A Doctor’s Mask Worn Awry Leads Me to Promising New COVID-19 Research

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Image courtesy of pixabay.com

I had an appointment with a substitute doctor this week. Attesting to his renown, his office walls were crowded with yearly awards demonstrating his leadership in his field.

He is a hematologist/oncologist. I was there to receive one of the twice-yearly injections I receive for osteoporosis. The same medication is given in greater strength and frequency to cancer patients to prevent bone fractures.

As he leaned forward to give me the injection, his mask was comfortably positioned beneath his nose.

I was distressed by his apparent carelessness: the man deals with cancer patients all day long, for goodness sake.

I was also amused, as it reminded me of a cartoon I’d seen, which I hope does not offend. I think it makes an important point in a memorable way.

Two roughly drawn panels—black outline, white interior. Inside the left panel is a sketch of a man with a long thin face and long thin nose. His mask is comfortably positioned beneath his nose. The legend reads: “Wearing your mask like this…” 

The right panel features a full-length sketch of the same man. That legend reads: “…is like wearing your underwear like this.”

But this was serious business, so I asked the doctor about his mask.

“I had COVID in March,” he told me. “I lost weight and slept a lot, and on the 14th day, I got up and could have run a marathon.”

He added that his wife, daughters, and one daughter’s boyfriend had also had mild cases and fully recovered. “And,” he said with certainty, “I’ll never get it again.”

I questioned him about the antibodies, which my reading had suggested was far from a settled matter. In fact, there are more than 100 vaccines in the works that are based on antibodies. But some people who recover never have antibodies, and others have them only briefly. 

“It’s not the antibodies,” he responded. “It’s the T cells. They carry memory of the virus and prevent it from reinfecting.”

He said he was so sure he’s safe that he often greets his elderly neighbor with a hug, unworried that he might infect her.

Huh! Or more specifically, Huh?

I had heard the T-cell theory, so I did a little research. In fact, there’s some exciting emerging research based on T cells and the coronavirus. Little had been known til recently about the role of the T cells in SARS-CoV-2, the virus that causes COVID-19.

For much of the following, I’m relying on Derek Lowe, who writes about drug discovery and pharma for In the Pipeline, an “editorially independent blog from the publishers of Science Translational Medicine. 

In May, Lowe wrote:

“One of the big (and so far unanswered) questions about the coronavirus epidemic is what kind of immunity people have after becoming infected. This is important for the idea of ‘re-infection’ (is it even possible?) and of course for vaccine development.”

I’ll spare you Lowe’s careful explanation of the various and complex aspects of our immune systems; if you’re interested, you can read it via the above link.

Instead, we’ll focus on two primary types of T cells. One is CD8+ T cells (among other names), which kill the virus-infected cells “before they can break open and spread more viral particles,” writes Lowe. 

“And then there’s another crowd, the CD4+ T cells, also known as T-helper cells and by other names…The helper T cells have a list of immune functions as long as your leg, interacting with many other cell types.” 

Those immune functions include spurring the CD8+ cells and “activating B cells to start producing specific antibodies,” among other tasks.

Lowe describes what I think of as the “Goldilocks response” to COVID-19:

“What you want: a robust response that clears the virus, remembers what happened for later, and doesn’t go on to attack the body’s own tissues in the process.”

This was what a team from La Jolla Institute for Immunology in California and Mt. Sinai in New York was studying. Comparing infected patients who’d recovered with those who hadn’t been exposed to the virus, they found all the exposed patients had CD4+ cells that responded to three specific proteins: Spike, M, and N. 

Lowe suggested that this discovery made the prospect of a vaccine more likely, and that though most efforts have been focused on Spike, adding the other proteins to the mix might further strengthen a vaccine’s efficacy.

Another study suggested that the memory T cells may protect some people with COVID-19 because they “remember” previous encounters with other human coronaviruses.

Of the large family of coronaviruses, six of them have been found in humans. Four are responsible for the common cold. The other two are more dangerous; they caused SARS (SARS-CoV-1) and MERS (MERS-CoV). ( I assume that means SARS-CoV-2 is number seven.)

