Corona Daily 186: This is Dangerous Stuff

On Friday, 5 February, an unnamed technician working at the Oldsmar Water Plant in Florida saw the curser moving by itself on his computer screen. He was six feet away from his desk. It didn’t bother him much, because the TeamViewer program allows his bosses to remotely view his computer. In pandemic times, much work was managed remotely. In the afternoon, the curser started moving again. This time, the technician noticed the curser went to the Sodium Hydroxide (NaOH) levels and started giving commands.

NaOH is the main ingredient in drain cleaners. In small quantities, it controls the acidity of drinking water. On the screen, the invisible hand changed its level from 100 parts per million to 11,100 parts per million. In the best case, people drinking water with that level of NaOH are likely to suffer burns, skin irritation and other complications.

The shocked technician re-set the level, called his colleagues from IT, and let the management know about the cyberattack. Yesterday, in a televised press conference, the Oldsmar Sheriff said, “this is dangerous stuff.” Florida senator Marco Rubio asked the incident to be treated as a matter of national security.

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Cyberattacks on power grids, water plants, oil pipelines, industrial facilities, traffic lights, aviation control are a nightmare scenario for modern governments.

The attacks can be carried out by bored teenagers, disgruntled employees or State actors. Not known who carried last week’s amateurish attack. It lacked sophistication.

In April 2020, Iranian hackers tried to change the level of chlorine in a water plant in central Israel. Yigal Unna, head of Israel’s national security said, “Cyber winter is coming even faster than I expected. We will remember this as a changing point in the history of modern cyber warfare.” Israel counterattacked an Iranian port.

In 2007, USA and Israel had joined hands in a project codenamed “Olympic Games.” The aim was to sabotage Iran’s nuclear program. The project succeeded in using the malicious computer worm Stuxnet to target the Siemens control system and tricked Iranian centrifuges to self-destruct.

More recently, in 2016, Russia was suspected of using the same Stuxnet to disrupt Ukraine’s power grid, and throw most of Kiev into darkness and cold in the middle of a harsh winter.

America and Russia have started the Cyber cold war. Both have reportedly entered each other’s networks, and parked malware and bugs. They are willing to be patient for years. At the right time, if required, the power in an enemy city can be switched off, or drinking water can be poisoned by changing the levels of chemicals.

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America, presumed to be a developed country, has its water supply made of 70,000 separate, independent utilities. It is hard to have uniform security standards across them. Experts acknowledge USA is ill-prepared to defend itself against cyberattacks on water plants.

Ideally, these facilities should not have remote access at all. But the world in which we live, this is difficult. With the pandemic on, remote work has become even more widespread. Most public utilities, the local municipalities, have low budgets, little cash, old computers and not enough attention to cyber security. (I am attaching a 56-page booklet called Cybersecurity fundamentals for water utilities. It may be useful for any place. And by the way, if you have TeamViewer on your computer, and you don’t use it or don’t know how to use it, please uninstall it immediately).

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The incident at Florida’s water plant last week is a wake-up call for every public utility in the world. In times of remote working, the cybersecurity must be even tighter. Always working remotely, hackers are capable of causing devastation.

Ravi 

Corona Daily 187: Will Business Cards Survive?

The ritual of exchanging business cards is nowhere more sacred than in Japan. When two Japanese, in complete formal attire, meet for the first time, they ceremoniously exchange their pristine business cards. Not a wallet, but an expensive looking metal cardholder contains them. They bow deeply and accept the card with both hands. Each slowly scrutinizes the business card, reading every word on it as if it were a Haiku. This is also the trigger for icebreaking and small talk. This sacred ritual is called Meishi-Koukan (card swapping). Along with masks, social distancing, handwashing, the Japanese government also recommended an online Meishi-Koukan.

For the Japanese, the card is like a gift, and the gifting is mutual. If a foreigner forgets giving a business card (a Japanese never will), it is an offence akin to not shaking a proffered hand.

