Peaceful life

Mackerel was boiled with soy sauce, sugar and sake. Green onions and ginger were added to it. We are trying to have sea grown but not artificially reared fish. The former is rich with omega 3 unsaturated fatty acid which is beneficial to avoid arteriosclerosis. Even though we should have been more conscious of this long before. Maybe, better than nothing. Pretty good taste. It is a kind of typical family dish in Japan. 

The dish below is salad featuring broccoli harvested in the garden farm. Some of them are already flowering. I have planted 3 of broccoli in the garden farm.

There is another japanese plum tree fully blooming at the eastern end of the property. In total, we have 3 of japanese plum trees. Two of them, including this one, have been planted by my father while the newest one by myself. Japanese plum requires partner tree to bear fruits in early summer. To enhance bearing fruits, a small one has been planted in between the other old two. The photo below is a close up view of the new one.

It has been a peaceful day. On the other hand, the news tells the number of infected people has increased abruptly after the Olympic games was postponed. The governor of Tokyo even warned that we might had been in the beginning of overshoot. I still suspect they have limited the tests in order to show less infected people than real. Politics is inclined to utilize such a crisis to get more power. Wondering if people could notice that or not. 

I should not take it granted to have such a peaceful day. Peaceful and tranquil life is being threatened by things going on. 

Anti-inflammatory drugs for COVID19

It is well known anti-inflammatory drugs so called NSAID are not indicated for any viral infection, including COVID19. Ibuprofen, one of the common NSAIDs, is told to exacerbate pneumonia in COVID19. It is not proved medically yet but is quite probable such an anti-inflammatory drug as Ibuprofen delays recovery or even aggravate the course.

https://www.bmj.com/content/368/bmj.m1086

NSAID could cause Reye syndrome, fatal liver/brain dysfunction syndrome, when given to the case of Influenza, especially type B. It is not clinically possible to tell COVID19 from Influenza or other common cold due to viruses. Knowing of the possibility to cause Reye syndrome with NSAID, we should not give any anti-inflammatory drugs, even including acetoaminophene, to viral infections. Even though some doctors may prescribe the latter one, which has less adverse effects than the other NSAID.

In rare cases with COVID19 or the other viral infections, a very serious condition named cytokine storm could occur and lead to multiple organ failure. It is a generalized too aggressive immune response to the pathogen. In that case, anti-inflammatory drugs should be tried. But in such a case, the patient is always so serious that he/she should be under the management by doctors at hospital.

Anti-inflammatory drugs give us only symptomatic relief. They should not be used for viral infections including COVID19.

PS;After writing this post, I have noticed this article on this issue. The effect of NSAID on COVID19 is not scientifically elucidated yet. At least, it is not advisable to give this kind of medicine to the patient of COVID19 at present. This article also mentions that ACE blocker has not been proved to deteriorate the course of COVID19.

https://science.sciencemag.org/content/early/2020/03/20/science.abb8034

Prediction of the peaked outbreak

In Japan, PCR tests are limited only for those in close contact with an infected person as already reiterated in this blog. Only 5% of requests for tests are allowed to be tested. That is told the main reason why the number of infected people remains rather small compared with the other countries.

Researchers of Imperial College London has published prediction of the infected cases in UK and USA. It is a horrible forecast. Without considering the overwhelmed healthcare especially for severe respiratory failure, the peak of the outbreak comes from May to June. Eighty one % of the population is expected to be infected. The expected deaths are 2.2 millions in US and 0.51 millions in UK in total.  

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf?fbclid=IwAR2pHXimauFMaS0MiA2tGlial7ed8tfCxR7K3HzvU420nYAAxLpUHwajvbs

The non pharmaceutical interventions could reduce the death rate. They include case isolation, household quarantine, social distancing especially of elderly and closing schools/universities. Among them case isolation seems to work best.

Case isolation depends on the right diagnosis. We should depend it on PCR tests result however the test's sensitivity is not ideal and could yield false negatives/positives if it is done as a screening test. History taking and examination by doctors may enhance accuracy of the diagnosis.

There are a lot of people insisting that PCR test is of limited value to mitigate the outbreak. They forget the fact we need to make case isolation by any means. We may utilize such as LAMP method for gene detection or immunochromatographic method for antibodies. PCR should be improved as well. Despite of the test defect at present, we should diagnose infected cases and put them in isolation as soon as possible.

Needless to say we should get ready for respiratory care intensive facilities to do with the peaked outbreak or overshoots coming up soon. 