Here’s the cool part: in that second study, reported in Nature,  Antonio Bertoletti of the Duke NUS Medical School in Singapore and his team looked at blood samples from people who’d recently recovered from mild to severe COVID-19. They all produced T cells that recognized many parts of the SARS-CoV-2 virus.

Then they looked at blood samples from people who’d also survived SARS 17 years ago—and their memory T cells from that illness also recognized parts of SARS-CoV-1.

Apparently, their immune systems were still attuned to protecting against the disease 17 years later.

After that, they checked for these T cells in blood samples from healthy people who’d had neither SARS nor COVID-19—and more than half had T cells that recognize one or more of the proteins under study.

So it’s possible that there are people who have some immunity to COVID-19 based on their previous bouts with the common cold.

Writes Lowe:

“This makes one think, as many have been wondering, that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between (1) antibody responses that seem to be dropping week by week in convalescent patients but (2) few (if any) reliable reports of actual re-infection. That would be good news indeed.”

Francis Collins, MD, who heads the National Institutes of Health, writes cautiously in the NIH Director’s Blog:

“It’s still not clear if this acquired immunity stems from previous infection with coronaviruses that cause the common cold or perhaps from exposure to other as-yet unknown coronaviruses.

“What’s clear from this study is our past experiences with coronavirus infections may have something important to tell us about COVID-19. Bertoletti’s team and others are pursuing this intriguing lead to see where it will lead—not only in explaining our varied responses to the virus, but also in designing new treatments and optimized vaccines.”

These studies may have huge implications in helping us combat COVID-19.

Bottom line for me: When I see that doctor again for my injection in 6 months, though I hope he’s wearing his mask properly, I won’t be quite as worried as I was this time. The degree of his certitude may not yet be warranted, but at least his decision is based on some solid emerging research.

Annie

Continue reading “A Doctor’s Mask Worn Awry Leads Me to Promising New COVID-19 Research”

A Mid-Pandemic, Anti-Panic, Slightly Manic Flight of…Oh, I Dunno

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Harlem Globetrotters image courtesy of commons.wikimedia.org

Dribble is a silly word.

Maybe not when we’re talking about the Harlem Globetrotters—or kids in a schoolyard testing their prowess by bouncing, bouncing, bouncing that ball on unforgiving asphalt, then arcing skyward toward a topless/bottomless structure seemingly stitched by a gargantuan spider.

Or a baby’s slo-mo Vesuvius after imbibing squished bananas and squashed squash from a teensy spoon dipped too generously into a tiny glass jar by a harried automaton-a-mama whose patience is now pandemic-thin. In such instances, the word bib, found conveniently nestling within the words dribble and imbibing, is very useful indeed.

Or the moistened sand transformed into architectural castle-wonder, dropletted with exquisite precision by small fingers onto a soggy mound, defying the waves in what was once as close to ecstasy as a five-year-old could fathom.

Those three dramatic exceptions aside, dribble makes me giggle.

Giggle is also a silly word.

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Giggle also makes me giggle.

Giggling, at my age, is better than dribbling. Giggling can still be age-appropriate. But dribbling?

It is fine to giggle when alone indoors. Funny fauna and flights of fancy courtesy of Google make me giggle. Philosophizing canines and condemnatory felines make me giggle.

Sometimes, the images projected onto the inner walls of my cranium, like bunnies made by silhouetted hands, make me giggle.

It is fine to giggle on phone calls or Zoomfests. It is OK to faux-giggle when old friends tell old jokes that once upon a long ago yesterday evoked a natural giggle—indeed, a full-throated chortle. After all, my own stories have surely outlived their shelf-half-life as well.

It is not fine to giggle when ambling alone in 90 degree heat around one’s neighborhood while dodging others who are far too near. It is not tempting to giggle then either.

But if one is tempted to journey outside one’s yard, appropriately masked and distanced, and one finds the absurdity of our contemporary lives so bizarre as to be ticklish, there are always earbuds.

Whether attached to a cell phone or merely ornamental, protruding earbuds provide the appearance of sanity. Of normality. Of stasis. Connected only to oneself, while appearing otherwise.

