobia leads to clenching and grinding, damaging the teeth.

Secondly, work from home has resulted in people working on sofas, beds, kitchen counters. The employee is sometimes C-shaped, bending to look at the smartphone. Dr Chen explains that the nerves in the neck and shoulder muscles lead into the TMJ (temporomandibular joint), which connects the jawbone to the skull. Bad posture during the day translates into a teeth-grinding problem at night.

Most people aren’t getting restorative sleep. Restlessness and insomnia are on the rise. Instead of resting and recharging, the body stays in a battle-ready state, and that tension is expressed through the teeth. Most of Dr Chen’s patients are unaware of their teeth grinding. (Heavy snorers also deny they snore).

Are your teeth currently touching, Dr Chen asks us. They shouldn’t, throughout the day, except when eating and chewing. To protect, a device called night guard or retainer can be held between the teeth. Better to crack a night guard than a tooth, says Dr Chen.

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Based on my reading, a summary:

·     Unless you are among the most vulnerable Covid-19 group, please visit your dentist, including for a preventive routine check.

·       Call to check precautions taken by the clinic and expected from the patients.

·       The pandemic may last for a long time. Not visiting a dentist for more than a year can create health problems worse than Covid-19.

·       Check your posture when working. Get a proper ergonomic chair and a table. When seated, your shoulders should be over your hips, and your ears should be over your shoulders. Computer screens should be at eye level.  

Ravi

Corona Daily 334: The Spy Wars

There is not one vaccine race but two. One race is to develop it; the second to steal it.

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According to the American intelligence agencies, Chinese hackers have been trying to steal American research work on vaccines. The hackers have focused their efforts on Universities and schools where research is conducted. They are softer targets than the pharmaceutical companies. The University of North Carolina was among those where Chinese hackers tried to break in. Agents are offering education to those bodies as to how to protect their data and research better.

China works on several fronts. Their operatives extract information from the World Health Organization. There is some truth in Trump’s accusation of China’s disproportionate influence on WHO. (Taiwan is not allowed in the WHO meetings despite all other countries supporting its inclusion). China allegedly uses that influence to understand which vaccine research efforts are more promising. (Steal only what is the most promising).

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On 21 July, two Chinese hackers, Li Xiaoyu and Dong Jiazhi, were indicted by the US justice department. They sometimes worked on behalf of the Chinese state, and sometimes as private freelancers. In 2015, Obama and Xi had signed a pact promising to stop the theft of technological knowhow. Its effect lasted 18 months. Then Li and Dong became active. As early as 27 Jan, 2020, the pair hacked a Massachusetts biotech firm researching a vaccine. In February, they breached a Californian company researching a coronavirus drug. In May, they burgled another Californian firm developing virus testing kits.

The Chinese hackers first broke into the networks of employees or customers. Then impersonating them, they gained access to the pharma companies. They could smoothly steal the source codes from the software companies. Li and Dong rummaged through the “recycle bins”, where files are available but rarely seen by the system administrators. The hackers can also manipulate or corrupt the data by changing the file names or the data itself.

Though the American justice system held them guilty, of course they suffer no sentence. They are based in China, well paid by the Chinese government. China has no extradition treaty with the USA.

On the next day, Trump administration closed the Chinese consulate in Houston, Texas accusing the Chinese staff of spying.

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Russian hackers are the other menace. Chinese generally focus on stealing intellectual property and technology. Russia’s cyber espionage aims on things like election interference, thereby weakening its geopolitical rivals.

This year, Russia is focused on stealing research by Oxford/AstraZeneca. British, American and Canadian agencies complained about the Russian hacking. On 16 July, the National Cyber Security Center published a 16-page detailed advisory.

Russia has two hacker groups, with wonderful names. Cozy Bear and Fancy Bear. You may remember them from the 2016 US presidential election. They are believed to be connected to different offshoots of KGB. Cozy bear is part of Russia’s foreign intelligence service (SVR). Fancy bear is linked to the military intelligence agency GRU (whose agents went to Salisbury to admire a cathedral).

