I am not a doctor, or a virologist, or any other sort of ‘gist. (Yet, anyway).
So, this is most definitely not an “expert opinion”. However, a growing body of research is supporting my ‘gut feeling’. (See addenda 5, later).
You could also fairly argue, given the lack of medical training, that it’s a long shot to call this post an “informed opinion”.
That said, I am exceptionally intelligent, I read widely, and I spend an awful lot of time around medical experts in multiple fields, so neither am I simply spreading misinformation or a fake ‘try this’ solution. I tend to see patterns and associations others might miss – not necessarily because I’m smarter, but because my mind is broken that way! Whether I am right or not, I see a pattern here.
(Equally, of course, the human brain is evolved to detected patterns, whether they are there or not, which is how the human race got were it is today – running away from sabre tooth tigers hiding in the grass. You (think you) see the big cat, you run away. Hanging around, or going closer to see if it was what you thought, or was just grass was a great way to thin the gene pool. Relates somewhat to apophenia and pareidolia, but general cognitive problem solving too).
Hypothesis: Renal factor
So, my hypothesis is that the key, or at least a key to the virus is the kidneys, not the lungs (noting the obvious that it IS a respiratory illness)!
Here’s why I have this thought:
As you age, following maturation, your kidneys slowly weaken (measurable by eGFR). It’s a very slow process – around 1% a year – but the end result is that the older you are, the poorer your kidney functions. Under 50% you might not even notice it, much, under 25%, well, it starts to take a toll, under 15% you are facing dialysis, below 8%, without treatment, you have a month, tops.
Following this reasoning, the older you are, the weaker your kidneys (especially if you are over 80!), and there is a big jump in deaths of people over 80-years-old.
Also, the highest co-morbidity risks, besides chronic respiratory disease which would follow with any additional respiratory illness, are cardiac, diabetes, hypertension, cancer.
If the theory held, you’d expect to see chronic kidney disease on the list, and I am surprised not to see it, which kinda shoots a hole in my conjecture. Or perhaps, perversely, it supports it, because you would expect it to be there, and it’s missing, which is why it flagged for me.
Being pedantic, kidney disease itself doesn’t actually generally directly kill you, rather it’s the causes and effects associated with kidney failure. (e.g. Your kidneys could have enough functionality in normal situations, but not enough to combat a potassium-rich diet, in which case cardiac arrest from potassium overload from a bowl of bananas or strawberries could be the cause. Or see star fruit, below).
So, for the coronavirus, the high risk categories, besides older people, already discussed above, are diabetes, heart problems, high blood pressure, and cancer:
Cardiac. Most kidney patients have or develop heart problems because, with other unpleasantries, kidney failure automatically causes high blood pressure (hypertension). All your blood is filtered through your kidneys; bottle-neck those, things back up. Then you get hydronephrosis, which the kidneys really don’t take kindly to, then, as things deteriorate, hyperkalemia, which can stop your heart. (It’s what kills a lot of renal patients).
(Acute renal failure can kill a healthy person in a matter of days, your kidneys are that important.)
Hypertension. Well, we just covered that.
Cancer. Firstly, the charts don’t break the numbers down, but we can assume they may include renal cancer. Secondly, a number of chemotherapy treatments are harsh on the body; they are actual poisons, their one job is to kill cells, but it’s a shotgun approach, rather than precise. Net result, kidney damage. (Noting that the treatment for cancer takes a massive toll on your immune system, taking up to ten years to recover)
Actually, a number of over-the-counter products are ‘nephrotoxins’. Booze (heavy drinking), some antibiotics, some laxatives(!), aspirins… Ibuprofen is especially nasty. Renal patients are warned not to take Ibruprofen, ever, and healthy people that get addicted to the things die.
(Have to wonder about all the people panic buying toilet roll – now might not be the best time to binge on laxatives! Interesting though that people are not emptying the shelves of alcohol, unless it’s to rub on their hands!)
(Random weird fact: Star fruit contains a neurotoxin (caramboxin) which can be lethal to renal patients, but is otherwise (generally) harmless. It was only discovered because a doctor in Malaysia, where it’s commonly eaten, noticed the pattern. The patients being brought the most star fruit were having hiccups, and seizures, and dying.)