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Sansan has started virtual cards where smartphones can swap the QR (Quick Response) codes. The software also allows a Japanese worker to send all virtual cards to his boss. The boss wants to know whom you have met.

It is said a business card is your face. The Japanese company Nagaya has taken this literally. It has produced Meishi masks where your visiting card details are printed on your mask. The 100% cotton, three-layer Meishi masks are available online for Yen 1500 ($14), in three different models: “reception mask”, “sales mask” and “business activity mask”.

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The cards are an ancient product that started in China in the fifteenth century. The Chinese introduced calling cards to let people know of their planned visit. By the seventeenth century, European traders had developed trade cards that served as small advertisements of their businesses.

In later centuries, the upper classes in Europe carried a visiting card/calling card. One side contained the person’s information, and the reverse side was for handwritten messages. When you visited someone, didn’t find the person home, you would leave your card with a handwritten message. As per etiquette, if the card was left with its corner turned, it meant the card had been left in person and not by a servant.

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The card represents the quality of the person and the company. It creates the first impression. The card’s visual appeal, thick paper, background colour, fonts are part of the brand appeal. Some super-wealthy Chinese were rumoured to carry cards made of gold. Who wouldn’t want to do business with a guy who gives you a 24-carat business card?

McDonalds executives have their cards shaped like French fries. A Kodak manager, a friend of mine, always complained nobody forgets him because his photo was on his business card. A Canadian divorce lawyer has a business card that can be torn in half – one for each spouse. Mark Zuckerburg’s first business card simply read: “I’m CEO, bitch”. Well, Zuckerburg could afford to have a card like that.  

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I have a habit of writing the date and time of the meeting on the back of every business card I receive. Now when I look at my visiting card albums from the 1990s, many cards resurrect memories of the person, and the history surrounding the meeting.

Several attempts have been made to replace business cards with something virtual. A Californian company Bump technology had developed an app that allowed two smartphones to tap and the contact details would be swapped.

The demise of the business card has long been predicted, with the rise of LinkedIn and smartphones. However, the card has lasted for more than five centuries, through world wars and pandemics. It will be interesting to see if it survives the Covid-19 pandemic.

Ravi 

Corona Daily 188: No More Bon Appetit

France knows best how life should be lived- with food, love and leisure.

Cuisine is a French word. Try to find an exact equivalent in your language, you will struggle. In Paris, I saw for the first time, rows and rows of people at restaurant tables facing the streets.  Eating out is a spectacularly social and boisterous event in the evenings. In places like Paris, every day is a food festival. French culture is the culture of the table.

And un baiser amoureux, the French kiss, is the only kiss I know that is named after a nation. The French know how to love, with abandon, without inhibition, without worrying about hygiene or diseases.

And work-life balance is far tilted towards life. This is one capitalist country with strict labour laws. France gave the world a 35-hour working week. I have first-hand experience of teams of French office employees disappearing for lunch, and not at all concerned about returning to the office in time, or returning at all. If it is best to be an employer in America, it is best to be an employee in France. The leisure and well being of an employee is governed by labour laws.

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Code du Travail (French labour code) is a 3,324-page document. Its length should tell you how serious the French are about protecting workers.

Article R4228-19 in that code has the following beautiful wording:  It is forbidden to let workers eat their meals in the premises assigned to work.

French are not allowed to eat where they work, no grabbing a sandwich next to your keyboard. That is considered a repulsive American habit in France. Each company must have a canteen or a separate eating place for the employees. Anybody eating at their desks can be fined and disciplinary action taken against them. The French have understood that we work in order to eat, and not the other way round. So, eating away from work is the revered practice. That is why it is legitimate to disappear from office for long hours during lunch. People must detach themselves from work and enjoy meals. Food and excel spreadsheets can never be mixed.