A Kremlin spokesman denied the accusations, saying he didn’t know who could have hacked the research in Britain. But then, the same spokesman didn’t know who poisoned the Skripals or Navalny either.

After the Russian vaccine announcement, the Oxford scientists expressed surprise at the resemblance between their vaccine approach and the reported work of the Russians. If the Oxford suspicions are true, Russia wouldn’t need to conduct large scale trials. They can simply rely on the Oxford trial results.

*****  

Ravi

Corona Daily 335: Bye Bye Mink

When I worked in Moscow, many Russian girls in my office wore mink fur coats. The coats looked elegant and warm, offering protection from the severe cold. They came in many colours, and discussing their prices was part of the office gossip. A British colleague, a woman, scorned at the wearers. In her country, it was illegal to make anything with mink. Until then, coming from a tropical country, I had no idea mink was an animal.

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Several countries have special mink breeding farms. Denmark, China, Poland, Netherlands and the USA are the top five producers. Mink is the most farmed furry animal, with more than 50 million minks bred every year. Minks breed in March, and have one litter per year. With a 45-50 day gestation, they give birth in May. With 6-10 kits per litter, the mink population grows dramatically by May. In November and December, they are killed, and in the following year worn by the elite women of the world.

For several decades, animal rights activists have been fighting against the cruelty of mink farming. In farms, minks are placed in small metal wire cages that restrict their ability to move. Such imprisonment is said to create abnormal behavior and repetitive actions. It is possible to create fur products with synthetic fibers (made from petroleum oil). The obsession to use natural fur is criticized and made illegal in some countries.

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Netherlands has more than 170 mink farms. On 23 and 25 April, two coronavirus outbreaks were reported at farms with 12000 and 7500 minks. More minks were dying than usual, and some were breathing with great difficulty. They had contracted it from farm workers who had covid-19, a case of zoonosis in reverse. Once the virus reached a mink farm, it spread like wildfire, though minks were housed in separate individual cages. Scientists suspect it moved via infectious droplets, on feed or bedding or in dust containing fecal matter.

That was just the beginning. More and more farms reported the epidemic among minks. Feral cats, roaming the farms, and stealing the minks’ food were found to be infected as well. In June, authorities in the Netherlands began gassing hundreds of thousands of minks, including new-born pups. They were culled using carbon monoxide. Until today, more than 2 million minks have been gassed.

Denmark and Spain reported few cases. But Utah, a major mink breeding American state has reported a number of infections in August. American scientists are worried that the virus could mutate and amplify in mink populations, before making a jump back into humans.

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Last week, Netherlands announced that the mink farming must end by March 2021. That nation was planning to stop it in 2024 for moral reasons. Coronavirus has forced the Dutch to bring that deadline forward by three years. The unaffected farms can still produce mink fur in November and December (by killing the uninfected). But they will not be allowed to replace them. After 31 March 2021, mink farming will be illegal in the Netherlands. The nation had closed down fox and chinchilla fur production in the 1990s. Closure of mink farms will end all fur farming on its soil.

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The next few months will show if the story sees repetition elsewhere. If severe epidemic among minks becomes universal, an industry considered immoral could become illegal for ever.

Ravi

Corona Daily 336: The French Connection

Benoit Paire, the controversial and therefore entertaining Frenchman, was seeded 17th in the 2020 US Open. Of course, winning the tournament was beyond him. But with many big names dropping out, perhaps he might make it to the quarters. Perhaps even semi-finals. He had been in a New York bubble since 18 August.

On 29 August, Paire received a call. He had tested positive. That he was asymptomatic didn’t matter. The strictest protocol was activated. For the next two weeks, he should not leave his room. His name was withdrawn.

The contact tracers’ interrogation lasted for more than two hours. Paire had won a few matches in shorter time.

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Kristina Mladenovic won her first match, and was hugely depressed. Contact tracers had established a list of seven players, five French and two Belgian, who had come in contact with Paire. As a special concession, they would be allowed to continue playing, but only after signing a new agreement.

Kristina had practiced once with Paire, but they were on the opposite sides of the court. That didn’t count. She had spent 30-40 minutes in the hotel lobby playing cards with a group of players, including Paire. Though all of them had worn masks, the 40 minutes of card-playing changed everything.