Now, of course, you are thinking, “all these clever people will have thought of an association between Covid-19 and the kidneys by now.”
Perhaps, perhaps not, for a few reasons. Firstly, there’s the obvious stuff all doctors learn – like the kidneys.
Contrary to popular myths, the kidneys function isn’t (just) to remove alcohol and ‘water’ from your system, so you can get another round in at the bar, it does a whole load of jobs, like balancing electrolytes, remove toxins, maintaining body homeostatis, producing hormones. In fact over 75% of human proteins are expressed in the kidneys.
Amongst all these we have:
Erythropoietin (epa), which is produced if you have low tissue oxygen (as can be the case with respiratory diseases).
(Kidney patients can need iron infusions because of renal anemia, which is caused by the kidneys being too knackered to produce enough EPA. The stuff is needed by your bone marrow to produce red blood cells).
Calcitriol is the natural form of vitamin D and is also produced in the kidneys, it’s needed for bone growth, and to prevent calcium-related diseases.
(Renal patients have their calcium and phosphorus levels monitored.)
Renin, which regulates your blood pressure.
(We covered that).
OK, I accept correlation is not causation, I ain’t stupid, but bear with me, ‘cos:
Symptoms of Covid-19, besides the temperature and cough, include difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion.
And the symptoms of chronic and acute renal failure include fatigue or tiredness, shortness of breath, (persistent) chest pain or pressure, and (new) confusion.
Despite all the above, you would obviously think that all the experts would have thought of this, (if there’s even anything to my thought), but it’s a funny old world, “we don’t see the world as it is, we see the world are we are”.
Forget rose-tinted glasses etc. for a moment and consider careers. In web design, as a generalisation, front-end designers only really care about the look of a page (art), back-end developers only really care about functions and security (code).
In medicine, the same applies, once they specialise. Renal consultants are known to call urology consultants “glorified plumbers” – and similar light-hearted (and occasionally more acidic) barbs and slurs occur with cardiologists, pulmonologists and so forth, down to proctologists. (Be kind now, they do a valuable job and it’s shitty enough without crude comments!)
Strangely, despite knowing that the kidneys (and co-related diseases) have a clear relationship with the lungs, relatively little research is carried out on this association.
Anyway, my ‘gut feeling’ is that a clue to corona virus lies in a blood protein imbalance, something that, perhaps, is being overlooked because “it obviously can’t be that simple.” Or perhaps a blood-protein attachment with the virus that occurs in the kidneys, then targets the respiratory system, (which I believe is not unknown).
Or, which might fit even better, it’s something that would normally happen (like EPA production), but isn’t because of structural damage. I’ve read hundred of medical papers on nephrology and while I said remember it all, something is nagging me about cell structure in nephritic kidneys…
Hmmm… got it, maybe:
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine.
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
One common symptom of renal failure is high levels of urea (yes, like urine) in your blood (which can be as physically nauseating as it sounds). Urea (aka carabide) metabolises nitrogen-containing compounds, particularly ammonia and proteins. Viruses are sensitive to blood acidity, could be a factor; also if I understand it correctly, viruses replicate by latching onto to proteins and ‘feeding’ to invade cells. Anything that lobs at spanner at that might be a harsher environment for said virus.
The other symptom is frothy pee! We aren’t talking a few bubbles here, we are talking about idly wondering if some pervert isn’t pouring washing-up liquid into the bowl to troll you. So, again, instead of protein rich blood in a healthy person, you are starving the virus; renal patients are literally pissing away the viruses food! Would make sense.
All of which suggests – possibly – that the corona virus cure, or at least a stabiliser, could lie in carbamide: CO(NH2)2. A thought, anyway. Two easy ways to confirm, or rule it out. Firstly, if there’s a statistically significantly deviation in patients with and without renal conditions (as there appears to be), then it supports the hypothesis. Secondly, if you grow a Corvid-19 culture in a urea rich medium and it chokes, well, you have an further support.