Earbuds are the last refuge of the solitary giggler—assuming said person cares about appearances and wishes to avoid arousing neighborly concerns.

Once in a while, with timely intervals intervening, the heaviness of political/pandemical events is outweighed by the ineluctable desire to allow the mind to enter stream-of-drivelness.

Any time now, I just may surrender to that desire.

Annie

Continue reading “A Mid-Pandemic, Anti-Panic, Slightly Manic Flight of…Oh, I Dunno”

After Dogs Detecting COVID-19, What’s Next?

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Image courtesy of en.wikimedia.org

You may recall my recent post describing studies that demonstrate how accurately dogs can sniff out COVID-19. The answer to “What’s Next?” may be found on your wrist right now.

“Wearables” outfitted with artificial intelligence (AI) to report back health data may send a message to asymptomatic or presymptomatic people with the virus before they spread the disease. That means Fitbits, smartwatches, and heart rate monitors that cardiac patients strap to their wrists may help us fight against those dreaded spikes we’re seeing nationwide. The key is that these wristlets monitor heart rate.

In a fascinating discussion, Abraham Verghese, MD, Professor and Vice Chair in Theory and Practice of Medicine at Stanford in California, spoke with Eric J. Topol, MD, Professor of Genomics at The Scripps Research Institute in La Jolla, California. Topol is also the editor-in-chief of Medscape, which carried the video and transcript of their interview.

First, a couple of items that may seem surprising. You know how diligently everyone’s taking your temperature as a precaution? I’ve visited two doctors, my dentist, and my hairdresser over the past several weeks; each time, my temperature was dutifully taken before I’d stepped well into the reception area.

“But that’s so silly,” said Topol, “because…multiple prospective studies about fever and COVID-19 have found that large numbers of people don’t have a fever.”

Topol mentioned a large study published in Nature Medicine that found only 30% of COVID-19 patients had a fever. Another recent study, published by Color genomics, put that figure even lower: 12%.

So temperature taking may catch some potential COVID-19 infections, but not that many. However, it’s such a noninvasive and seemingly inexpensive method that it seemed to me worthwhile. Unless, of course, it’s causing a distraction, and that appears to be Topol’s objection.

Wth those study findings in mind,  consider that between 30% and 40% of COVID-19 patients are asymptomatic but are still shedding virus—and that presymptomatic people are also shedding virus and are as infectious, possibly even more infectious, than those with symptoms.

For these reasons, Topol calls temperature taking “a placebo.”

Verghese agrees.

“We learned too late that we didn’t emphasize masks enough and we overemphasized temperature measurements.”

Lest anyone be thinking, “Oh, these scientists; they don’t know what they’re doing,” I want to underscore here—because science and scientists are under such unjustifiable and dangerous fire now—that both men agreed the progress that’s been made with the coronavirus has been remarkable.

Said Topol:

“The science is moving at a pace that I’ve never seen—everything, from the structural biology of the virus and the antibodies to the virus from patient, to the design of drugs and vaccines and neutralizing antibodies. The sequence of tracing it temporally and spatially geographically through the world has been extraordinary.”

The point is that this is a very complex virus causing a worldwide pandemic. Equally important, scientific progress isn’t linear: there are bound to be erroneous assumptions, initial errors, blind alleys, and failed medication/vaccine clinical trials.

It’s always been that way. Many of us just haven’t followed the process so closely because we’ve never been in a pandemic before—in which there’s such pressure to move quickly and get things right (and in the US, I must add, ignorant political interference that has had lethal effect).

Topol did discuss testing problems, including the false negatives, the logistics of testing done appropriately to scale, and the expense and time limitation of all these one-time tests. He looks forward to home testing but believes that’s at least several months from now. (See also The New York Times for this article about better testing.)

The big question remains:

“How can we find people in a cluster or an emerging outbreak before it spreads more? Because we know, by the famous Pareto rule or principle, that 80% of transmission comes from 20% of the cases.”

Since we can’t test everyone constantly, the urgency is to locate and concentrate on those “early spreaders.” And that’s where the wearables show promise.