She would be tested every day from now on. Nobody was allowed in her room. Meals would be delivered to her room. Henceforth, she was responsible for changing the bedsheets and cleaning her room. Used towels and sheets should be dropped outside. She would leave her room at pre-determined time, and would be escorted. No using the elevator.  She must use the stairs along with the escort. Every day, on returning to the hotel, her credential (badge) will be confiscated. (Without it players can’t move inside the hotel).

On the ground, Kristina would no longer have access to locker rooms and dining areas. She would have a separate area for the warm up. The key to her isolation area will be with the tournament staff.

This was described as “a bubble inside a bubble”.

On Wednesday, 2 September, Kristina was leading 6-1, 5-1, 15-0 against Varvara Gracheva, a debutant Russian. It should have taken her another five minutes to finish the match. Instead she mentally collapsed. Her opponent saved four match points. Kristina couldn’t win a single game in the third set and lost the match.

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On Friday, 4 September, Adrian Mannarino was ready to go to the court, when the tour manager came to him and said the New York State didn’t approve of him playing. Mannarino was one of the seven players in the contact tracers’ list. He was already in a bubble inside another bubble. His opponent Alexander Zverev was told the match may or may not happen. New York City health authorities were ok with the match, but the New York State authorities had overruled them. Djokovic, on hearing this, tried to contact Cuomo, but couldn’t get through. Cuomo is a busy man.

After three hours’ toing-and-froing between New York City and New York State, finally the match happened. Like musicians, tennis players “tune” their rackets to suit the weather. Zverev’s rackets were strung with a higher tension for the afternoon heat. He had to readjust them for the evening. Zverev won against the Frenchman.

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Kristina Mladenovic has had 37 negative tests. “I have the impression we are prisoners or criminals.” She said. “For the slightest movement, we have to take permission. It’s abominable. The conditions are atrocious.” Kristina is the no. 1 seed in doubles. All other French players are knocked out. However, none of them will be allowed to leave the room or the country until 12 September.

Ravi

Corona Daily 337: A Closed US Open Tournament

The US open that started in New York this week is usually the year’s last grand slam tennis tournament. In 2020, Wimbledon was cancelled, French Open postponed, and US Open doubtful with the ever-rising infection numbers in New York. A few months ago, the National Tennis center was turned into a field hospital with sirens and ambulances instead of cheering fans.  

Annually 850,000 spectators from all over the world attend it, with some American celebrities given front view seats. The 80 luxury suites are sold to corporate sponsors for $500,000 for the fortnight.

This year, players were tested before they left for New York. On Long Island, they are provided two rooms in official hotels. Players must wear masks unless they are practicing or playing or working out. Last year’s winners Nadal and Andreescu withdrew. Nick Kyrgios tweeted he would travel in a Hazmat suit, and then spend two weeks in quarantine on his return to Australia. He wasn’t exactly joking. The legendary Brian twins, earlier meaning to make it a swansong, retired before the tournament.

Djokovic and Serena Williams are renting private houses paid for by themselves. They also had to pay for the USTA-approved security guard who monitors their movements. Absolutely no player is allowed to go anywhere except between the home and the tournament.

Not a single spectator is allowed. The smell of hamburgers and waffle fries is missing. A handful of lucky bartenders, laundry workers and security are the only people watching. And players watch one another’s matches because they have nothing better to do. Ball boys are not allowed to touch a towel. Nadal made it a ritual to ask for a towel after each point. But now players must fetch a towel themselves, from the colour-coded boxes. They are allowed 25 seconds between points. Even Djokovic received a warning for a towel-time violation.

Most line judges are gone. Hawk-eye live, the electronic system, makes all line calls. So as to feel familiar, the hawk-eye talks in male and female pre-recorded voices shouting “out”, “fault” or “foot fault”.

Since the whole show is arranged for television, sound system provides background noise and crowd cheering taken from the 2019 matches. The public address system introduces players with highlights of their careers. There is nobody at the venue who doesn’t know those details.