As an interesting addenda (20th March), I found another possible piece of the puzzle (or another wrong tree to bark at?), compliments of a supercomputer crunching molecular adhesion using pre-existing medications to find a cure. And lo, in the top three theoretical solutions, along with pemirolast (an anti-allergy medication used in treating chronic asthma), was nitrofurantoinan – an antibiotic for use against urinary tract infections. The reason this is possibly relevant is that such infections are common with kidney patients (notably those with catheters and/or uteric stents). (See ChemRxiv citation below)
(Funnily enough, conversely, the people most are risk from the related (pre-existing) MER-CoV strain of the virus are those with renal failure (and diabetes)).
Corona virus takes a week to kick in, acute renal failure takes a week to kick it, perhaps – just perhaps – one aspect of the severity of the virus is related to the proteins it targets?
“Coronaviruses are unique among enveloped viruses in that assembly of the viral envelope occurs at the ERGIC”
“To date, E (the SAR-CovE E protection) has only been reported to interact with five host proteins, i.e. Bcl-xL, PALS1, syntenin, sodium/potassium (Na+/K+) ATPase ?-1 subunit, and stomatin [18, 66, 82, 87].”
“Viroporins can transport different ions but appear to be largely selective for the positively charged ions hydrogen (H+), K+, Na+, and calcium (Ca2+)”
(Schoeman & Fieldin, (2019), Virology Journal)
Kidneys, electrolyes and blood acidity.
Kidneys, and potassium, sodium and calcium levels…
I’m a code monkey, not a doctor or virologist, but if I was the latter I’d be looking at the kidneys (as much as the lungs) and thinking, “what are you up to down there, you sneaky little bastard?”
Not saying I’m an correct, or even that I have ‘an’ answer, merely that a lot of it ties together and that if I was an expert in kidney proteins and in viruses, it would be an avenue to explore, or rule out, perhaps sooner rather than later. Assuming they haven’t already.
Viruses are sensitive to acidity, and nurtured by proteins; compared to a normally person, CKD 3/4/5 kidney patients are increasingly high in urea and electrolytes, lower in protein. Could be the solution, or a direction, is as simple at that. (The urea idea, not CKD, that would be silly!)
Note this is a different argument from Corvid-19 attacking the kidneys and inducing AKI; different corona strains attack the kidneys in different ways. For instance, medical researchers in Italy report that “Acute kidney injury might be a predictor of mortality in infected patients.” They make no comment on those with existing CKD.
Similarly, wisely, kidney organisation are warning patients to be extra vigilant (as with all similar outbreaks), but are not warning of a direct, implicit threat. Fact is, given the current evidence, people with AKI and symptoms associated with CKD are taking it hard, but people with CKD (thus far) are not showing up in reports like you would expect.
Certainly I’m not advocating that folks on dialysis or under the care of renal teams relax their normal vigilance, more that maybe, just this once, it might have worked in our favour, for this one strain.
Cold, hard truths and nightmare scenarios:
All that said, at least from a purely naturalistic, ‘save the planet’ point of view, rather than offering a possible solution, (harm to pets aside), I’d quite happily watch Covid-19 spawn into the evil brother of MER-CoV! The latter kills up to 70% of its hosts, which would reduce our over-populated planet from 7.8 billion to a slightly more manageable 3 or 4 billion humans. Still over-crowded, but I’ll take that (probably posthumously!)
You think humanity is bad now, fighting over bottled water and toilet roll in case they might be quarantined – image the fake veneer of humanity shredded when there’s a pandemic pathogenic that kills as many as 7 out of 10 people it infects. Stuff of nightmares, dystopian futures, and end-of-days anarchy.
I rather suspect that virology experts are not so much concerned about what the coronavirus is, but what it could mutate into! The more people it infects, the greater that chance. At over 12,000 cases (and rising fast) of one and an unknown number cases of the other, Iran would be my bet for that to be ground zero if it were to happen.
The intrinsic error rate of RdRp is approximately 1,000,000 mutation/site/replication, resulting in continuous point mutations. Point mutations alone are not sufficient to create a new virus, however; this can only occur when the same host is simultaneously infected with two coronavirus strains, enabling recombination.