*****

The news coming from the French labour ministry last week is catastrophic. The pandemic has already affected France in several ways. Teletravail (work from home) is encouraged. But in January, only 64% of those who could work from home did so. A 6 pm curfew prevents the pre-dinner stop at the boulangerie. Closure of cafes and restaurants has prompted “le click and collect”. From 29 January, a distance of two meters is mandatory between people at work when masks can’t be worn, including in canteens and lunch halls.

And now the labour ministry has announced it will allow eating at the work desk. The twentieth century regulation that prevented the ruthless capitalists from exploiting workers during their lunch hours has fallen apart for the first time. The French are devastated by the news.

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For the sake of the French, and for the global labour movement, one hopes the measure is temporary, and once the pandemic is over, Parisians will continue to disappear for those interminable hours called their lunch break.

Ravi 

Corona Daily 189: Virus Politics

Ayatollah Ali Khamenei, Iran’s supreme leader, addressed the nation on television on 8 January. He said the vaccines from United States and United Kingdom were forbidden in Iran. “They are completely untrustworthy. It’s not unlikely they would want to contaminate other nations.” He tweeted. 

The Red Crescent Society is a humanitarian organization in Iran. US based Iranian scientists were planning to send 150,000 doses of Pfizer vaccine to Iran. That shipment was cancelled following Ayatollah Khamenei’s comments.

Minoo Mohraz, an epidemiologist who heads Iran’s coronavirus task force, announced the Ministry of Health would import the AstraZeneca vaccine from Sweden. Since 1999, Astra (Sweden) and Zeneca (UK) merged to form a multinational company with headquarters in the UK. Minoo Mohraz emphasized this was a Swedish company, and omitted all references to Oxford to bypass Khamenei’s ban.

In late January, Iran approved the Russian vaccine, Sputnik V. Its first doses are expected to arrive next week. China has also promised to deliver one million doses to Iran.

Iran has had nearly 1.5 million cases, and 59,000 deaths.

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While Iran approved the Russian vaccine, the Ukrainian parliament approved a bill that officially banned any vaccines made in Russia.

Ukraine is the largest country in Europe with 42 million people, and no covid vaccines. It has had 1.25 million cases, and 24,000 deaths. Ukraine’s talks with the USA collapsed when the Trump administration banned vaccine exports. Ukraine’s leaders, who would prefer to literally die before accepting help from Russia, turned to China. In hurried negotiations with China, 1.9 million doses have been promised by Sinovac Biotech, the Chinese supplier. They may arrive this month.

“Russia, as always, uses this in its hybrid war, as an information weapon.” Said Ukraine’s health minister. “One political force just created some hysteria over the registration of the Russian vaccine. I can say at once: You can be hysterical for a very long time, no one will register the Russian vaccine in Ukraine.”

“It’s in Russia’s political interest that Ukraine receive the vaccines from elsewhere as late as possible,” said another minister. “We cannot rely on a Russian state company during an armed aggression against Ukraine” said the government’s medical director. “It’s so politicized it can’t be used.”

*****

In January, Taiwan once again confirmed that any vaccines made in China were banned from import. Taiwan’s Mainland Affairs council said vaccination was a medical matter and that it “should not be used as political propaganda”. This announcement was made after China offered to vaccinate the 400,000 Taiwanese citizens who live in China.

Taiwan’s government find the vaccines made by the Chinese companies Sinovac and Sinopharm suspect. Any Taiwanese who has received the Chinese vaccines is required to quarantine for fourteen days upon arrival in Taiwan. “There are political concerns, but there are also big concerns about the safety and effectiveness of China-made vaccines.” Its official said.

Having refused the Chinese vaccines, Taiwan currently has no vaccines. It has placed orders with Astra-Zeneca and the Covax, the global initiative. The stocks are expected to arrive in March.

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India, in January, supplied most of its neighbours free doses as a friendship gesture. Bhutan (150,000 doses), the Maldives (100,000), Bangladesh (2 million), Nepal (1 million), Myanmar (1.5 million), Mauritius (100,000) and Seychelles (50,000) received the grant. Pakistan with 550,000 cases and 12,000 deaths till today hasn’t ordered nor granted any vaccines from India.