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In this knockout tournament, losing in the first round is cruel. But every year, those unlucky players still retain a free room for two weeks at a midtown Manhattan hotel and enjoy the nightlife and shopping. This year, they must continue to stay in a boring bubble.

Damir Dzumur travelled from Belgrade and spent 16 days in a bubble before losing in a second round of an earlier tournament. With a world rank of 109, he has been spookily unlucky; his US open first round opponents for the last three years were Federer, Wawrinka and now Djokovic. He duly lost in less than two hours. For three matches in New York, he has already spent three weeks in seclusion and travelled 9000 miles wearing a mask.

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US Open started in 1881. It is the only grand slam tournament that was never cancelled. During the world wars; Wimbledon, French and Australian were cancelled but not the US open. After the bombing of the Pearl Harbour (1941) president Roosevelt insisted it is held as a morale booster.

This uninterrupted record looks like the main reason why a spectator-free, bubbled- players tournament is held this year.

Ravi

Corona Daily 338: A King and Twenty Women

The king of Thailand Vajiralongkorn, also known as King Rama X is the world’s richest royal. Richer than the kings of Brunei, Saudi, UAE, Morocco and Queen Elizabeth II, he is worth at least $30 billion. Among his jewellery is a 545-carat Golden Jubilee Diamond, the world’s largest cut diamond. During the coronation ceremony, the king was carried on a golden platform in a spectacular six-and-a-half hour procession through Bangkok’s historic quarter.

The king has an estate on Lake Starnberg, near Munich. In March, when the pandemic began, for logistical reasons, he decided to move with his entourage to a hotel. The Grand Hotel Sonnenbichi in the resort town of Garmisch-Partenkirchen was closed for all other guests, but couldn’t say no to the King of Thailand. This hotel has a great view of the Bavarian Alps. The fourth floor is reserved for the king and his harem of twenty sex soldiers. The harem is ostensibly assembled as a military unit. But their objective is to please rather than protect the king.

According to the German authorities, the king and his harem were given special permission because they are “a single, homogenous group of people with no fluctuation.”

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King Rama X, now 68, has been married four times, and has seven children. He always needs a young wife irrespective of his age. He divorced his third wife and sent her relatives to jail. Then in May 2019 he married again. His wife was a former flight attendant. In two months time, though, he declared a girlfriend as his concubine. The king awarded her the title of a “Royal Noble Consort”. However, in three months, when she started to behave like an official queen, her title and ranks were removed and she was sent to prison.

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While King Rama X lived at the Munich hotel with his harem, his official wife lived at his house in Switzerland.

Since the lockdown, Thai Airways has banned all international flights except to Munich and Zurich. On April 5, the king took off in his plane. He picked up his wife from Switzerland and landed in Bangkok to celebrate an annual event. Every year, Thailand celebrates the coronation of Rama I and the establishment of the Chakri dynasty, of which the current king is tenth in line. As a king, he had convinced the German government quarantine was not necessary for him. And he has diplomatic immunity. At the Bangkok party he said, “This pandemic is not the fault of anybody. The government must solve the problem by understanding its causes.” Saying this, he immediately went back to the plane, and flew back to Germany. He sent his wife back to Switzerland. Between March and today, that was the only day he spent in Thailand.

This week, on 2 September, possibly bored with the harem, the king ordered the release of the Noble Consort (concubine), and brought her to the hotel in Germany.

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King Rama X is protected by the strictest Lese-Majeste laws. The criminal code says anyone defaming, insulting or threatening the king will be punished with imprisonment of three to fifteen years.  

Nationwide protests are happening in Thailand for the last two months. They are against the government, but the king is not spared. #WhyDoWeNeedAKing has been a trending twitter topic. When life outside prisons is as rotten, and life is as miserable as death, protestors have nothing to lose. The King of a mismanaged country with a collapsed economy lives abroad with a harem viewing the Bavarian Alps.   

Will political protests in pandemic times succeed in removing dictators or kings? Let’s wait and see.

Ravi

Corona Daily 339: India’s Vaccine Prince

Adar Poonawalla.