(Disease Briefing: Coronaviruses (Cortellis™ A Clarivate Analytics solution)
Note, however, that virology and pathogens is not something I claim any expertise on; people who I must assume know and understand far more have informed me that:
They enter cells through entirely different receptors (ACE2 for SARS-CoV-2), which is linked to their pathogenesis
At present I don’t have the time to begin to become an expert on the subject, but if I did I’d start here:
Fehr and Perlman, (2015), ‘Coronaviruses: An Overview of Their Replication and Pathogenesis‘, published in ‘Methods in Molecular Biology’.
See also the 285p book by Maier, Bickerton, and Britton (Editors), ‘Methods in Molecular Biology 1282. Coronaviruses: Methods and Protocols‘, also available as a download direct from Springer / Humana Press.
Then head here:
COVID-19 Open Research Dataset (CORD-19):
(Found originally via: MIT Technology Review: Over 24,000 coronavirus research papers are now available in one place
Links of possible interest:
Cath Lab Digest, (March 2020), Are Kidneys Targeted by the Novel Coronavirus?
Kidney Care UK, (March 2020), Coronavirus (COVID-19) guidance for patients with kidney disease
Kidney Fund (US), (March 2020), Coronavirus, COVID-19 and kidney patients: what you need to know
Chu et al, (2005), Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney International,
Schoeman & Fieldin, (2019), Coronavirus envelope protein: current knowledge, Virology Journal
Smith, Micholas; Smith, Jeremy C. (2020): Repurposing Therapeutics for COVID-19: Supercomputer-Based Docking to the SARS-CoV-2 Viral Spike Protein and Viral Spike Protein-Human ACE2 Interface. ChemRxiv. Preprint. https://doi.org/10.26434/chemrxiv.11871402.v4
Appenzeller-Herzog & Hauri, (2006), The ER-Golgi intermediate compartment (ERGIC): in search of its identity and function, Journal of Cell Science 2006
Floege & Uhlig , (2019), Kidney calling lung and call back: how organs talk to each other, Nephrology Dialysis Transplantation, Volume 25, Issue 1,
Gluhovschi et al, (2014), Aspects of renal-pulmonary pathogenic relationships in chronic kidney disease and chronic pulmonary diseases – a less-known connection, Romanian Journal of Internal Medicine, 2014 Apr-Jun
Donald Kaye, MD; Marjorie P. Pollack, MD, (2014), MERS vs. SARS: Compare and contrast, Infectious Disease News, February 2014
Livescience: The 12 deadliest viruses on Earth
Scientific America: How China’s “Bat Woman” Hunted Down Viruses from SARS to the New Coronavirus
National Geographic: Coronavirus 101: What you need to know
World of Statistics: Coronavirus
91-divoc: Covid spread visualisation
Related to corvenavirus is MER-CoV, the ‘Middle-East respiratory Corvenavirus. More of the same, except for 3 factors:
2) CoV-19 has a mortality rate currently in the order of 2% to 7%, MER-CoV is 35% to 70%
3) CoV-19 is highly infection, MER-CoV (so far!) is not, but is more durable and has been spreading slowly for years.
In the US, the CNC consider it an emerging infectious disease
No comments below, here, but an interesting conversation on Facebook over it.
Charlotte Bird (a researcher and educational consultant)
I believe it is an accumulation of organ damage that contributes to the fatality in older adults, and a lack of organ damage in children that allows them to survive safely. There is also the fact that repeated exposure to coronaviruses worsens the body’s response, and children simply have not been around and alive as long to have as many previous exposures. Then there is the nutrition aspect. As we age, we tend to run deficient in more and more nutrients, including many that are critical for immune function. Children do not have that problem. There is also a component of milk that appears to offer some immunity against coronaviruses, so perhaps temporal proximity to a milk-based diet could offer some protection for infants and children. I am certain that your hypothesis is correct in that pre-existing kidney damage is a deciding factor in survival. This virus infiltrates every tissue in the body, not just the kidneys, but the kidneys definitely play a role.
You are probably correct, though I would suspect stem cells play a part; children have more stem cells than adults, and women who have had babies have more stem cells than men, or women who haven’t.
This is supported when you look at the statistics: men are 68% more likely to die from coronavirus than women (though there could be any other number of additional factors to that sum).