China has donated 500,000 doses to Pakistan, they will be given to the health workers next week. Pakistani regulators have approved Sinopharm (China), Sputnik V (Russia) and Oxford (UK).

Strangely, 90% of all vaccines (non-covid) administered in Pakistan come from India. Pakistan’s pharma annual imports from India exceed $70 million. 70% of the active ingredients in medicines sold in Pakistan are imported from India. But Covid Vaccines are newsworthy.

Covid Vaccines are an instrument to make new friendships and to emphasize old enmities.

Ravi 

Corona Daily 190: On Efficacy and Herd Immunity

In my research, I increasingly come across the words “efficacy” and the more awkward “efficacious”. When newspapers say the Pfizer-BioNTech vaccine has a 95 percent efficacy, why don’t they say it is 95% effective? Because in the pharma and medical world, the two terms are technically different. 

Efficacy is the number we get from a clinical trial, in research settings. Though the trials had tens of thousands of volunteers who lived lives as they normally do, it wasn’t the “real world” test of the vaccine.

Effectiveness is what happens in the real world.

In many other fields of life, we know there may be a difference between the controlled setting and the real world. In cricket, batting in the nets, and playing in a real match in front of crowds. Between rehearsals and on-stage theatrical performances. Projections in the corporate board rooms, and actual company performance.

As we already know, some pregnant women are opting to take the vaccines. They were not included in any trials. Also, the racial and ethnic composition of the trials didn’t exactly represent the populations where trials were conducted.

As a rule, the effectiveness of the vaccines will be lower than the efficacy. The coming years would show how effective Moderna, Pfizer or Oxford were. Neither the efficacy nor the effectiveness can accurately tell you your personal risk. It depends on your immune system, health conditions, and exposure to the virus. At this stage in the pandemic, experts are urging people not to focus on the efficacy numbers, but just go ahead and take whichever authorized vaccine that is offered.

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Herd immunity is another popular expression few people had heard before the pandemic. When a significant percentage of the population is vaccinated, or has recovered naturally, it is difficult for the virus to spread. Think of an unsuspecting village, in which a burglar goes from house to house robbing households. In the beginning, he can enter any house of his choice and take cash and jewelry. Over time, he can’t enter houses which are well locked (vaccines) and houses he has already broken into (antibodies). Finally, unable to penetrate an unburgled house, he leaves the village or dies. I imagine the virus to be like that burglar.

Depending on the virus, there is a certain % that needs to achieve immunity before herd immunity is reached. That % is called the “herd immunity threshold”. Measles, a particularly contagious disease, slows down only after 95% of people become immune. Herd immunity doesn’t protect against all vaccine-preventable diseases. Tetanus, for example, is caught from bacteria in the environment, rather than from other people. No matter what percentage of population is vaccinated for tetanus, it doesn’t protect an unvaccinated person; for tetanus herd immunity is not possible.

Herd immunity is important for people with low or compromised immunity, people with HIV, newborn babies too young for a vaccine, elderly or very ill people who can’t safely get vaccinated.

Currently, India is doing very well, with low numbers of cases and deaths, and except for mask-wearing, life is returning to normal. In Delhi, a recent survey suggested more than half of Delhi’s population had antibodies. Many Indians attribute India’s current well-being to the presumed herd immunity. I would like to wait till the monsoon season is over to pass that judgement. June to September is India’s annual infection season, just like winter is Europe’s and America’s. In my view, if India’s numbers remain low till the end of September, it may be out of the woods.