Boiled chicken wings

Chicken wings boiled with soy sauce, sake and sugar. Cooked for an hour, the meat is soft and tasty. 

I would have cooked pork spareribs. But it was not sold at the supermarket I always go for shopping. Whether it was not very popular or the supermarket is not doing with common people like me.

This was pretty successful. Honestly, most of the dish is not the meat but the bone. Bone could be a source of stock. But not suitable for commoners' dinner.

I have purchased a bit more of foods than usual. I am afraid the viral infection could overshoot very soon and it could be difficult to go for shopping then. I have heard of the difficult situation in the West Coast from a few friends this morning. I hope the situation might be settled down soon. The professional committee of the government announces only that the infection is under control not telling any actual data. I am afraid they have very few epidemiological data if any. How could they announce that way without any definite epidemiological data? 

Another candidate drug for COVID19

Researchers of Institute of Medical Science, Tokyo University, announced that they had found another promising candidate drug for SARS CoV2. It is Nafamostat Mesilate, a protease inhibitor, which has been used for treatment of pancreatitis. SARS CoV2 requires a serine protease to invade into the cell. Nafamostat Mesilate seems to inhibit that process working as a protease. A derivative of this substance has been given to COVID19 patients in Germany with certain success. But it should be given at large dose. Nafamostat Mesilate seems to work at rather smaller dose.

Among depressing news regarding this disease in pandemic inundating in the mass media, this is a news of hope. The researchers told they had not published on this drug as a paper yet but, considering its importance for COVID19 treatment, they decided to publish it as an announcement. I was impressed at their conscience and passion as researchers in medical science. All the knowledge and experience should serve for the patients who need help.

Let's hope this drug turns out to be effective for the cases of COVID19. 

Favipiravir as a treatment choice for COVID19

A good news has been come out of a Chinese site as I already posted in Facebook.

Favipiravir turned out to be effective for SARS CoV2, the pathogen of the novel Corona virus infection, as they say. No notable side effects. They are including it to the treatment protocol.

http://www.xinhuanet.com/english/2020-03/17/c_138887971.htm

Favipiravir is a potent antiviral agent discovered by Toyama Chemical Co. in 2014, presently FUJIFILM Toyama Chemical Co. It inhibits RNA dependent RNA polymerase and is shown to be effective against wide range of RNA viruses. Working on the gene itself, it is expected to develop less chances of treatment resistance not like the most preceding anti Inluenza drugs. It has been deemed a key medicine for bird Influenza viruses, another example of RNA viruses. Since SARS CoV2 belongs to RNA virus group, they have started using it to COVID19 cases in China. A Chinese Pharmaceutical Co. seemed to have obtained the production license from FUJIFILM Toyama Chemical Co.

I would emphasize that early diagnosis, as the general rule in infectious disease treatment says, is mandatory to get a good result from this drug. It is surprising there are a number of "professionals" still insisting the RT PCR tests are of limited value so that they should not give it even to the suspicious cases. Of course, the government and MHLW are the source of such wrong opinion. They would pretend to have the number of infected cases much lower than real. In Japan, only 5% of the suspected cases could be tested for diagnosis. It is a non sense and even inhumane. It is irrational from the epidemiological stand point. Since this drug turns out to be a curative one, those test denial people have lost their standpoint. 

I hope this drug will be given to many patients in early stage. Hopefully, the other candidates for the treatment will bring good results in the very near future as well. 

Test, test and test

Our government is intending to limit the number of the test for COVID19. I could not help feeling they will have the outbreak progress and have those elderly and with underlying illnesses pass away. They just hide and falsify the facts. It is a willful negligence by the authority.

They have got through a lot of scandals through that evil way. The outbreak is not a political matter itself but is a phenomenon of nature which could never be hidden or never be falsified. It is an urgent issue if the healthcare system could do with the explosive outbreak or would be collapsed with too many patients.

In our country, the rule of funeral has been changed and those corpus died from unknown cause of pneumonia should be cremated in 24 hours after death. They are regarded as infectious with COVID19. The authority may be conscious that certain number of people are dying from COVID19.

No, it is not my intention to induce panic among people. But we should understand what is going on with the outbreak and should calmly deal with it step by step. People should be informed right and accurate facts. It is the first step for us to manage the ongoing crisis.

https://www.cnbc.com/2020/03/16/who-says-some-nations-arent-running-enough-coronavirus-tests-test-every-suspected-case.html