The factor here is that without stem cells feeding back into the mother through the placenta, the growing foetus, kicking away and pushing organs aside as they do, would kill the ‘host’ through organ failure, notably the heart and kidneys*. Nature finds a way, as they say. (*e.g. New Scientist, (2011), Fetus donates stem cells to heal mother’s heart)
Just seems odd, out of place, that a high-risk category like CKD doesn’t show in the statistics, while co-morbidity factors associated with CKD all increase the severity and fatality risk of the COVID-19 infection.
Another comment, also elsewhere, from someone you clearly reacted without reading or comprehending was Donna (from Apple, (the company)), who said:
It’s not funny. I have a lung disease and COVID 19 will kill me.
I would quibble about the difference between ‘might’ (0 to 99.99% probability) and ‘will’ (100%), be I digress, my reply in full is below:
And I have end-stage kidney failure, I wasn’t being funny.
If you look at the links in my post they include the CNC, WHO, specialist viral research organisations, health care organisations. Academic links rather than conspiracy blogs.
My point is that if appropriate researchers find a nugget of truth in my hypothesis, then, while not offering a cure, it would offer a possible way to slow the disease in those hardest affected.
Suppose, against whatever odds, I am correct, that blood chemistry is a factor in how the virus works (or, here, doesn’t work). If you caught the virus and were told, “OK, we can give you oral urea, (or perhaps sodium bicarbonate) it could probably make you nauseous, but it could save your life” Would you send them away? Or take the tablets?
OMG, Coronavirus! We’ve all going to die! PANIC PANIC*
My original view – and current – is that the corona virus hysteria is manufactured, it is being hyped and manipulated to make some people gains, and sod the rest of the world. That’s not to underlie the seriousness of this strain, merely to point out is it being used and abused for profiteering and other reasons verging on conspiracy theory. For stores, pharmaceutical, and others companies this panic buying is like all their Christmas’ rolled into one. (Airlines, convention centers, holiday destinations, etc. not so much!)
Let me quote a scientific paper by Geller et al (published in Viruses, Nov. 12th 2012):
“… human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections.”
The common cold is ‘a’ coronavirus. SARS is ‘a’ coronavirus. Covid-19 is ‘a’ coronavirus. MER-CoV is ‘a’ coronavirus with a 35 to 75% kill rate. Viruses mutate, it’s what they do. If this pandemic was MER-CoV, the hysteria would be justified, that things just nasty.
Back to the original point.
“Coronaviruses also well survive in suspension. At 37 °C, HCoV 229E and OC43 displayed survival rates of 80% and 100%, respectively, in phosphate buffered saline.”
So, as a family, they are happy with sodium, which is alkaline.
And lo, your blood has a normal pH range of 7.35 to 7.45, alkaline.
COVID-19 evolved to adapt to ‘normal’ humans.
But, to the virus, people with CKD are not ‘normal’, at least haematologically speaking, our blood is a cocktail of drugs, some of which are there because our blood acidity is off-kelter.
“Metabolic acidosis is a common complication of chronic kidney disease… Several small trials now suggest that the treatment of acidosis with oral alkali can slow the progression of kidney disease”.
Depending on diet and meds, a person with CKD has a blood pH between 7.2 and 7.6. Might not seem a lot, but is it, as it can inhibit cell receptors: “slightly decreasing the extracellular pH from 7.4 to 7.2 rapidly inhibited intracellular calcium mobilization through the calcium-sensing receptor”
And from Nutrition.org (on alkaline diets and CKD):
“Many dangerous fad diets exist that purport to treat diseases such as cancer by manipulating the pH of blood with different foods. While there is no good evidence that acidic foods alter the body’s pH and promote disease, the hypothesis that “dietary acid load” relates to disease should not be completely dismissed.
The kidney serves to regulate blood pH, but if kidney function declines and other tissues catabolize to maintain pH, then it is very plausible that manipulating the diet to reduce the acid load could spare tissues and improve outcomes in chronic kidney disease (CKD). After all, for example, the metabolism of amino acids yields hydrogen ions, whereas fruits and vegetables contain organic salts that generally reduce acid load when metabolized. Recently, a growing number of human studies that manipulate diet acid load using fruits and vegetables and sodium bicarbonate support this hypothesis.”