Apparently, such wearables had been generating great interest even before the pandemic, but are now attracting the attention of large research consortiums because of their potential to forewarn about infection with this tricky and highly contagious virus.

Acknowledging that the US is far behind most countries in controlling the spread, Topol said:

“Here is the opportunity to use sensors that get continuous data and would give us an edge.”

In a project named DETECT, begun in March, he and colleagues now have roughly 38,000 participants using a smartwatch or fitness band. Other studies are using rings.

In the first 30,000 people, they found changes in three indicators: increased resting heart rate, more sleep, and fewer steps. And all three indicators then correlated with symptoms and positive tests.

Topol’s group had previously used sensor technology in studying a flu-like illness. When their findings were published in January, a group in Germany developed a smartwatch app that’s being worn by more than 500,000 people; in China, 1.3 million are using such an app.

Verghese, impressed by the number of people involved in Topol’s study, asked two questions: have the results been rigorously tested?; and “do we get the signal early enough to make a difference in some way?”

Topol said they still have to validate the results, but in their Fitbit flu-like illness study, they saw the signal well before the CDC had even observed the presence of the illness. COVID-19 is even more suited to the technology, he believes, because of the large numbers of asymptomatic people.

Studies of asymptomatic people who were on the Diamond Princess cruise ship and in Korea found more than half of them showed the same lung abnormalities as people who’d had symptoms. The presumption is that their heart rates would have shown what they did not feel.

Amazingly, more than 100 million people in the US are currently wearing some kind of wrist sensor to monitor their heart rates. Twenty percent of Americans wear a fitness tracker, according to a Pew Research poll done in January.

I sense that if this approach is validated, it might escape the politicization we’re currently seeing over wearing masks!  Think that’s possible? Of course, it wouldn’t replace masks, but it might be acceptable to some of the diehard anti-maskers among us.

Topol points out that the measure isn’t as helpful on the individual level as it is in a neighborhood.

“If your heart rate goes up, you still don’t know why. But if COVID-19 is in your neighborhood, if there is a cluster, then that makes it more of a real signal.”

Then what? Suppose your Fitbit is yelling at you (digitally)—what do you do next? That’s when testing, tracing, isolation come in, says Topol—while we await more accurate home tests that could provide quick results.

As to the wearable alerts, he says:

“The issue is to get people to be citizen scientists….a lot of people like to get their data and like to get a notification that something in their neighborhood is showing a potential signal, without inducing anxiety. But I’d like to at least raise awareness. You don’t need everyone in the country to be a citizen scientist; you just need enough. We have every state covered but not densely enough yet, so that will be important.”

Verghese raised an important question about equity and access. Not everyone has a Fitbit, smartwatch, or heart rate monitor.

“How do we ensure that we truly are studying a representative cross-section of this country and that everyone has equal access to what is basically a public health issue?”

Acknowledging the gravity of the question, especially in terms of the statistics showing the far greater burden of the pandemic on minorities, Topol stressed that not everyone needs a device: if enough people in the area are alerted to a problem, “The people who don’t have this technology will still derive the benefit of knowing that there’s an outbreak potential in their area.”

I would hope that with this knowledge, there would be a concerted effort to ensure that sufficient numbers of wearables were available in areas most likely to see disease clusters.

But that’s not enough. Topol pointed out:

“The problem is that people in these underrepresented minorities and of lower socioeconomic status don’t have access to testing. They aren’t looked after. Many of them are afraid to come in because they could be deported, or who knows what could happen to them. We have a lot of collateral damage from the pandemic here because of our tenuous and, in many cases pathetic, framework of healthcare.”

It is deeply troubling that we continually confront the vast numbers of people, particularly poor and minorities, who are being deprived of decent health care in our still wealthy nation. But I was pleased to see that the question was at least asked and discussed in this conversation. I’ll be looking at additional ways healthcare has been inequitably skewed in the near future.

My questions for you: Do you currently wear a Fitbit, smartwatch, or heart rate monitor? If you do, would you like to have it inform you if you have possible COVID-19 symptoms? If you don’t wear one, would you be willing to for this purpose? And any other comments you’d care to add are, as always, most welcome!

