Saturday, 26 September 2020

UK Universities in a Covid-19 World

I am just finding it hard to work out why the people responsible for controlling the Covid-19 pandemic apparently didn't recognise that requiring students to 'return' to universities was going to add to the problem,of controlling viral transmission. University students are usually in their late teens and early 20's. This is an age group that is not particularily vulnerable to a Covid-19 infection. So they may feel less pressure to take actions to suppress viral transmission. It is also an age group that is often experiencing new conditions and new connections for the first time. Traditionally, students tend to aggregate, live and work in areas where 'crowding is relatively common. They are encouraged to question things and to explore their environment. Although lots of the face-to-face teaching (along with field courses and practical elements) have disappeared from the curriculum, students are still operating (in many cases) under unfamiliar circumstances. It is also clear that the 'test and trace' facilities, that students can access, is generally far from a) convenient, b) accurate and c) good at rapidly finding contacts. I suspect that many students will be worried by suggestions that they may not be allowed to return home at Christmas but should remain in their hall accommodation. The worry is that students returning home could 'seed' outbreaks throughout the UK. But this was always very predictable (many of the current new lockdowns seem linked to outbreaks occuring in universities). Why did it not occur to the policy planners that a) encouraging people back to work, b) requiring the schools to commence face-to-face teaching and c) openning of bars and restaurants, combined with a restarting of university courses, would make social spacing less than easy. Social spacing (always harder as the weather gets more wintery) is actually the most important remedial action we can take to reduce viral transmission. It seems to me that too many things were 'released' from lockdown simultaneously. Perhaps prioritising and doing things in stages would have been a better strategy?

Good News and Bad News in the Search for a Cure for Multiple Sclerosis

Multiple sclerosis (MS) is a progressively debilitating disease where the patient's own immune system destroys the fatty myelin sheath around his/her nerves. The sheath is important as it allows nerve impulses to pass quickly along the neuron. MS can result in a loss of balance, blindness and a variety of motor impairments (including the loss of the ability to walk). Although there is currently no cure for the condition, a number of drugs have been approved for lessening the symptoms and/or slowing the progression of the condition. Recent studies have been described where the drug bexarotene was administered to patients with relapsing MS (an early form of the disease). The good news is that brain scans demonstrated that the myelin sheath was newly intact after treatment and visual signals passed more quickly from the retina to the visual cortex in the brain. (https://www.theguardian.com/society/2020/sep/25/ms-treatment-step-closer-drug-shown-to-repair-nerve-coating-trial-multiple-sclerosis). Both findings confirm that remyelination of the nerves is possible (at least in this early stage of MS). The bad news is that there were a variety of side-effects (damage to both the thyroid and the pancreas) that preclude bexarotene's clinical use. The fact that remyelination can occur is, however, important. Another study aims to combine a diabetes drug, metaformin with an anti-histamine, clemastine. The combination has been shown to produce remyelination in animal studies by rejuvenating the stem cells that secrete the myelin sheath. The hope is to find drug treatments that can repair the myelin sheath without having dangerous side-effects.

The Medical Importance of Sex in Covid-19 Research

The fact that male and female patients often respond differently to medications has been known for decades (for example, the heart drug digoxin, reduces mortality in the male but increases it in female patients). I have also complained, for quite some time, that much of the animal research testing exploring potential drugs is often limited to the male (on the slightly odd grounds that they are less 'variable'). There is now a timely warning that much of the relatively rushed research on medications to treat Covid-19 is not considering the potential impact of sex appropriately (https://www.theguardian.com/science/2020/sep/25/not-accounting-for-sex-differences-in-covid-research-can-be-deadly). Studies often give the total numbers of males and females used in their investigations but they rarely balance the genders in their individual categories (such as those for different ages). An example of this was seen in attempts to establish whether the long-used antimalarial drug, hydroxychloroquine, could benefit people with a Covid-19 infection. The incidence of dangerous side-effects was much greater in women. As one of the authors emphasised 'women are not just little men'. We really need to establish the efficacies and safety of all treatments in both males and females.

Friday, 25 September 2020

Mutation, Mutation!