“The concentration of hydrogen ion is normally managed by several buffering and elimination systems, including the kidney. Consequently, progressive renal failure is accompanied by an increasing inability to excrete metabolites of fuel consumption, lower blood pH, and reduced plasma bicarbonate levels”
I could go on, but there’s countless thousands of journal papers on blood pH, especially relating to kidney failure.
My analogy, my hypothesis is that there is something about the blood chemistry of renal patients that CORVID-19 does not like, and several of the factors (hydrogen ion levels, protein issues, irregular acidity) could indeed be unpleasant for it. Here’s an analogy: humans adapted to breath at sea level, the oxygen and temperature favour us; you try going up a high mountain, see how far that gets you. Above 2,500m, unless (like say Tibetans and Andeans) you have evolved for it, you risk hypoxia, and possibly even death.
Healthline (2016): Acid-Base balance (Medically reviewed by Debra Sullivan, PhD, MSN, CNE, COI)
Chen & Abramowitz, (2014), ‘Metabolic acidosis and the progression of chronic kidney disease‘, (BMC Nephrology, Apr 3rd)
Nutrition.org (2017), Alkaline Diets and Kidney Disease
Lynda A. Frassetto and Chi-yuan Hsu (2009), ‘Metabolic Acidosis and Progression of Chronic Kidney Disease‘, Journal of the Amercian Society of Nephrology (September, 2009)
Tinfoil hat time
Remember at the start, I said the hysteria over this virus was being manufactured and being manipulated, well in steps Big Brother. According to Gizmodo, Police in Spain Are Using Drones to Tell People to Stay in Their Damn Homes During Coronavirus Crisis”. Not only that, but:
“We won’t hesitate to use all the measures we have at our disposal to look out for your safety and everyone’s safety,” the police wrote on Twitter. “Although some of you will give us a hard time.”
(“Policía Municipal de Madrid?
No dudaremos en utilizar todos los medios de los que disponemos para velar por tu #seguridad y la de tod@s, aunque algunos todavía nos lo pongan difícil…
The article goes on to add, “people who break quarantine in Spain can be fined up to 600,000 euros and face prison time.”
Spain does have something of a turbulent history, but in the past year it has gone from being a favourite holiday resort to experiencing brutal regime tactics (as seen by the police violence when Catalonia tried to separate from Spain in 2019) to morphing into a full on police state. France and Italy aren’t far behind.
Again, this is not to underestimate the lethality of the coronavirus, especially for at risk sections of the community (which, given my age and health conditions, probably includes myself), just to highlight the fact that if something (anything!) can be misused for gain, especially by people already in power, then it will be, regardless of the consequences. Using terror as a tactic has consequences.
The irony of all this? Businesses and governments are closing off cities, cancelling conventions and football events, banning air travel, all to stop contact. So what to the people do? They pack into the supermarkets like sardines to panic buy soap, toilet roll, water, tinned carrots, and eggs.
Tinned stuff I can understand, but buying up 3 months supply of product with a one month shelf life is madness, and binge-eating food packed with cholesterol is hardly healthy, that’s without the salmonella risk of bad eggs if you leave them too long.
Soap? Well, as one wit pointed out, if you hoard all the soap, you increase the risk from all those who now have dirty hands – because of you.
Toilet roll? Maybe they need that for the salmonella from eating 2-month out-of-date eggs? Who knows!
“OMG, I /might/ get coronavirus! I must self isolate.
OMG, I’ll starve! Whatever will I do?
I MUST hoard essentials, MY life depends on it.
God help you if you get in my way!”
Here’s a little perspective:
Human coronavirus (HCoV) strains and their mortality rates:
Flu (~ 0.1%): world opinion: Keep away from me!
SARS (~10%): world opinion: old news
CoV-19 (~2% ~3%): world opinion: *PANIC*
MER-CoV (> 35%): world opinion: Huh?
(And you think the guy above, wrapped in tin foil is irrational?)
Meanwhile, in the real world, one free from hysteria:
Store delivers, people, there is no need to panic buy! There is a long list of supermarket chains that will happily take your order online and leave it on your doorstep, contact free. In the UK you can pick from most of your favourites: Amazon Fresh, Amazon Pantry, Co-op, Morrisons, Sainsbury’s, Tesco, Waitrose…
There are no shortages – only those which you are creating by mindlessly, hysterically panic-buying.
