COVID-19: Facts, Bats and the Chloroquine Cure

In terms of information on the COVID-19 crisis, this week was a rollercoaster ride. As the pandemic continued to spread, misinformation ran rampant. From the disease itself to where it came from and the supposed miracle cures being by some doctors, politicians, political operatives and the media, let's take a fact-based look at where we are and what we currently know.

By the time Friday's numbers were totaled, the U.S. had reached 20,456 COVID-19 deaths, surpassing Italy. Friday had turned out to be the deadliest day yet, with 2,064 COVID-19 deaths in the United States, making it the number one cause of death for the day for the first time, well ahead of the two which perennially occupy the top spots: heart disease and cancer. For perspective, consider all of the comparisons to influenza and pneumonia, which were responsible for a total of 153 deaths on Friday, according to CDC data.

Since the firstconfirmedCOVID-19 death in the United States on February 29, it has moved all the way up to the number four cause of death in the U.S. since and will have reached third by the time this weekend's numbers are compiled. At the beginning of the week, it had trailed influenza/pneumonia deaths since the first confirmed case but had already passed it with those maladies coming in at a still staggering 9th place as cause of death with 6,254 since March 1, compared to COVID-19's 18,488.

In Florida, there had been 17,968confirmedcases, 2,496 hospitalizations, and 419 deaths so far, as of Friday. Manatee County had 13 confirmed deaths. Meanwhile, medical experts worried that Hialeah–Florida’s 6th most-populated city–was a hotbed waiting to happen with cases on the rise and a massive elderly population, most of whom live in close quarters in nursing homes.

The internet was nonetheless awash with conspiracies with people claiming that the CDC was for some largely unexpressed reason forcing doctors to classify anyone who died anywhere of anything as a COVID case, despite the fact that causes of death for the other major maladies having remained static with the exception of car accidents, which have dropped considerably in recent weeks for obvious reasons. In other words, if that were happening, there would have to be a precipitous dropoff in the other deaths to "make room" for the manipulated COVID figures. Rest assured, these numbers are real, and they are quite sobering.

In fact, the persistent lack of testing capacity that has existed for so long (and in many places continues to exist)suggests that, if anything, COVID deaths have actually been depressed in the data. There's also the fact that studies of the virus's DNA are actually suggesting that it started much earlier than initially believed–possibly early November in China, and later November or early December in the United States, meaning there were likely many more deaths from the disease that occurred before we understood what it was.

First, in order to avoid getting confused by terminology, here’s a brief primer. Viruses are microscopic organisms that can replicate only inside the cells of a host organism. They are essentially a genetic code wrapped in a protein. Corona is Latin for crown, and coronaviruses get their name from the spikey parts of the protein that help it attach to cells.

SARS-CoV-2 is the name given to this particular coronavirus, and COVID-19 is the name given to the disease it causes. There are many coronaviruses andnovelis the term for ones that have not previously been found in humans. Infectious disease experts have been very clear for months that relatively little is known about the virus and that–despite perhaps the greatest organized global scientific effort in human history–it would still take plenty of time to fully understand how it works.

In some of the worst news of the week, a panel convened by the National Academies of Sciences reported to the White House on Tuesday that the virus is unlikely to slow its spread when summer arrives, as was hoped for based on the behavior of some other respiratory viruses like influenza, though again noting the vast uncertainties that remain.

The reportstated that there exists "some evidence to suggest that SARS-CoV-2 may transmit less efficiently in environments with higher ambient temperature and humidity; however, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread," especially without maintaining our current social distancing policies.

Another factor that remains unknown is whether those who’ve been exposed to the virus, whether symptomatic or asymptomatic, build immunity to repeated exposures, as is often the case. When a virus enters your body, the immune system responds by trying to kill it. Some of its methods are fever (which does not seem to be as effective against this virus, but more on that later), inflammation and the formation of proteins called antibodies.

Most of the time it's harder to get reinfected once you have the antibodies for a specific pathogen because they can deactivate it as soon as it's recognized by your body. The time in which antibodies remain in your body also varies wildly among pathogens spanning from just a few months to the rest of your life. For example, you're usually told that once you have chickenpox, you can't get it again, though some people go on to develop shingles later in life when the virus is reactivated, usually when their immune system is somehow weakened or compromised.

Even after extensive studies, it's unclear whether most people who get this virus generate enough antibodies to create an immunity effect, let alone how long it would last, and it seems that some people who get the disease do not develop antibodies to the virus. Scientists say that it will take much more research to better understand antibody immunity to this coronavirus, but are hoping that at least some immunity is gained by most people and, even if it isn't permanent, that it would last long enough for a successful vaccine to be developed and tested.

