Covid-19 had us all fooled, but now we might have finally found its secret

medium ^ | 5 April 2020 | libertymavenstock

[COBOL2Java]

In the last 3–5 days, a mountain of anecdotal evidence has come out of NYC, Italy, Spain, etc. about COVID-19 and characteristics of patients who get seriously ill. It’s not only piling up but now leading to a general field-level consensus backed up by a few previously little-known studies that we’ve had it all wrong the whole time. Well, a few had some things eerily correct (cough Trump cough), especially with Hydroxychloroquine with Azithromicin, but we’ll get to that in a minute.

There is no ‘pneumonia’ nor ARDS. At least not the ARDS with established treatment protocols and procedures we’re familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required… They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.

The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.

Here’s the breakdown of the whole process, including some ELI5-level cliff notes. Much has been simplified just to keep it digestible and layman-friendly.

Your red blood cells carry oxygen from your lungs to all your organs and the rest of your body. Red blood cells can do this thanks to hemoglobin, which is a protein consisting of four “hemes”. Hemes have a special kind of iron ion, which is normally quite toxic in its free form, locked away in its center with a porphyrin acting as it’s ‘container’. In this way, the iron ion can be ‘caged’ and carried around safely by the hemoglobin, but used to bind to oxygen when it gets to your lungs.

When the red blood cell gets to the alveoli, or the little sacs in your lungs where all the gas exchange happens, that special little iron ion can flip between FE2+ and FE3+ states with electron exchange and bond to some oxygen, then it goes off on its little merry way to deliver o2 elsewhere.

Here’s where COVID-19 comes in. Its glycoproteins bond to the heme, and in doing so that special and toxic oxidative iron ion is “disassociated” (released). It’s basically let out of the cage and now freely roaming around on its own. This is bad for two reasons:

1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once all the hemoglobin is impaired, the red blood cell is essentially turned into a Freightliner truck cab with no trailer and no ability to store its cargo.. it is useless and just running around with COVID-19 virus attached to its porphyrin. All these useless trucks running around not delivering oxygen is what starts to lead to desaturation, or watching the patient’s spo2 levels drop. It is INCORRECT to assume traditional ARDS and in doing so, you’re treating the WRONG DISEASE. Think of it a lot like carbon monoxide poisoning, in which CO is bound to the hemoglobin, making it unable to carry oxygen. In those cases, ventilators aren’t treating the root cause; the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. The red blood cells just can’t carry o2, end of story. Only in this case, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry o2 because it has lost its iron ion. The body compensates for this lack of o2 carrying capacity and deliveries by having your kidneys release hormones like erythropoietin, which tell your bone marrow factories to ramp up production on new red blood cells with freshly made and fully functioning hemoglobin. This is the reason you find elevated hemoglobin and decreased blood oxygen saturation as one of the 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.

2) That little iron ion, along with millions of its friends released from other hemes, are now floating through your blood freely. As I mentioned before, this type of iron ion is highly reactive and causes oxidative damage. It turns out that this happens to a limited extent naturally in our bodies and we have cleanup & defense mechanisms to keep the balance. The lungs, in particular, have 3 primary defenses to maintain “iron homeostasis”, 2 of which are in the alveoli, those little sacs in your lungs we talked about earlier. The first of the two are little macrophages that roam around and scavenge up any free radicals like this oxidative iron. The second is a lining on the walls (called the epithelial surface) which has a thin layer of fluid packed with high levels of antioxidant molecules.. things like abscorbic acid (AKA Vitamin C) among others. Well, this is usually good enough for naturally occurring rogue iron ions but with COVID-19 running rampant your body is now basically like a progressive state letting out all the prisoners out of the prisons… it’s just too much iron and it begins to overwhelm your lungs’ countermeasures, and thus begins the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to all that nasty stuff and damage you see in CT scans of COVID-19 patient lungs. Ever noticed how it’s always bilateral? (both lungs at the same time) Pneumonia rarely ever does that, but COVID-19 does… EVERY. SINGLE. TIME.