I am not questioning the wisdom of avoiding your fellow petri-dishes in a pandemic situation*, rather I am highlighting the fact that social media and the press is weaponising the outbreak. Some are spreading misinformation out of ignorance, others out of mischief, and still others because they have a scam in progress and fear is good for business. (e.g. Note how Google, Facebook etc have clamped down on fake cures.)
From Public Health England (i.e. the government): ‘This is a rapidly evolving situation which we are monitoring carefully but based on the available evidence, the current risk to the UK is moderate.
*(For regular flu, having CKD, I am in the ‘at risk’ category for the annual flu outbreak, and always get called in for a booster; tried that once, was as sick as anything, ever since I just avoid the doctor’s surgery and packed hospitals whenever possible, and if the kids come home with bugs I stay out of their way. Not had a cold or flu since. Q.E.D. self-isolation helps.)
One (otherwise apparently educated woman) commented on a TedX post (‘how can we control the coronavirus pandemic‘) that,
So this ‘older people with underlying conditions’ thing is beginning to look like a myth.
At first I point out the distinction that, to be more precise, the CHANCE of GETTING it is the about same for everyone (high), the severity is a different matter.
However, people over 60 (over 50 actually) – especially those with certain pre-existing medical conditions – are at a much higher risk of DYING.
The statistics are a fact, not a myth. As an educator you should understand this. Don’t let media disinformation feed you false data.
A healthy young person could end up in ICU with it, and will probably recover.
A young person with diabetes and high blood pressure will take a lot longer to recover.
An 80-year-old with the same health problems is perhaps a 1,000 times less likely to recover than the first youth.
Her reply, which I concur with, was that:
That may be true, but as others have said, people in china were trying to warn others that not only older unwell people were dying. I am waiting to see what happens next with the figures. This us changing every day and we must be open to new information.
I further replied:
I don’t disagree, but when the pandemic has run its course, I’m willing to bet they find a correlation, a single factor that connects the percentage of otherwise young and healthy dying with old folk dying. I’d also bet that that factor relates to kidney functions, specifically blood pH and chemistry.
I’d also wager, at least based on the current figures (but open to change if evidence contradicts) that something about long term renal failure (CKD) offers a barrier to Covid-19 that other conditions (including AKI) do not. You may note that, given the data, chronic renal patients should appear in the high in the death tallies, and they don’t. Either everyone is keeping lousy records, or there is a biological reason they aren’t there.
It could be as simple as the fact renal patient know their blood chemistry is wrong and have it corrected. However, older people (ALL of whom have reduced kidney functions) don’t; young people with undetected renal failure don’t. Corona patients with AKI, however, are known to get walloped by the virus. (A number of infections are know to cause very rapid acute kidney failure).
(Normal blood pH has a pH of 7.4, and even small changes in the order of 0.1, 0.2pH have consequences).
Blood [H+ ] correlates positively with age
At age 80 years, blood [H+] is 6-7% higher than at age 20 years
Plasma [HCOj] correlates negatively with age
At age 80 years, plasma [HCOj] is 12-16% lower than at age 20 years
Blood PCO2 correlates negatively with age
At age 80 years, blood PCO2 is 7-10% lower than at age 20 years
(Where [H+] is blood hydrogen ion concentration and PCO2 = blood carbon dioxide tension;)
(Citation for figures: Age and Systemic Acid-Base Equilibrium: Analysis of Published Data, Journal of Gerontology: BIOLOGICAL SCIENCES
1996. Vol. 51A. No. 1, B91-B99) (No link, article behind paywall).
I have no idea if I am right. Still, from my current reading and research, and basic understanding I’m rapidly picking up on viral pathology, my gut feeling is blood pH, and hydrogen ions, (and perhaps also free radicals) are a differentiator between cases.
Also of interest:
Futurelearn are offering a free module course on: COVID-19: Tackling the Novel Coronavirus
“What is COVID-19 and how might the outbreak affect you? Find out more about coronavirus and explore its worldwide implications.”
(3 weeks, 4 hours study a weeks)
(Other, related courses are also available, also free).