There are reports from the USA, looking at changes in the genotypes of the Covid-19 virus, suggesting that it is becoming more infective (https://www.theguardian.com/world/2020/sep/24/coronavirus-mutate-contagious-study-us-cases). They also note that there is no evidence that the virus is becoming more lethal and suggest 'that mutation is still likely when we have a vaccine'. I appreciate that this is not the intention, but the coverage gives the impression that mutation is a deliberate 'policy'. Mutation occurs, whenever organisms reproduce or replicate. With its crossing the species barrier to humans, there has never been more copying of the short RNA sequence that largely makes up this virus. Micro-organisms, such as bacteria and viruses, reproduce very quickly (much much faster than we humans), so there are bound to be lots of mutations in the viral populations. Most of these mutations will be short-lived and have little or no influence on the viral population. Viruses, like everything else, are subject to Darwinian natural selection. The virus that made the 'jump' from bats to humans probably had mutations facilitating that move. The virus didn't choose to change host species. Those that could, however, suddenly had major replicating and population expanding possibilities. The currently recorded mutations are also random events. Covid-19 might well be becoming more infective as certain mutations might enable the virus to partially overcome some of the human attempts at limiting transmission (such as social spacing). The evidence that the virus is not becoming more lethal is very likely to reflect the fact that killing the host reduces the replication opportunities for the virus (so, like any good parasite, infections producing milder forms of the disease might well be getting more common). It's absolutely certain that mutation will continue when a vaccination is found and utilised (this happens with monotonous regularity in seasonal influenza). The vaccination will constitute a selection pressure for the virus (as do antibiotics for bacteria, producing 'superbugs'). Only the viruses that can infect, get the chance to replicate. So those with mutations that allow them to overcome the immune defences of the vaccinated host will get the chance to replicate in initially well-protected (vaccinated) populations.

Thursday, 24 September 2020

The Power of the 'Common Good'?

At the start of the second wave of Covid-19 infections in the UK, there has been much talk about how 'freedom loving' people are now breaking the rules (whether they understand them is another issue) and making transmission of the virus worse. There is an interesting opinion piece by Nicky Hawkins (https://www.theguardian.com/commentisfree/2020/sep/23/people-follow-covid-rules-fear-common-good-uk-restrictions) who cites a study from the London School of Economics on the first wave. The study found that there was extraordinary adhering of people to the lockdown rules. This was neither driven by knowledge nor fear. Social responsibility and the perception that most other people (with some notable exceptions) were also 'doing the right thing', were what caused people to stick to lockdown. Fear of fines were not strong factors then and probably won't be very effective in the second wave. Hawkins also points to a King's College London study that found that (surprisingly) 75% of respondants thought that other people were insufficiently worried about climate change (actually a more terminal problem for our species). The claim was that, as we constantly hear that few people are taking it seriously, individuals feel powerless and positive action becomes less likely. Hawkins' suggests that there should be less lecturing and lambasting on the topic and more positive actions displayed for people to follow (presumably so we can feel that we are 'all in it together' on this problem also). I would argue, however, that there are major differences between these two crises. The Covid-19 pandemic was something that was a danger to all and people could recognise that lockdown was likely to have only a short, finite duration. Climate change, on the other hand, results in short-term gains for some groups (e.g. oil companies and politicians) but problems for the 'powerless' masses. We are clearly not 'all in it together'. Climate change can only be 'cured' by almost permanent alterations to living conditions that go well into the future (or so they hope). One could argue that many older folk appear unwilling to give up pleasures (and pensions based on petrochemicals) that were regarded as standard until recently. It seems to be mainly sections of the young who campaign against global warming as they perceive that they will have to 'pay' for the consequences of what they regard as the antisocial behaviour of the earlier generation.

Seeing the Changes 1496

A hoverfly (probably Blera sp) attempted to sunbathe in Loughor.

Not To Be Sniffed At?

It's not just drugs and explosives that sniffer dogs can detect! A pilot study (get it?) at Helsinki airport has used 4 dogs in a trial, to determine they can detect people infected with the Covid-19 virus (https://www.theguardian.com/world/2020/sep/24/close-to-100-accuracy-airport-enlists-sniffer-dogs-to-test-for-covid-19). It is reported that the dogs have close to 100% accuracy (unlike temperature measuring devices or immunological tests). The tests can be carried out within 1 minute (the dog bit only takes 10 seconds), so delays would be minimal. Sniffer dogs have been used successfully to screen other illnesses such as cancers, so this is a logical development. If the results are confirmed, it is possible that we will get sniffer dogs (or pigs, as they are also pretty good at olfactory detection) at the entrances to companies, universities, schools and football stadia.

UK Universities in a Covid-19 World

I am just finding it hard to work out why the people responsible for controlling the Covid-19 pandemic apparently didn't recognise that...