Ravi 

Corona Daily 191: Story of the Taiwanese Chen

In the last week of October 2020, Chen’s flight from Hong Kong landed at Taiwan’s Taichung international airport. At immigration, he gave the address of his friend in Nantou where he would quarantine for the next 14 days. Chen knew how strict the quarantine regulations in Taiwan were. He was happy he would spend the two weeks in an empty apartment, rather than a hotel. The friend had promised to keep the fridge full. Chen’s suitcase was filled with lots of easy-to-cook meals. As agreed, he found the key to the apartment under the carpet outside. The fridge was full, a note with the wifi password was pasted on it. The hotplate worked well. Chen managed to switch on the TV and flick through the channels. Weather was great. The 14-day quarantine promised to be a comfortable experience. 

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On the third night the doorbell rang. Chen got up from his bed and checked the time on the cellphone which was charging. It was 23.15. The simple and honest man that he was, he went to the door and opened it. That was a mistake. Two guys, with short hair, and arms toned up in Nantou gyms, came inside and shut the door behind them. They clarified they were not robbers, but debt collectors. They told Chen the amount he owed to them. He simply needed to pay it, and go back to bed in peace.

Chen told the gentlemen they were mistaken. This was not his apartment. He was simply staying here for the 14-day quarantine. Of course, the debt collectors didn’t believe him. They had heard many creative stories from the debtors before. The taller man hit Chen hard. The other held him, and carried him to the car that was waiting downstairs.

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The news reports from Taiwan don’t mention how the debt collectors managed to extract the large amount from Chen. One assumes they took him to an ATM, and made him withdraw cash to hand it over to them. It was only the following afternoon that in a bruised state, his body aching and head spinning he landed back in the apartment of his friend.

A few hours later he was surprised to hear the doorbell again. The same goons have come back, he thought. This time, he won’t open the door. “Police”, the loud voice said.

*****

Taiwan has some of the strictest quarantine laws in the world. You may remember the story where $4700 fine was slapped on a man for leaving his hotel room for eight seconds.      

The Taiwanese government uses what is called an “electronic fence” system. The system monitors all phone signals to see if anyone in quarantine takes their phone out of the address or turns it off. In theory, one can leave the apartment without the smartphone and try to beat the system. But the police are smarter. They call the phone twice every day at random times, and if it is not answered, visit the place. Stories have been heard of their calling people at odd hours.

When Chen was kidnapped, his phone was left home. When the police called it twice, and there was no answer, they decided to visit the address. On opening the door, they informed Chen he must pay a fine of Taiwanese $100,000 ($4700) for breaking the quarantine law. Chen tried to tell them he was abducted and assaulted; the police didn’t believe his story. They had heard many such stories before.

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This week, the Taiwanese Justice ministry said the investigations into the events that happened three months ago were complete. Chen’s explanation was confirmed, he had violated the quarantine regulations not by his own intentional or negligent behaviour. The fine of Taiwanese $ 100,000 was revoked. The police are now looking for the debt collectors.

Chen’s is the only case in Taiwan where the quarantine fine was cancelled.

Ravi 

Corona Daily 192: Year of the Ox

If not for the pandemic, the world’s largest human migration would be taking place this month. Next Friday, on 12 February, begins the Chinese New Year (Year of the Ox, last year it was the Rat) known as such everywhere except China, where it is called Chunyun, the Spring Festival. During a forty-day festival period (28 January- 8 March) in a normal year 3 billion trips happen. It’s not only a family festival. People can visit relatives and friends uninvited. 

China has a large population of domestic migrants, 300 million. Mostly rural, the workers move to bigger cities to earn higher wages, leaving their families behind in the villages. Chunyun is the only time of the year when they return home. (Indians will recognize the migration phenomenon.) Chinese bureaucracy makes the migrant workers second-class citizens. They must register in the city of their job to access medical and social facilities. The registration system is strict making it difficult for people like factory workers to visit their families any other time of the year.

In 2020, the Year of the Rat had started on 25 January. Following the Wuhan outbreak, China had suddenly introduced travel restrictions before Chunyun. Some workers who had managed to reach their homes were stranded there for a few months. The Chinese State was unhappy that Beijing and Shanghai factories couldn’t run at their full capacity due to the stranded workers. Many suffered severe pay cuts.