Despite widespread rumors since early in the outbreak, it is still unknown whether the virus originated in bats. This coronavirus is very similar to one previously found in Chinese horseshoe bats, and its initial flare-up was in Wuhan, China, where the bats are regularly sold as food in wet markets. This, along with a shrimp vendor in one of the marketsthought to bethepossiblepatient zero for the disease, has led some scientists to theorize that the virus may have jumped from bats to humans–though possibly through another animal, as many exotic animals and pets are typically trafficked there.

Now, there’s been a lot of commentary as to the backwardness of eating bat soup and, at first, I found this a little hypocritical, particularly since I live in a state where people routinely eat alligators, which doesn't seem any less strange. However, it turns out that there are many good reasons that humans should avoid eating, hunting or otherwise having contact with bats. For one, they tend to have tremendous resilience toward viruses.

Earth’s only flying mammal, bats can live for up to 20 years and move at great ranges in large numbers, so it’s not uncommon for them to pick up and carry a wide array of pathogens. Their internal temperatures also spike during flight in a way similar to a human fever, which means that viruses that develop in them must become resistant to these high temperatures.

This could explain why the fever human victims are getting seems to be ineffective in many cases. Scientists also believe that humans hunting the bats or encroaching on their terrain via development stresses the animals, making them less resistant to viruses they might otherwise successfully cope with, causing them to begin shedding the virus in a way that is transmissible to other animals and humans.

China is not the only place where bats are sold and eaten. Other countries include Indonesia, Vietnam, Thailand, Guam and even Australia, where they are hunted by Aborigines. One major lesson that must be gleaned by the entire world from this pandemic is to leave the bats alone!

There were widespread rumors this week that a doctor in New York had found a successful treatment of COVID-19 via the off-label use of an anti-malaria drug called hydroxychloroquine, in combination with the antibiotic azithromycin (marketed at Zithromax and often called Z-PAK), while a French doctor had previously claimed his study supported the treatment.

Let’s start by understanding the drugs involved. Hydroxychloroquine is primarily an antimalarial drug used to essentially destroy the malaria parasite in humans who contract it. It’s been approved for use in the United States since 1955 and is also commonly used off-label to treat other conditions, including lupus and rheumatoid arthritis. Previous research had shown no effectiveness as an anti-viral.

Zithromax is an antibiotic (meaning it is used to treat bacterial infection, not viruses). It is commonly used in treating a host of problematic infections, including things like strep throat, pneumonia, ear and intestinal infections, chlamydia, and gonorrhea. It too has been used in combination with other drugs to treat malaria.

Earlier in the outbreak, some doctors in China started treating COVID-19 patients with hydroxychloroquine because a 2005 study had found that the drug prevented the replication of the similar SARS-CoV-1 virus that causes the SARS disease that first appeared in China in 2002, at least in a laboratory (it was never studied on humans).

Earlier this year, some Chinese doctors reported that the drug seemed to shorten the duration of symptoms for patients who had exhibited minor symptoms of COVID-19 from the SARS-CoV-2 coronavirus. The claims were merely anecdotal, however, as there were no studies conducted. This led some doctors in other countries to try the drug, though many ceased because the side effects were worse than the symptoms the patients were exhibiting from the virus (including some who reportedly died of cardiac arrest).

Then, in late February, a French doctor named Didier Raoult, director of the Research Unit in Infectious and Tropical Emergent Diseases in Marseille, announced what he claimed could be an "endgame" for the pandemic. Raoult uploaded a video to YouTube that went viral–no pun intended–and soon, leaders all over the world, including President Trump, were touting the effectiveness of the drug against COVID-19, and people were angrily questioning why broadscale treatment wasn’t being made immediately available–or why quarantines weren’t being lifted, now that there was a "cure."

A non-peer reviewed preprint of the study was released on March 16–the day it was submitted to a medical journal–which makes sense, as we are in the middle of a global pandemic and peer-review and publication of a scientific study generally takes weeks or even months. Raoult reported that there were 26 patients in the study, 20 of whom completed it, and that six were given Zithromax in addition to hydroxychloroquine.

Dr. Raoult claimed that half of those who were treated with hydroxychloroquine were no longer testing positive for the virus, while all of those who received both it and Zithromax were testing negative. Meanwhile, the entire "control group" was said to remain positive.The paperwas accepted as a peer-reviewed study by the International Journal of Antimicrobial Agents the very next day, meaning its peer review must have taken place in less than 24 hours, and published online March 20. Not surprisingly, the appearance of such a study in a peer-reviewed medical journal gained enormous attention, but that's when other doctors beganraising the red flags.

Across the globe, doctors and scientists quickly pointed out that Raoult’s study was problematic, at best. Ideally, clinical trials utilize very comparable subjects who are randomly selected to either receive the drug or a placebo. This is done not only to improve the representativeness of results but also to avoid bias–researchers consciously or subconsciously choosing subjects most likely to prove the result they are invested in.