— — — — — — — — — — — — -

Once your body is now running out of control, with all your oxygen trucks running around without any freight, and tons of this toxic form of iron floating around in your bloodstream, other defenses kick in. While your lungs are busy with all this oxidative stress they can’t handle, and your organs are being starved of o2 without their constant stream of deliveries from red blood cell’s hemoglobin, and your liver is attempting to do its best to remove the iron and store it in its ‘iron vault’. Only its getting overwhelmed too. It’s starved for oxygen and fighting a losing battle from all your hemoglobin letting its iron free, and starts crying out “help, I’m taking damage!” by releasing an enzyme called alanine aminotransferase (ALT). BOOM, there is your second of 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.

Eventually, if the patient’s immune system doesn’t fight off the virus in time before their blood oxygen saturation drops too low, ventilator or no ventilator, organs start shutting down. No fuel, no work. The only way to even try to keep them going is max oxygen, even a hyperbaric chamber if one is available on 100% oxygen at multiple atmospheres of pressure, just to give what’s left of their functioning hemoglobin a chance to carry enough o2 to the organs and keep them alive. Yeah we don’t have nearly enough of those chambers, so some fresh red blood cells with normal hemoglobin in the form of a transfusion will have to do.

The core point being, treating patients with the iron ions stripped from their hemoglobin (rendering it abnormally nonfunctional) with ventilator intubation is futile, unless you’re just hoping the patient’s immune system will work its magic in time. The root of the illness needs to be addressed.

Best case scenario? Treatment regimen early, before symptoms progress too far. Hydroxychloroquine (more on that in a minute, I promise) with Azithromicin has shown fantastic, albeit critics keep mentioning ‘anecdotal’ to describe the mountain, promise and I’ll explain why it does so well next. But forget straight-up plasma with antibodies, that might work early but if the patient is too far gone they’ll need more. They’ll need all the blood: antibodies and red blood cells. No help in sending over a detachment of ammunition to a soldier already unconscious and bleeding out on the battlefield, you need to send that ammo along with some hemoglobin-stimulant-magic so that he can wake up and fire those shots at the enemy.

The story with Hydroxychloroquine

All that hilariously misguided and counterproductive criticism the media piled on chloroquine (purely for political reasons) as a viable treatment will now go down as the biggest Fake News blunder to rule them all. The media actively engaged their activism to fight ‘bad orange man’ at the cost of thousands of lives. Shame on them.

How does chloroquine work? Same way as it does for malaria. You see, malaria is this little parasite that enters the red blood cells and starts eating hemoglobin as its food source. The reason chloroquine works for malaria is the same reason it works for COVID-19 — while not fully understood, it is suspected to bind to DNA and interfere with the ability to work magic on hemoglobin. The same mechanism that stops malaria from getting its hands on hemoglobin and gobbling it up seems to do the same to COVID-19 (essentially little snippets of DNA in an envelope) from binding to it. On top of that, Hydroxychloroquine (an advanced descendant of regular old chloroquine) lowers the pH which can interfere with the replication of the virus. Again, while the full details are not known, the entire premise of this potentially ‘game changing’ treatment is to prevent hemoglobin from being interfered with, whether due to malaria or COVID-19.

No longer can the media and armchair pseudo-physicians sit in their little ivory towers, proclaiming “DUR so stoopid, malaria is bacteria, COVID-19 is virus, anti-bacteria drug no work on virus!”. They never got the memo that a drug doesn’t need to directly act on the pathogen to be effective. Sometimes it’s enough just to stop it from doing what it does to hemoglobin, regardless of the means it uses to do so.

Anyway, enough of the rant. What’s the end result here? First, the ventilator emergency needs to be re-examined. If you’re putting a patient on a ventilator because they’re going into a coma and need mechanical breathing to stay alive, okay we get it. Give ’em time for their immune systems to pull through. But if they’re conscious, alert, compliant — keep them on O2. Max it if you have to. If you HAVE to inevitably ventilate, do it at low pressure but max O2. Don’t tear up their lungs with max PEEP, you’re doing more harm to the patient because you’re treating the wrong disease.