Annie

Continue reading “After Dogs Detecting COVID-19, What’s Next?”

Mindfulness and Trumpiness–plus a little something extra…

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Image courtesy of commons.wikimedia.org

In the world of the lovingly kind
I’ve found myself caught in a bind:
Consumed by my hate
It made my gut ache
’Twas a matter far over my mind.

Of course I can always deep breathe
Whenever I’m starting to seethe
But hate’s the wrong path;
There’s just too much wrath,
So my ideals I tried to retrieve.

This effort is surely ongoing
The seeds of contempt could keep growing
As malevolent eyes
Ignore COVID’s new highs
And the pain in the streets’ overflowing.

But one thing I’ve learned is that thoughts
If dwelt on can leave one distraught;
Accept that they’re there,
Make space for more air,
And allow them to flutter aloft.

Thus I’ve moved beyond being whiny
And reduced trump so he’s quite tiny
He’s gone from my head,
I don’t hear what he’s said…
My plan, on Day Two’s, working finely!

_______________

And, because my inner critic suggests this reflection is self-indulgent when there’s so much grief in the world, I’m adding a delightful, gently philosophical video that I hope you haven’t seen before and I think is guaranteed to make you smile.

Its title: “Amazingly simple theory for a happy life.”

Namaste!

Annie

Continue reading “Mindfulness and Trumpiness–plus a little something extra…”

Paging Dr. Dog! Another Weapon in the Battle Against COVID-19

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Image courtesy of flickr.com

We often see them in airports, sniffing around for drugs and other questionable substances. Now, it seems, dogs are being trained to use their powerful sniffers (aka snouts) to detect the coronavirus.

How do they do it? First, let’s look at the dog’s olfactory advantage for this work. Humans have a mere six million smell receptors; dogs have as many as 300 million.

Dogs trained in scent detection can discern low levels of what are called volatile organic compounds (VOCs) that are found in human blood, breath, urine, and saliva and have been associated with a number of diseases. I hope to write more about these fabulous pups and their detection of other diseases in the near future.

As to our urgent international need, here’s a sampling of some ongoing studies:

In the UK

They’re actually engaged right now in what might be considered the first step toward an airport version of a clinical trial.

There are six dogs, aptly called “The Super Six,” a combo of labrador retrievers and cocker spaniels. The premise is that the dogs will be able to detect the scent of the disease on asymptomatic travelers.

So our future may include appearing at the airport, suitcases ready, passports in hand, and then a cold little nose says, in effect, “No trip for you, buddy! You’re outta here!”

But as a dog worshipper, I can’t think of a happier way to help bring a worldwide pandemic under control.

This effort is backed by the UK government, which has donated funds to a research team from the London School of Hygiene and Tropical Medicine, in collaboration with Durham University and a charity named Medical Detection Dogs.

And the head of the research team, Professor James Logan, who also heads the department of disease control at the London School of Hygiene and Tropical Medicine, expresses optimism.

He observed in an interview with cnn.com that this work evolved from earlier research findings that people infected with malaria have a specific body odor—and “dogs can be trained to detect that with very high accuracy.”

The training involves dogs’ sniffing face masks and/or nylon socks worn by both individuals who have tested positive for COVID-19 and those who haven’t.

Why nylon socks? Professor Steve Lindsay, a public health entomologist at the university, acknowledges that it’s a “bit strange,” but their experiences have shown them it’s “a really good way of collecting odors from people and it’s such an easy way to do it.”

In the US (Two Studies) [NOTE: SEE CLARIFICATION BELOW]

Similar research is being done at the University of Pennsylvania’s School of Veterinary Medicine (Penn Vet). Same premise: uncover asymptomatic patients, who are most likely to spread the disease. Also: focus on screening in specifically challenging environments for testing, such as hospitals or businesses.

In the Penn Vet study, which began with eight dogs, the dogs were first given saliva and urine samples from COVID-19 positive patients in a lab-oratory (spelled out and hyphenated to avoid confusion with this post’s stars!). Then they were given negative samples.