However, Raoult seems to have handpicked the patients that got treatment in the Marseille clinic, then selected 16 patients who were scattered across other clinics and were receiving standard treatment who were supposed to serve as the control. Was this done because they were patients deemed more likely to get sick or get well? That's part of the whole point of randomization in such studies.

There are also conflicts in the way the study was designed vs. the manner in which it was executed, in terms of patient age, the dates on which patient data was supposed to be collected vs. when it was (which raises questions as to whether the results weren’t as favorable on the dates originally planned) and the length of the study, which is contradicted in some of the data.

Also, what became of the six patients who did not complete the study? It’s since been revealed that three of them became ill enough to be transferred to intensive care and one died. These results, however, were conveniently kept from the study’s conclusions. The International Society of Antimicrobial Chemotherapy has since said that the study failed to meet expected standards and that they're reviewing the study and "a correction to the scientific record may be considered."

The Food and Drug Administration approved the use of hydroxychloroquine and a related medication on March 28 for emergency use in the United States to treat COVID-19. Meanwhile,other studiesin France and one in China showedverydifferent results.Onesuch studywas titled,No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection.

Here in the U.S., Dr. Vladimir Zelenko, a self-described "simple country doctor" in a small village in upstate New York, claims to have had 100 percent success treating hundreds and hundreds COVID-19 patients with the same combination of drugs plus zinc, an essential mineral that aids the human body in a number of biological processes.

Like Raoult, Zelenko also posted his supposed success to YouTube, causing a huge sensation globally. However, he has published no data, described no study design, and reported no analysis. He’s also acknowledged that his regimen is new and completely untested and that it was too soon to assess its long-term effectiveness but argued that the risks of waiting to verify its efficacy were more grave.

Officials in his community, however, were outraged,claimingthat Zelenko had wildly exaggerated his claims as to how many people have been both sick and cured in the village, noting that, despite his near-daily posting of videos making such monumental assertions, he has no background in infectious disease or epidemiology, and that the county’s own health commissioner called his extrapolations "highly irresponsible."

This is where things got political. Soon Zelenko, who’d posted one video as a direct communication to President Trump, was being heralded by Trump advisor Rudy Giuliani and soon appeared on the cable television show of unofficial Trump advisor Sean Hannity. Zelenko and Raoult have since been embraced by the far-right, perhaps because their success would contradict criticisms of the President in undermining U.S. health officials in touting the promise of the treatment.

Meanwhile, Dr. Anthony Fauci, who's been the Director of the National Institute of Allergy and Infectious Diseases since 1984 and leading the White House task force on COVID-19, has worked hard to cool everyone’s heels in terms of such mass hysteria over a completely unproven treatment. For his efforts, Dr. Fauci been attacked by conspiracy theorists who assert that the doctor–widely recognized as one of the world's leading experts on infectious diseases–is some sort of liberal deep deep state plant looking to take down the president, despite having dedicated his life to fighting infectious diseases and having served as an advisor to every American President since Ronald Reagan.

It is possible that drugs like hydroxychloroquine and Zithromax will play a role in eventual treatments of COVID-19 for some patients. However, there currently exists no concrete evidence that will be the case, and the misrepresentations of its potential have caused countries to start banning its export and begin stockpiling reserves, which has threatened its availability for those who need the drug to treat other ailments.

That said, many more studies are needed to ensure not only its efficacy but that it does not cause more damage than it brings benefits.What’s the harm in trying?some people ask. Well, given that COVID-19 seems to be highly survivable by a majority of people who contract the disease, it could be considerable given the reported side effects and still unknown potential complications.

Meanwhile, we’d be better served to stop rooting for our favorite politicians to be on the side that advocates the winning solution and return to a time when the scientific community operated on the established principles of science, while snake oil pushed on television shows and sensational yet unproven claims published on the internet were seen for what they were–something infinitely less.

Much of this infighting and speculation is driven not only by our tribal polarization but the desire of Americans to end quarantine and return to normal life. While Dr. Fauci and other medical experts have said that they are optimistic things can begin returning to normal in late summer or early fall, perhaps with gradual steps in between, they are quick to note that there are infinite variables, beginning with how effective we are in maintaining our current social distancing policies.

However, until there is an effective vaccine for the virus, it is unlikely that many activities will be able to resume at their previous scale. Even if a successful vaccine is created, it is unknown whether the virus will be able to successfully mutate and become something similar to influenza in terms of an ongoing part of human life. In many ways, the world may very well never be the same.

Dennis Maley is an editor and columnist for The Bradenton Times. With over two decades of experience as a journalist, he has covered Manatee County governmentsince 2010. He is a graduate of Shippensburg University, where he earned a degree in Government. He later served as a Captain in the U.S. Army. Clickherefor his bio. Dennis's latest novel, Sacred Hearts, is availablehere.