Ideally, some form of treatment needs to happen to:

1. Inhibit viral growth and replication. Here plays CHQ+ZPAK+ZINC or other retroviral therapies being studies. Less virus, less hemoglobin losing its iron, less severity and damage.
2. Therapies used for anyone with abnormal hemoglobin or malfunctioning red blood cells. Blood transfusions. Whatever, I don’t know the full breadth and scope because I’m not a physician. But think along those lines, and treat the real disease. If you’re thinking about giving them plasma with antibodies, maybe if they’re already in bad shape think again and give them BLOOD with antibodies, or at least blood followed by plasma with antibodies.
3. Now that we know more about how this virus works and affects our bodies, a whole range of options should open up.
4. Don’t trust China. China is ASSHOE. (disclaimer: not talking about the people, just talking about the regime). They covered this up and have caused all kinds of death and carnage, both literal and economic. The ripples of this pandemic will be felt for decades.

Fini.

[mewzilla]

Just ran across this, for anyone else interested...

Oxygen Therapy is effective to help the immune response fight COVID-19 by AHA Hyperbarics | Mar 12, 2020 | news

[grey_whiskers]

I salute you.

I was making a sarcastic rejoinder to your earlier “resonance frequencies” sarcasm about 5G.

Here, if you have time. People tend to dismiss out-of-hand even the slightest suggestion of any effects on the body, of WiFi.

But when I tracked down a link listed in a YouTube, I found... peer reviewed journals (Elsevier, for example).

https://www.sciencedirect.com/science/article/pii/S0013935118300355#bib11

The links on this page, appear at first blush to be from reputable, peer-review journals.

e.g. https://www.sciencedirect.com/science/article/pii/S000527361500053X?via%3Dihub

Investigation of the effects of distance from sources on apoptosis, oxidative stress and cytosolic calcium accumulation via TRPV1 channels induced by mobile phones and Wi-Fi in breast cancer cells

is from Elsevier.

It considered oxidative stress on certain breast cancer cell cultures as a function of distance and frequency of several WiFi signals.

It did look at distance — not from a tower, but from a cell phone, and found that the control group had no statistically significant difference from 20 cm and 25 cm separation. Consistent with “rapidly-diminishing effects beyond trivial distance” so beloved of the 1/R**2 community.

Have read into detail to suss out in vivo vs in vitro, study design, or sample size.

Or of course, regular tissue compared to breast cancer cells.

[Norseman]

Yes, I saw that. I read others making the point and didn’t think they were doing so very clearly so I wanted to make sure you knew it, is all.

You said you see people getting off ventilators. Are you using HCQ too, and if so, with either zinc or azithromycin? Just wondering. Also, if you are using HCQ, did it get added to the treatment protocol after a point and did you see an obvious difference before and after it was added?

[grey_whiskers]

Head down is a bad idea in prone or supine ventilation as it causes an increase in WEST Zone three via a restrictive mechanism (abdominal contents reducing thoracic volume). So the notion of draining is not founded.

They showed (what was it?) 7% or 14% increased survival in ICU patients with this Coronavirus in a real-life hospital setting, other things being equal. Theory should FOLLOW data. Mumble harrumph "not well designed" mumble "small sample" mumble "no control group" ...

well, the medics in the thick of this were a bit overwhelmed for that at the moment, IIRC that report came from...Italy.

[Flick Lives]

Getting *way* more real info from these sorts of F/R discussions than anything in the so-called MSM.

[grey_whiskers]

*PING*

http://freerepublic.com/focus/f-news/3832769/posts

[reasonisfaith]

“80 or 90% just die in hours”

Where’s the study proving this percentage?

Where’s the study proving anything you say, ever in your life?

[gas_dr]

Your points are well taken...In the order presented...

1. I can’t explain why viral PNA looks bilateral and bacterial PNA is lobar. That is an exquisite question that we are just not sophisticated enough to answer. My guess is that bacterial PNA infects a lobe but can’t make it across the fissures so you see lobar consolidation. I suspect (but my opinion only) is that viral replication creates a different and more diffuse release of cytokines that are not limited to a specific lobe.