The researchers plan to begin testing the trained dogs with live humans in July. They’ll test both sensitivity—the ability to correctly identify those who have the disease (true positive rate)—and specificity—the ability to correctly identify those who don’t have the disease (true negative rate).

Cynthia Otto, DVM, PhD, professor of Working Dog Sciences and Sports Medicine and director of the Penn Vet Working Dog Center, is leading a multidisciplinary group across the University.

According to Otto:

“The potential impact of these dogs and their capacity to detect COVID-19 could be substantial. This study will harness the dog’s extraordinary ability to support the nation’s COVID-19 surveillance systems, with the goal of reducing community spread.”

Another study, at Cold Spring Harbor Laboratory in New York State, bears the names of numerous authors. Involving 198 samples of axillary (armpit) sweat collected from various hospitals, the study was conducted with 18 dogs on three sites. It took the dogs between one and four hours to learn to recognize the odor and then four to ten hours to detect positive samples.

In a subset to demonstrate proof-of-concept, the researchers focused on eight dogs that had previously been trained to detect explosives or colon cancer and had now expanded their doggie resumes with this new specialty.

Their task was to pick out the positive sample from among negative or mock (made up) samples. After 368 trials, here are their percentages: four dogs scored 100%; one achieved 83%; another 84%; another 90%, and the eighth dog 94%.

All those percentages were deemed significantly different from what would occur by chance.

Thus,

“We conclude that there is a very high evidence that the armpits sweat odor of COVID-19+ persons is different, and that dogs can detect a person infected by the SARS-CoV-2 virus.”

Perhaps, theorizes Annie the English major, that also means that armpit sweat can be added to the bodily substances cited earlier that contain volatile organic compounds.

And in Finland

This article’s title appeals to my weakness for bad puns: “The Finnish COVID dogs’ nose knows!”

At the University of Helsinki, researchers from the veterinary and human medicine faculties are working together. The first dogs have successfully differentiated between the urine samples of patients that have COVID-19 and those that don’t.

The researcher and DogRisk group leader, Anna Hielm-Bjorkman, observed:

“We have solid experience in training disease related scent detection dogs. It was fantastic to see how fast the dogs took to the new smell.”

The preliminary tests have demonstrated that the dogs learned fast and worked fast, outperforming the COVID-19 tests based on molecular approaches.

But now comes the big step, prior to moving the scent detection into practice. They’ll begin a randomized double-blinded setting, “introducing them to a larger number of patient samples that are either positive or negative.

And they’ll throw in a curve ball: some of the negative samples will have other respiratory diseases.

They foresee the many beneficial possibilities, which include identifying infected individuals in nursing or retirement homes, and screening health care workers to discern those who are actually ill, rather than just having been exposed, thereby avoiding unnecessary quarantines.

And, to bring us back to where we began, they’re also looking toward screening at airport checkpoints and other border points.

These are, as far as I can tell, all preliminary studies, with the Finnish study moving closest to peer review status, and the Penn Vet study ready to take a big leap forward in just a few weeks.

But with the dogged determination of researchers, trainers, and humans’ best friends, it certainly looks as though we may soon see a warm and fuzzy side of the successful efforts to contain this terrible pandemic.

Though most of these tests will be processed in lab-oratories, if you were in an airport and given the choice, which would you prefer: a large swab inserted into your nostril, or a tail-wagging canine circling around you once or twice (no petting allowed!)?

Warmest thanks and profound love to my daughter the professional dog trainer, par excellence, who suggested the idea and provided me with the articles that formed the basis of this post.

Annie

CLARIFICATION: The study I attributed above to the Cold Spring Harbor Laboratory in the US was based on an abstract bearing its logo. I subsequently learned that the study is, in fact, being conducted in Paris, at the Alfort School of Veterinary Medicine; Ajaccio, France, at the South Corsica Fire and Emergency Dept, and Beirout (sic), Lebanon, at the French-Lebanese University Saint Joseph.

Continue reading “Paging Dr. Dog! Another Weapon in the Battle Against COVID-19”