This name will be heard a lot more in the next couple of years. The 39-year old is the CEO of the Serum Institute, the world’s largest vaccine manufacturer. 65% of the children in the world across 170 countries receive at least one vaccine made by Serum. At an average of 50 cents a dose, these are among the cheapest.

Poonawallas belong to the Parsi community, the fire worshippers, who fled Persia during the seventh century Muslim conquest. Practitioners of Zoroastrianism, they settled in India and prospered. Distinguished by their industry and integrity, Parsis are among India’s most successful entrepreneurs. Overzealousness about ethnic purity has made Parsis an endangered species; they will soon be called a tribe. Adar will require only two hours to produce enough doses to vaccinate every Parsi in the world. Many Parsees took their professions (doctor, carpenter) or locations as surnames. The family of Poonawallas is indeed from Poona.

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Though Adar is a charming prince, the kingdom was founded by his father, Cyrus. The Poonawalla family traditionally owned horse stud farms. The family was closely tied to India’s horse racing circuit. As a young man, Cyrus realized horse racing had no future in socialist India. A chance conversation with a vet led Cyrus into vaccines. Until then, Poonawallas donated the retired horses to Bombay’s Haffkine institute. Haffkine collected the horses’ serum to make vaccines. Cyrus decided to cut the chain short by making vaccines himself. One way was to inject horses with small amounts of toxin and then extract the horse’s antibody-rich serum.

In 1967, Cyrus began with the tetanus vaccine. That was followed by snakebite antidotes, TB, hepatitis, polio and flu. Cheap labour, focus on volumes over margins, and advanced technology made the Serum Institute the world’s top vaccine manufacturer. Dr Cyrus Poonawalla is India’s seventh richest man valued at $15 billion. The Serum institute remains an unlisted private company with two decision makers, Cyrus and his son Adar. That helps quick decision making, so essential in crisis times.

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The Poonawallas are not shy to flaunt their wealth. Adar’s office is a refurbished A-320 aircraft. He can have dinner in Poona, sleep in one of his long-range jets, conduct meetings in Europe, and return to Poona the same day. He has never experienced the airport crowd. The family has an insanely large collection of Rolls Royces, Ferraris, Batmobiles, and top-end Bentleys and Lamborghinis. This is in addition to thoroughbreds which Adar rides regularly.

Adar and his wife Natasha, a fashion icon, and an MSc from the London School of Economics, is perhaps India’s number one power couple. It is an honour for Bollywood and other celebrities to attend parties at their home. In 2013, they hosted Prince Charles and his entourage during his visit to India.

In 2015, Poonawallas bought Lincoln house, a palatial seaside house occupied by the US Consulate in Bombay for decades. They picked up the 50,000 sq feet heritage mansion for $113 million, India’s most expensive house purchase ever. Residents of Bombay applying for a US visa may have visited the grounds of that house in the past.

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Despite the lavish lifestyle, Poonawallas are grounded and known for their philanthropy. Adar has decided to gamble in a big way by already starting the production of the Oxford vaccine. He expects to sell them for $3 per dose to India and other poor countries. If after the trials, the vaccine is unsuccessful, the millions of doses will have to be thrown away.

No Covid-19 vaccine is possible without involving India’s Serum institute. For the sake of his courage, one wishes Adar Poonawalla success in his gamble.

Ravi   

Corona Daily 340: My Country First

Yesterday, on 1 September, United States of America, under the influence of its top man, officially refused to be part of another global initiative.   

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The world population is close to 8 billion. Immunologists feel at least two Covid-19 vaccination doses will be needed, doubling the requirement to 16 billion. Currently, the world’s total manufacturing capacity is 6.4 billion a year. Remember, this capacity is needed to fight diseases like polio, flu, chickenpox, diphtheria, hepatitis, and measles. To prevent one disease, you can’t allow an outbreak of another. In essence, globally an incremental capacity of 16 billion doses needs to be built, a near impossible task. Based on the efforts so far, in 2021, some 2 billion doses will be produced. Who gets them first? The richest countries, of course. They pay for the vaccine development, and lock up millions of doses for their own people.

