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3 September 2021
1. Whole lung irradiation for COVID-19 treatment?:
Decades ago it was noted that exposure to ionizing radiation above certain levels can suppress the immune and inflammatory responses in many tissues, including lung. Low doses (0.3-1 Sv, or 30-100 rads back then) were used to treat viral pneumonias until the 1940s, when other treatment modalities became available and the hazards of radiation-induced pneumonitis (due to decreased surfactant production in the alveolar cells) and late lung cancer were better understood. Now low-dose radiation therapy is being explored in clinical trials for COVID-19 treatment in India and other countries. Preliminary results show that it reduces supplemental oxygen demand and, in one study of 25 patients where 0.5 Gy was given bilaterally within 10 days of symptom onset, most showed significant improvement in oxygenation and significant reduction of supplemental oxygen usage. Of these patients 22 attained clinical recovery within 10 days after treatment and were discharged in 6 days. Three patients deteriorated and died, though this was most likely from the disease, not the radiation treatment. Trivia question: in the first year following Wilhelm Conrad Roentgen's discovery of "X-rays" in 1895, how many cases of radiation dermatitis of the hand and hair loss occurred from testing the new "rays"? (Hint: choose from 10, 25, 60, 100, or 250.)
2. More details on microwave auditory effect (a.k.a. "Havana Syndrome"):
In 1961 Alan Frey identified a phenomenon, inducible in both normal and deaf human ears, that became known as the "Frey effect". Modulation of RF energy by varying the frequency, pulse width, pulse-repetition frequency, and peak power density could produce perceptions of "buffeting of the head", a buzz, clicking, hiss, or knocking within the head, and even speech-like sounds. The cause was thought to be due to thermoelastic expansion of portions of the auditory and balance apparatus. Under the right conditions, microwave heating of middle and/or inner ear tissues would cause these sounds and other effects by rapid heating with minute expansion and subsequent contraction of neural and labyrinthine tissues without causing detectable structural injury. The sounds would be the result of the pressure waves produced. (However, it should be noted that persistent white matter abnormalities have been noted in some studies.) And, of course, the precautions used to avoid exposure could themselves cause complications. It is said that Vice President Harris was intending to offer Hanoi a million doses of coronavirus vaccine. But during her three-hour flight delay, the Chinese envoy in Hanoi quickly offered two million doses! (Just FYI.)
3. New COVID-19 treatments:
The NIAID is sponsoring a trial comparing the combination of two drugs called BRII-196/BRII-198, manufactured by Brii Biosciences, in cutting the risk of COVID-19 patients becoming severely ill. They enrolled 837 patients considered at high risk of progression to severe disease due to age (>60) or pre-existing medical conditions within 10 days of symptom onset. Risk of hospitalization and death decreased by 78% and adverse events were lower in the intervention vs. placebo groups (3.8% vs. 13.4%); "few" of these were thought to be drug-related. Of note is that in vitro studies showed the combo's efficacy against the Alpha, Delta, and Lambda variants. Results from patients with different variants aren't complete though.
Israeli researchers noted that coronavirus cases can have abnormal accumulation of lipids, which are known to initiate severe inflammation (called "lipotoxicity"). A lipid-lowering drug, TriCor (fenofibrate), both reduced lung cell damage and blocked virus replication. A single-armed (i.e. no placebo group for comparison) study of 15 patients hospitalized with severe pneumonia and given TriCor plus standard treatment removed the need for oxygen in 14 patients within a week, allowing for discharge and home treatment.
A monoclonal antibody (mab) called sotrovimab received an EUA to treat mild-to-moderate COVID-19 in patients at high risk for progression to severe disease, e.g. those over 65 and/or who have certain medical conditions. A monoclonal antibody is a particular protein used by the immune system to bind and eventually destroy a specific pathogen. Current mabs that have been tested against SARS-CoV-2 include sotrovimab, casirivimab/imdevimab (REGN-COV2, made by Regeneron), tocilizumab, sarilumab, and bamlanivimab. Treatment centers providing REGN-COV2 have been set up at multiple sites in Florida. Treatment is intended for high-risk persons over 12. Regeneron claims that the risk of infection in high-risk patients exposed to COVID can be temporarily reduced by 80%.
4. COVID-19 in military:
Last week 5 active duty troops died from COVID-19, the deadliest week by far for the U.S. military. So far, the military has reported 34 deaths from COVID-19, a 0.01% death rate (the overall U.S. rate is 1.7%). For much of 2020 the U.S. overall rate was around 3%, while it was only 0.0004% for the military. The current infection rate for both military and civilians is 10-11%. About half (47%) of the military is fully vaccinated. Reason(s) for the sudden spike aren't clear.
5. "Vaccine blunts, but does not defeat, Delta":
So one may paraphrase the title from a recent article in Science pertaining to the vaccination situation in Israel. Because of its early vaccination, small size, and outstanding data processing Israel is "the world's real-life COVID-19 lab". Yet it now has one of the world's highest infection rates, with more than half of these cases in fully vaccinated people recently hospitalized; the Delta variant is responsible for most of them. Booster shots have been given for over a month now; almost a million Israelis have already received a third dose. Results to date indicate that those over 60 receiving the booster are half as likely as their twice-jabbed peers to be hospitalized. Most say that side effects from the third shot were no worse, and sometimes milder, than from the second. Social distancing and masks are returning.
6. Medical WMD Trivia:
Last week's trivia question asked what were the characteristic odors from three possible CW gases: carbon monoxide (CO), hydrogen cyanide (HCN), and hydrogen sulfide (H2S). CO is odorless, HCN can smell like bitter almonds, and H2S like rotten eggs. Congratulations to Dan Corti, Dr. Alan Ducatman, Lisa Foddrill, Thomas Gibson, Pat Hebert (who also got last week's question re Havana Syndrome), and Pete Zielinski for sniffing the answers out! (Based upon personal experience from an inadvertent spill at work, Joel Baumbaugh thought that HCN had "sort of a chlorine smell".) On a not so trivial point: hurricanes are responsible for knocking out power, compelling people to use gasoline generators and other alternate power sources that, if not placed properly, can lead to CO buildup inside closed spaces. Last Saturday the CDC issued a Health Alert Network (HAN) warning on "Clinical Guidance for Carbon Monoxide (CO) Poisoning". Symptoms include cardiovascular effects such as tachycardia, hypotension, and possibly fatal cardiac dysrhythmias, tachypnea, metabolic acidosis, and pulmonary edema. Unfortunately CNS effects such as irritability, impaired memory, cognitive disturbances, and altered consciousness cause unawareness of environmental CO exposure, resulting in seizures, coma, and death.
To your health,
Rad Doc Consultant, Inc