Associate Professor and Deputy Director for Research for the UK-Public Health Rapid Support Team, The London School of Hygiene & Tropical Medicine
Clinician, Researcher and Coordinator for the UK Public Health Rapid Support team based at The London School of Hygiene & Tropical Medicine.
Professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine. She teaches epidemiology and outbreak investigation
Olivier le Polain
Senior epidemiologist and Deputy Director of Operations on the UK-Public Health Rapid Support Team.
Who developed the course?
London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world leader in research and postgraduate education in public and global health. Its mission is to improve health and health equity worldwide.
UK Public Health Rapid Support Team
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Addenda 5, 4th April
As i have said, what I find curious is that Covid-19 is known to attack the kidneys, in some cases causing (and/or being especially aggressive with those) acute kidney injury. Yet, when you look at the people most at risk, renal patients (chronic kidney disease) are not statistically significant.
The risk of dying if infected by Covid-19 is considerably increased is you have cardivascular disease, diabetes, chronic respiratory disease, hypertension, (or cancer). Of these, CKD is a commmon with diabetes, hypertension is pretty guaranteed with CKD, and while heart and lung diseases aren’t a direct co-morbidity factor, heart and breathing problems are, compliments of said high blood pressure, bouts of hyperkalemia, renal anemia, etc.
Also, kidney functions drop with age (by about 1% a year), and age is a significant factor. Given all that, and given kidney patients are considered high risk for flu, etc, why are they not showing up on lists? Either there is something different enough in the blood chemistry, or the deaths are not being recorded
For instance, Renal.org, in March post (Coronavirus (SARS-CoV-2) and its associated illness (COVID-19)) say
to date we are not receiving information that children with Chronic Kidney Disease or those on dialysis experience an obviously worse COVID-19 illness
Slightly contradicting this, ERA-EDTA, consider anyone with a chronic medical condition (inc kidney, heart, lung disease, etc) at a higher risk of getting very sick.
(COVID-19, the Novel Corona Virus. News and information for the ERA-EDTA community and kidney patients)
However, another early paper by Wang et al, entitled Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China, which was published in the American Journal of Nephrology, concluded:
AKI was uncommon in COVID-19. SARS-CoV-2 infection does not result in AKI, or aggravate CKD in the COVID-19 patients.
Equally, renal patients are not included in the list of medical conditions that the UK government considers ‘extremely vulnerable to coronavirus’: Do you have a medical condition that makes you extremely vulnerable to coronavirus?
Similarly, the ISN (International Society of Nephrology, COVID-19) say that there in no AKI in mild cases, but that 25 to 50% of serious cases have some kidney-related problems, of which 15% lead to AKI. For CKD though, it depends (as you would expect), but – supporting my hypothesis somewhat – COVID-19 can be milder in some cases.
COVID-19 infection presents a special threat to patients with CKD, especially to those on dialysis and kidney transplant recipients. Hemodialysis patients may have milder clinical disease than other patients with COVID-19 infection. Kidney transplant patients should undertake the measures above recommended to prevent infection. All patients should continue all medicines in prescribed doses including ACE inhibitors unless advised otherwise by their treating doctors.
That said, kidney care covers dialysis, pre-dialysis, transplants etc. You would still be at a very high risk; just because some studies suggest its not specifically aggravating your condition doesn’t mean it won’t. Flu is bad, this would be much worse.
See Kidney Care UK : Coronavirus (COVID-19) guidance for patients with kidney disease
Addenda 6, October 2020
Interesting, but not (to me) surprising update, here – DNA and blood type and chemistry appears to be a factor:
In June, one such genomewide association study in The New England Journal of Medicine (NEJM) found two “hits” linked to respiratory failure in 1600 Italian and Spanish COVID-19 patients: a marker within the ABO gene, which determines a person’s blood type, and a stretch of chromosome 3 that holds a half-dozen genes.
A more surprising hit from the U.K. study points to OAS genes, which code for proteins that activate an enzyme that breaks down viral RNA.
The U.K. genetics study did not confirm that the ABO variants affect the odds of severe disease. Some studies looking directly at blood type, not genetic markers, have reported that type O blood protects against COVID-19, whereas A blood makes a person more vulnerable.