Nearly half of the migrants were stranded in the town of their work. They have not seen their families since 2019. Some fathers haven’t seen their newly born children. They terribly fear not being able to go this year either.

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China fears Chunyun will be a superspreader event. This year is the 100th anniversary of the Communist Party of China, and the Party would have liked to arrange spectacular celebrations. Instead, China has come up with a strategy that tries to dissuade citizens, migrants and tourists alike, from travelling. The three-pronged plan is based on stick, carrot and emotional appeals.

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People visiting rural areas are subjected to a 14-day quarantine. They must produce a negative test and pay for it themselves. The health code on the app must be green. Some have to carry a ‘community acceptance certificate’ from the village leaders. Railway stations and airports have stepped up their precautions. The two-way quarantine and the tests may make the trip too expensive or impractical for many.

Normally, more than seven million Chinese tourists travel to Thailand, Japan, Vietnam, Singapore and Malaysia during Chunyun. Fortunately for China, all five countries have shut their borders this year.

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The list of incentives is long. Workers staying back will get gift baskets, shopping discounts. In Shanghai, officials will pay the phone and medical bills of those forgoing trips. Companies in Beijing will pay overtime, house maids will receive an extra $60. In Tianjin, the government will give subsidies to businesses for every worker who doesn’t leave for a holiday. Hangzhou, Zhejiang, Ningho and Quanzhou will issue “red packets”. Red packets were traditionally envelopes with money given to employees or children or surprise gifts. Now that happens digitally. WeChat is the most popular app in China on which those red packets can be transferred.

The city of Yiwu offers free admission to cultural places, free winter camps for children, and free subscription to online films.

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And there are campaigns to appeal to their sense of morality and patriotism.

“Mask or a ventilator? Choose one.” Reads an outdoor hoarding. “If you come home with the disease, you are unfilial.” Says another. “If you spread the disease to your parents, you are utterly devoid of conscience.” “Don’t leave Beijing unless necessary.”

Last year, with the sudden lockdown, the total number of trips (cars, trains, flights) was 1.5 billion. The Chinese administrators are practical and know their people well. Due to all persuasive and dissuasive measures, they forecast the total trips this year will be 1.7 billion instead of the 3 billion in a normal year.

*****

Ravi 

Corona Daily 193: Captain Tom Moore’s Remarkable Year

The flags above the British PM’s residence are lowered to half mast to pay tribute to Captain Tom Moore who at the age of 100 died of covid yesterday. Boris Johnson appealed to the British citizens to join the national clap for him at 6 pm today.

A year ago, very few people knew Captain Moore, even inside the UK. And yet he had the most remarkable year and died as a celebrity. 

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Tom Moore was born on 30 April 1920. He served as a British army officer in the second world war, with long stints in India and Burma. Once the world was at peace, he worked for a cement company. In his youth, he was an avid motorcycle racer. In 2018, following a fall, he was treated for a broken hip, broken rib, punctured lung and other serious injuries. He also had skin cancer. After a hip replacement and two knee replacements he used a walker.

In the spring of 2020, England was in bad shape. Hospitals were overwhelmed, morgues were full, Boris Johnson was in intensive care. Shutdowns and sickness were depressing and frightening. Against this background, a few days short of his 100th birthday, Captain Moore decided to start his walking marathon. He announced he will walk up and down his garden every day 100 times before his 100th birthday. Through this act, he wished to raise funds for the NHS. He wanted to thank NHS for his treatment as well as celebrate the health service in the time of crisis. Captain Moore was interviewed on BBC Breakfast, where he said his target was raising £1000. “Remember,” he said during the interview, “tomorrow is a good day, tomorrow you will maybe find everything will be much better than today.” This man with experience of one hundred years represented hope.

*****

What happened in the next few months is a fairytale.