2. I saw the same Youtube, but it just makes no sense. I am sure there is necrotic debris in the alveoli of ARDS, however, it is so deep in the lung circuity that if you stood on your head for a year it wouldn’t drain. Secondly, the ideas of proning has to do with physiological oxygenation called the West Zones (the sentinel work in respiratory physiology). Briefly, West Zone I is dead space, It is where there is ventilation but not a lot of blood flow. In the supine human standing up, the gravitation effect on liquid (blood) creates a gradient that the apices of the long have less blood flow than the bases. So — dead space mismatch. West Zone 2 is optimal, it is where ventilation and perfusion are matched. It is the site of most efficient oxygen an CO2 exchange. West Zone 3 are where hydrostatic pressures (liquid weighs more than gas) exec alveolar ventilation. So there is Shunt (blood flowing past collapsed gas spaces). So, proning someone tends to create more West Zone 2 because there is less hydrostatic forces across the entire lung (biophysics suggest that in the spin position there is more dorsal lung surface area than ventral). So, putting the thorax below neutral axis would actually expand west zone 3 and increase shunt physiology — it just doesn’t make sense from a bedside perspective

3. I think the myocardial injury is demand ischemia from tissue level hypoperfusion. There is always an increase in Troponin I when there is a patient with shock and ARDS. Positive pressure ventilation is inotropic in nature so without a long discussion of Starling curve, there is improved contractility, BUT it beat the hell out of preload, (impedance to venous inflow). Mechanical vent support is a beast to balance fluid resuscitation and pressure forces to maintain optimal cardiac output and reduce tissue level hypoperfusion....add to this the idea that we should run ARDS patients dry to facilitate oxygenation. Its like walking a tight rope across Niagara Falls in an ice storm

4. When I refer to restrictive transfusion practices, blood transfusion is an ORGAN transplant, and stimulates a SIRS response. All comers studied, including ARDS patients have better survivability at 30 days and one year. The studies are impressive enough that it is a standard of care. Truthfully the survive sepsis work tells the story best on this. We should really perhaps draw VBG and only transfuse when there is saturation <65% st the SVC or 60% at the PA if there is a swan Ganz catheter present.

At the end of the day —
1. I will not transfuse CoVID patients liberally because what I do know is that it will promote SIRS which is what we are trying to avoid

2. I will keep looking though the labs and literature to refine my knowledge of the ferritin and hub deficiencies, but I agree with MOM MD that if this were a primary Hgb problem, we would see a different clinical picture (and then hyperbaric may work).

3. Its the daily dilemma to treat critically ill patients because the above is balancing just one of the eight systems that we worry about...

[Norseman]

Thanks for the reply. I don’t have medical knowledge so a bit of it was Greek, but I got most of it, ABG PaO@ being the biggest mystery (to me). Also, not sure what you meant by “routing issue.” (Hopefully, not meaning that the paperwork to obtain it is too challenging...*s*)

[gas_dr]

the 80 - 90 % die in hours is BS

[gas_dr]

Sorry PaO2 —
ABGs measure three variables:

1. pH of blood (metabolic state)
2. PaO2 arterial tension of oxygen — does the patient have good oxygen exchange
3. PaCO2 — partial pressure of carbon dioxide — which gives us an idea of how the patient is ventilating

[grey_whiskers]

(Hopefully, not meaning that the paperwork to obtain it is too challenging...*s*)

The single greatest medical challenge for *any* physician, is not medical. It is

a) paperwork
b) billing / collections
;-)

[Mom MD]

interesting but imaging (CT and regular x-ray) tend to lag behind the clinical presentation so some nl studies in sick people is not surprising. In my experience most covid pts are pretty short of breath even if oxygen level is OK

[Mom MD]

we are using hydroxychloroquine and zmax sometimes vitamin c as well. It’s not a magic bullet some get sicker and die on it. It’s a reality of our supply issues that unless you are in ICU or headed there quickly you don’t get it. We simply do not have the supply to give it to everyone

[gas_dr]

You are using Vitamin C? IV? How much? 3 Grams or so? I read about this the other day...there were some studies from DUKE about 4 years ago...I am just waiting for someone to try a real transplant to stop the inflammatory response.