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In 2007, Indonesia, one of the hardest hit countries, could not buy H5N1 influenza (bird flu) vaccine, because the rich countries had signed advance purchase agreements to buy the entire stock. The virus was raging in one country, and shots were given in another. (Indonesia tried getting back by temporarily not sharing the virus samples).

In 2009, it happened again. Rich nations bought the entire stock of the H1N1 influenza vaccines, initially leaving nothing for poor countries. Fortunately, in both cases, the epidemic did not last long.

If two doses were blocked by the USA and EU/UK, almost nothing will be left for others, including Brazil and India, currently in the top three countries affected.

A vaccine effort is always global, not local. India is the world’s largest vaccine manufacturer (not a developer). Ebola vaccine was invented by Canadian researchers, licensed to a multinational American company, and produced in Germany.

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COVAX (Covid-19 Vaccines Global Access) is a global initiative to ensure fair and equitable vaccine distribution across the world. 80 rich countries (called “self-financing”) including EU, Japan, Canada, Brazil, Korea, Singapore, UK, and 92 countries (called “funded”) including (a) low income countries like Afghanistan, Nepal, and many African countries and (b) lower-middle income countries like India have shown willingness to join COVAX.

The rich countries will subsidize the poor countries. A dose will likely cost $25-$40 in rich countries, middle income countries like Turkey will pay $10-$16, and India, other parts of Asia, and Africa will pay $3-$5. No country can receive more doses than to cover 20% of its population. The vaccines will be offered to all countries in proportion to their populations. Health care workers will get priority, followed by vulnerable groups, including the elderly and those with medical conditions. Further doses will be available based on the country need, and Covid-19 threat. A buffer stock will take care of severe outbreaks anywhere in the world.

On the supply side, COVAX has already signed agreements with nine main vaccine makers, two from China, two from the USA, one each from Korea, UK, Germany, Australia, and one multi-national.

The goal of COVAX is, by the end of 2021, to deliver 2 billion doses of safe, effective vaccines equitably across the world. The deadline for confirming commitment is 18 September, and upfront payment from rich countries (without which the project is not possible) is due by 9 October.

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The White house spokesman Jude Deere issued the following statement yesterday: “The United States will continue to engage our international partners to ensure we defeat the virus, but we will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China.”

Ravi

Corona Daily 341: A Tango After Hundred

Anna Lanelli, born in Brooklyn, New York, was six years old when she was infected in the dangerous influenza pandemic. Her three-year old sister Helen was also down with what would later be called the Spanish Flu. At the time the two sisters caught the bug, the First World War was still on. Coincidentally, both sisters were born on the same date, 5 September, with a gap of three years. Anna was born in 1912, the year the titanic sank, Helen in 1915. Fortunately, both survived the Spanish flu pandemic.

Their parents were deaf. The girls communicated with them in sign language. Anna married Frank Del Priore, a professional tango dancer, with whom she would often dance. She had a job as a seamstress.

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In May 2020, Darlene Jasmine, 66, received a phone call from Brighton Gardens in New Jersey. Her grandmother had come down with Covid-19. “Oh my god, this is it” thought Darlene. Her grandmother Anna was 107 years old.

Anna Del Priore had fever, cough, and a loss of appetite. But she didn’t need a ventilator, nor was she hospitalized. Anna fought for six weeks, and completely recovered. “God made me better” she said smiling on FaceTime.

Anna became the oldest woman to survive two pandemics that were more than one hundred years apart.

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Anna’s granddaughter, Darlene, says Anna has always been active and mobile. She would do her own cooking and grocery shopping. She specialized in Mediterranean cuisine. Anna herself credits her longevity to the Mediterranean diet - fish, olive oil, fresh vegetables, fresh fruit and pasta. “And eat a lot of peppers” she says laughing.

Swimming and sewing are two activities she has never stopped. And given an opportunity, she still dances the tango. As can easily happen with a 100+ old lady, her husband and two daughters are not alive any more. Anna lived with her granddaughter until the age of 101. Till then, she would walk a mile to McDonalds every morning for coffee with friends (who were presumably younger). Then she moved to an assisted living facility in New Jersey. The staff describes Anna as always positive and always smiling. Now, four days shy of her 108th birthday, she gets up, combs her hair, walks and dances.