Money started pouring in from all corners of the kingdom, some from abroad. In total 1.5 million people donated to raise £39 million ($ 54 million),

With the British singer Michael Ball, Captain Moore sang a song “You’ll never walk alone”. The single topped the UK music charts, and Captain Moore entered the Guinness World Records by being the oldest singer to top the charts.

On 30 April, his centenary, Royal mail had to allocate twenty employees to sort out the 150,000 greeting cards sent to him. Royal Mail postmarked each envelope with a special stamp: “Happy 100th birthday Captain Thomas Moore NHS fundraising hero 3oth April 2020”.

The Queen sends a congratulatory letter on the 100th birthday to every British citizen. She not only wrote to him, but promoted him to the rank of colonel. Then, on popular demand, on 17 July, Queen Elizabeth came out of isolation for the first time to make him Sir. During the TV interview, Captain Moore said he will not kneel before the queen. Because if he did, he will never get up again. The queen used her father’s long sword to touch his shoulders, a ritual to award the knighthood. Prince William called him ‘a one man fundraising machine.’

He had his sense of humour intact. In September, it was decided a biopic will be produced on his life. “I don’t know any actor who is 100 years old. But Michael Caine or Anthony Hopkins would do a wonderful job if they don’t mind to age up.” He said.

British Airways offered him free tickets to Barbados. He and his family enjoyed, what turned out to be his last vacation, in December 2020.

*****

Captain Moore showed how optimism, hope and energy can inspire the world. Age is no bar.

Ravi 

Corona Daily 194: Covid and Diabetes: A Two-Way Relationship?

We knew all this time that the coronavirus is more dangerous for those with diabetes. Now intriguingly it appears the relationship may be both ways. Covid-19 has caused diabetes newly in some patients. Some patients had their blood sugar higher when they were ill with covid. By the time they left the hospital, the level had returned to normal. Others went home with full-blown diabetes.

Beside attacking the lungs, Covid and in particularly long covid can cause several complications including blood clots, neurological disorders, kidney and heart damage. Now onset of diabetes may soon be added to this list. In Type 1 diabetes, (earlier called insulin-dependent or juvenile diabetes), pancreas doesn’t make insulin. This is usually diagnosed in children and younger people, and constitutes only 10% of the diabetic population. In Type 2 diabetes, very widespread, cells don’t respond normally to insulin, which is called insulin resistance. Pancreas can’t keep up trying to make more insulin to provoke cells to respond. Blood sugar rises causing all sorts of health problems. Covid may cause either type.

A year ago, in Wuhan, doctors had noticed elevated blood sugar in covid patients. Some patients who got diabetes after covid had obesity. Dexamethasone, a drug I mentioned yesterday, also causes elevated blood glucose levels. But in some cases, none of these factors were present. And some cases developed diabetes months after recovering from covid.

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John Kunkel, a 47-year-old American banker, was hospitalized in July. In a follow-up visit, his blood sugar level was dangerously high. He was readmitted and diagnosed with Type 2 diabetes. He has since had five emergency room visits and three hospital stays. He recently lost his job as a result. John is still puzzled. He had no pre-existing health issues before covid.

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An analysis published in the journal Diabetes, Obesity and Metabolism said 14.4% of people hospitalized with severe covid-19 developed diabetes. The data was collected from more than 3700 patients across eight different studies. At present researchers don’t know whether the cases are temporary or permanent.

To find out more, Francesco Rubino, a diabetes surgery professor at King’s college London and his colleagues launched a global registry of patients with covid related diabetes. God forbid, if you have had covid, and developed diabetes after that, please register here.

Some of the cases in the database provide an additional mystery. Usually, Type 1 patients may burn through their fat stores, Type 2 may experience severe dehydration and coma as the body pumps excess blood sugar into urine. The two types have different symptoms.

In some patients with Covid-19, the complications cross types. Scientists feel this may be a new hybrid form of diabetes. Professor Rubino is especially concerned about reports of diabetes diagnosed among patients who were asymptomatic or had only mild symptoms.