[Zhang Fei]

FYI:

---

https://www.ecodibergamo.it/stories/bergamo-citta/coronavirus-the-real-death-tool-4500-victims-in-one-month-in-the-province-of_1347414_11/
[We compared the number of deaths over the first three months of this year with the average figure of the last three years, in order to verify the increase in mortality across Bergamo’s territory - explains Aldo Cristadoro, founder of InTwig and professor in Digital methods for social research at Bergamo University -. Our evaluation, carried out with great accuracy by means of the official data provided by each local administration, tells us that during the month of March more than 5.400 people have died, and approximately 4.500 of these are ascribable to coronavirus. One year ago, in March, the total deaths were almost 900]

[Mom MD]

some are getting it I’d have to look uo the dose. I think 1500 TID but not sure

[grey_whiskers]

I saw the same Youtube, but it just makes no sense. I am sure there is necrotic debris in the alveoli of ARDS, however, it is so deep in the lung circuity that if you stood on your head for a year it wouldn’t drain. Secondly, the ideas of proning has to do with physiological oxygenation called the West Zones (the sentinel work in respiratory physiology). Briefly, West Zone I is dead space, It is where there is ventilation but not a lot of blood flow. In the supine human standing up, the gravitation effect on liquid (blood) creates a gradient that the apices of the long have less blood flow than the bases. So — dead space mismatch. West Zone 2 is optimal, it is where ventilation and perfusion are matched. It is the site of most efficient oxygen an CO2 exchange. West Zone 3 are where hydrostatic pressures (liquid weighs more than gas) exec alveolar ventilation. So there is Shunt (blood flowing past collapsed gas spaces). So, proning someone tends to create more West Zone 2 because there is less hydrostatic forces across the entire lung (biophysics suggest that in the spin position there is more dorsal lung surface area than ventral). So, putting the thorax below neutral axis would actually expand west zone 3 and increase shunt physiology — it just doesn’t make sense from a bedside perspective

Possible confounding variable.

https://www.hawaiinewsnow.com/2020/03/24/virtual-rendering-coronavirus-patients-lungs-shows-extensive-damage-virus-can-cause/

The damage caused by this virus is *diffuse*. I don't think we have enough data, to have defined if there are any regular patterns in the damage, in a majority or even just a plurality, of the patients.

This leaves open the possibility, that there are compromised alveoli (see the WebMD link, which has language contradicting your assertion of inflammation being the sole cause of inhibited O2/CO2 exchange), throughout each of the West Zones. God only knows, what that would do, to either pressure gradients (no longer a monotonic function of distance along the lung), blood flow (necrotic debris probably doesn't have the same rate of flow through the capillaries as intact tissue), or the ratio of the two...

A second issue, in the YouTube you saw, is it necessarily true that all of the fluids being drained, are necrotic debris rather than surfactant-mixed-with-mucus (I read elsewhere, one of the first spots hit by this virus is the cilia in the bronchial tubes, so that mucus doesn't get swept out of the lungs, thereby somewhat mimicking Cystic Fibrosis)...So if you loosen *that*, it doesn't "run downhill" and further clog up the works, just when you have all the inflammation / necrosis / body-trying-to-clean-up going on. Or, as Calvin and Hobbes might put it:

[MHGinTN]

Thank you, Doctor. I do understand the science. It is also ‘the science’ that the ionophore action of BCQ qyickly reduces the vural load when there is not a zinc insufficiency. Thank you for adding to the discussion of ‘the science’.

[gas_dr]

These are all great questions, but clinically its the risk benefit analysis. I would be hard pressed to give up west zone 2 for 3 in oder to drain.

But anyone who quote Calvin and Hobbes is Ok in my book, even if we disagree...