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Two months before Anna was down with Covid-19, Nick Guzzone, 77, received a call from a nursing home in Queens, NY. His mother had tested positive. Nick could not sleep for a few nights. His mother, Helen Guzzone was 104 years old. Fortunately, Helen recovered in two weeks time. On FaceTime, she gave the good news to her elder sister, and asked her to take care of herself.

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Dr Purvi Parikh, an immunologist at NYU Langone said genetics probably played a role and the two sisters may have highly efficient T cells. T cells are white blood cells we all have that help us fight infection, especially viruses. The two sisters may have T cells far more efficient than the norm, which allowed them to recover against the Spanish flu and Covid-19.

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One gerontology website tracks people over 100 who got infected by Covid-19. Several centenarians across the world have survived. They say people over 65 are at a higher risk and those above 85 much more so. I wonder if the vulnerability meter resets itself on reaching 100. Anna and Helen certainly seem to suggest so.

The coming Saturday, on 5 September, Anna will turn 108, and Helen 105, both in good health and spirits.

Ravi  

Corona Daily 342: Testing Times

Since the time life became surreal, the world has been in a tearing hurry to end the nightmare. State health regulators committed serious compromises. In April, America’s Food and Drug Administration decided to approve tests without reviewing their safety and effectiveness data. The US market was flooded with poorly performing tests.

In March, the UK bought 2 million unproven finger prick tests from China, which Boris Johnson advertised as the “game changer”. In April, an Oxford study confirmed the tests were too inaccurate to be used. In May, a new antibody test from Roche was reported to be 100% accurate. Public Health England showed that the test couldn’t identify 16% samples who had suffered from covid-19. In June, MHRA (Medicines and Healthcare Products Regulatory Agency) banned sales of several tests, including all finger-prick tests. (Antibody tests either draw blood that is sent to the lab, or are rapid finger-prick blood tests.)

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Wrong/unproven drugs/vaccines can cause damage, occasionally kill. Hydroxychloroquine was given an emergency authorization under political pressure. Later when it was clear the possible heart damage outweighed any benefits, the authorization was withdrawn. Tests don’t kill directly, so the regulation is more lax. The world over, Covid-19 tests are prone to give wrong results because the regulatory process is weak, and inadequate. Approvals are issued based on self-declaration rather than scientific scrutiny. This is particularly true of antibody tests. An expert panel in the USA examined 9500 papers describing test validation and found only 47 worth considering. The UK has not approved any at-home tests. Several people offering tests are arrested, and over 47,000 tests have been seized.

Generally, after many tests, follow-up testing is recommended. Canada, with fewer people and ample resources insists on two virus tests. The first result is called presumptive and second confirmatory. The result is confirmed only when the two tests match. Neither such luxury nor the required resources exist in most parts of the world. The world is living with false positives and false negatives.

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Antibody tests for Covid-19 have largely been unreliable, inaccurate and devoid of meaning. They may look for the wrong antibodies, the timing of the test may be wrong, or the right antibodies may fade away. For people from low-prevalence areas, the test gives a large number of false positives. (Even without doing the test, we know the probability of having antibodies, and not having them, is 50% each.)

There is a global consensus among doctors and healthcare experts that antibody tests should be used only for checking the virus spread in the community, not for testing an individual. Due to poor controls, and unreliability, a positive result may create a sense of false security.

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To make matters even more exciting, CDC (Centers for Disease Control and Prevention) admitted they were mixing the results of viral and antibody tests. That way USA could show a higher number of tests done. Mixing the tests makes it much harder to understand the meaning of “positive” tests (in a viral test, one hopes to be negative, in antibody test, the reverse). Virus testing shows the number of people infected, whereas the antibody testing is compared to a rearview mirror. A Harvard professor of global health called it a total mess.

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In short, avoid an antibody test, unless you are taking part in a population survey where you live. If for some reason you must give blood to check antibodies, please ask the service provider about the regulatory approval they have got.

Abandoning scientific method in crisis times simply creates additional crises.

Ravi