Diabetes has already reached alarming levels in many countries including India and the USA. When not managed, it can cause a number of complications including heart disease, stroke, blindness, kidney failure and nerve damage.

After the 2003 SARS pandemic, Chinese researchers had tracked 39 patients with no history of diabetes, who after being hospitalized with SARS had developed acute diabetes. For 33 patients, the diabetes was temporary. For four patients it lasted several months, and two patients had it after two years.

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If the suspicions about the bidirectional link between Covid-19 and diabetes turn out to be true, it is another reason everyone needs to continue taking care to avoid getting infected.

Ravi 

Corona Daily 195: Vaccines vs Drugs

In the last few months, we have been bombarded with news about Covid-19 vaccines; little has been said about Covid-19 drugs. As if protecting healthy people from Covid-19 is far more important than treating people ill with Covid-19. In the weekend edition, Carl Zimmer, a NYT columnist, discusses the reasons for this imbalance.

*****

The US Government invested $18.5 billion into vaccines, producing five effective vaccines at record speed. Investment in drugs was less than half at $8.2 billion, and lopsided. Too much money spent on few candidates such as monoclonal antibodies. Antivirals are drugs that can stop the disease early. But their trials could not happen for want of funds or enough patients.

Trump did much damage by being brand ambassador for hydroxychloroquine and chloroquine. All evidence pointed out these malaria drugs don’t work against Covid. Yet, there are still 179 clinical trials with 170,000 patients carried on.  US federal government spent a few million dollars infusing convalescent plasma into some 100,000 covid patients. In January, the trials showed it didn’t work for hospitalized patients.

Hydroxychloroquine story showed science and politics should not be mixed.

*****

Dexamethasone, a steroid drug, has been successful in reducing mortality of the severely ill patients.

Medicines need to be tested in large trials just as vaccines, with half the groups given placebos. Getting thousands of patients to take part in these trials is a logistical challenge. Patients generally visit hospitals for treatment, and not to be guinea pigs for unproven drugs. At the beginning of the pandemic the focus was on two drugs: Remdesivir, which stops viruses from replicating inside cells. This drug could shorten the recovery time, but had no effect on mortality. Monoclonal antibodies stop the virus from entering cells. Powerful, but only if given before patients are sick enough to be hospitalized.

Some researchers and doctors went for trial and error, on their own. Doctors at French psychiatric hospitals noticed that few patients became ill with covid as compared to their caretakers. It was speculated Chloropromazine, an antipsychotic drug, may be the reason. In the lab, it prevented the virus from multiplying. Enthusiastically, the doctors decided to start a trial, but the pandemic subsided at that time. Trials couldn’t happen in France or the USA because they ran out of patients.

Scientists believe the best time for a drug trial is at the beginning of the infection. But it is very hard to recruit trial volunteers at that stage. Participants who have just tested positive must be contacted, their consent obtained, and drugs given to them.

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Drug development sometimes takes ten to fifteen years. Dr Sumit Chanda, a Californian virologist, and his team screened a library of 13000 drugs, mixing each of them with cells and coronaviruses to see if infections could be stopped. A cheap leprosy pill Clofazimine fought of the virus in hamsters and other animals. Now Dr Chanda is hoping some pharma company or Joe Biden can sponsor a large clinical trial.

Pharma companies have started funding some trials of repurposed drugs. Plitidepsin, a 24-year-old cancer drug, was 27 times more potent than remdesivir at halting the coronavirus, in lab conditions. A large trial is planned in Spain.

Merck is running a trial for Molnupiravir, originally meant for influenza. It has been effective in curing ferrets of covid-19. In March, the results will show if it can cure human beings. This is a particularly interesting drug because for infected mice, it could treat all coronaviruses, including SARS and MERS.

“The efforts are unlikely to provide therapeutics in 2021,” said Dr Francis Collins, the head of the National Institutes of Health. “If there is Covid-24 or Covid-30 coming, we want to be prepared.”

Ravi