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Over the past two weeks, retail shops were allowed to open in England and in Wales.

Shops in Wales opened a week later than in England’s because of the devolved government. Scotland and Northern Ireland are also operating their own reopening timetables for the same reason.

England

The government encouraged shops to remove as much risk from COVID-19 as possible. Certificates are available for shops that do so.

On Monday, June 15, a number of retail shops reopened.

Primark was the biggest draw.

These were the scenes in Birmingham:

It was the same in Liverpool …

… and Bristol …

… and Hull:

These are Primark’s in-store guidelines:

If you need a laugh, this is a great video about Primark’s guidelines:

Oxford Street in London was the same. There is obviously something about Primark, as can be seen from this photo of Berlin:

Here’s a shop in Oxford Circus. Also note that some secondary schools reopened and that face masks became compulsory on public transport in England:

Oxford Street was busy in places:

These were Selfridge’s first shoppers on that beautiful Monday morning:

More waited in the queue outside:

For some, social distancing was so last month:

Grandparents still cannot hug their grandchildren, but there was a workaround for that. I believe this was outside the Nike Store:

Apparently, not everyone was happy with non-essential retail shops opening for the first time since March:

How true:

Mandatory face masks on public transport have been causing concern for some:

Transport for London trusts passengers who say they cannot wear face coverings:

Public transport was a mixed bag with regard to masks:

Things were more relaxed in Bristol:

I had to wear a mask indoors today for a while. I walked home in it just to see what would happen. While the mask was comfortable, I was getting short of breath after my five-minute walk home. Was it hypoxia? I would not recommend walking the streets with a mask for that reason:

We have more reopenings to look forward to on Saturday, July 4, which will be an Independence Day of sorts for us, too.

Wales

Shops in Wales reopened on Monday, June 22.

Everything was much quieter there.

Wales Online reported that shops had made a lot of adjustments.

Cardiff has redesignated thoroughfares in the main shopping area:

Some shops did not reopen until Friday, June 26. Here’s Primark in Cardiff:

Schools in Wales can reopen next week, with social distancing measures in place:

We had a splendid week of warm and sunny weather. Unfortunately, it brought out the worst in some people:

Even the First Minister Mark Drakeford remarked on unauthorised mass gatherings and the lack of social distancing:

In brighter news, an online #IAmOpen campaign kicked off today:

Just another step forward to normality:

More reopening updates will follow in the weeks ahead.

Like France and other European countries, the UK is now advocating wearing face masks during the coronavirus pandemic, especially on public transport.

This Daily Mail article explores what is reopening in England and adds (emphases mine):

Firms will be told they must provide staff with face masks to be worn at work, on public transport and when shopping. But wearing face coverings will not be compulsory

Thank goodness for that.

Metro had more:

The Government is now advising ‘that people should aim to wear a face-covering in enclosed spaces where social distancing is not always possible and they come into contact with others they do not normally meet, for example on public transport or in some shops.’ The advice continues: ‘Homemade cloth face-coverings can help reduce the risk of transmission in some circumstances. Face-coverings are not intended to help the wearer, but to protect against inadvertent transmission of the disease to others if you have it asymptomatically.’

Note that a ‘face-covering’ is not the same as a surgical mask or respirators used as part of PPE, and the advice stands that such equipment should be reserved for those who need it. Face-coverings should not be used for anyone under the age of two, or on those who may struggle to manage them correctly. People are urged to always wash their hands before putting them on and taking them off.

What a palaver!

This is what schools in Asia look like today, reminiscent of a 1970s film with John Travolta:

One thought did cross my mind about the barriers, so I was happy to see someone on Twitter mention it:

However, masks, including homemade face coverings, are not a good idea. The same goes for making them mandatory.

This woman yells that she cannot breathe with it. The mask is around her neck as she and her small child are apprehended by police somewhere in the United States:

The same Twitter user posted a two-part video, allegedly from a nurse, who explains in layman’s terms why masks do more harm than good in healthy people. In short, most hospital masks — which is why there has been a shortage of the correct ones during the pandemic — are there to keep bacteria from travelling. A bacterium is much larger than a virus droplet, therefore, wearing ordinary hospital masks for COVID-19 are useless, especially if you are healthy:

Ann Barnhardt’s website has more in ‘**UPDATED WITH TESTIMONY OF A FIREMAN** FACE MASKS ARE GENUINELY, SCIENTIFICALLY USELESS: Multiple RNs check in’. Don’t miss the photo of the man wearing an adhesive sanitary towel!

Excerpts follow.

A nurse wrote to Ann Barnhardt to say (emphases in the original, those in purple mine):

Hello Ann,

I listened to your Podcast Episode #110. Wonderful as always, and strengthens my resolve and fight. Thank you. One thing I don’t think people know about masking is that when we don a mask if we have any virus we breathe it back inside over and over again increasing viral load and weakening our own immunity, so we get sicker, which seems to be the point.

I’m an RN, graduated 2002 from (major, redacted) school of nursing. When i started my career as an ER nurse, one requirement was TB mask fitting. They fit a duck bill mask to your face and put a plastic cylinder with a vent opening over your head and sprayed a concentrated sucrose mist.  If you could taste just a bit of sweetness through mask, you were at risk for contracting TB. So again, what the hell are cloth or surgical masks gonna do?… umm make ourselves sick – that’s it. Any honest doctor/nurse/scientist/virologist knows this mask thing is bullshit.

God bless Ann keep it up. Thank you.

Another nurse wrote in to corroborate the first nurse’s comment. The second nurse says, in part:

Bottom line – if it isn’t fit tested then there’s no guarantee that the “viral particles” are being filtered out. So this mask wearing that we are all “required” to do is…..wait for it….BEE ESS.

I laugh when I see the general public wearing N95s they bought at Home Depot. Unless you fit test it (an N95), you have no idea if it’s actually “working”.🙄

It’s all a mind game.

The fireman said, in part:

Having conducted countless N95 quantitative tests for medics on base when I was still in the military, I can echo that not being fit tested for an N95 pretty much renders it useless.

The proper fit varies from person to person not only by size of the mask, but by brand. So you can’t just say you need a medium, but a medium in brand X. So optimally, your employer would have to buy the right size and right brand for each employee that they attained an acceptable fit factor in. Good luck with that. N95’s are probably the hardest masks to get a proper fit on.

This is all smoke and mirrors.

On masks, Barnhardt concludes:

And remember, folks, this ONLY applies to N95-level masks. Putting a few ridiculous layers of gauze, or even more ridiculously, FASHION FABRIC (I’ve even seen DENIM – that’s just going to give you elevated Carbon Dioxide levels – absolutely STUPID. Carbon Dioxide inhalation is a common method of stunning hogs at slaughter) serves ABSOLUTELY NO PURPOSE WHATSOEVER EXCEPT to signal TOTAL SUBMISSION TO THE LIE and to THE TOTALITARIAN REGIME.

It isn’t a “sanitary barrier.” It doesn’t block viruses, and certainly not this common cold virus. COLD VIRUSES CANNOT BE CONTAINED ANY MORE THAN MANKIND CAN AFFECT THE GLOBAL WEATHER. Such a contention is PURE, HUBRISTIC, LYING BULLSHIT.

Regarding the pandemic regulations in general, she rightly thinks these can damage susceptible children (red used in the original):

Finally, let me just put out there the call for one and all to sit in stillness and think about the intense psycho-spiritual damage that is being done to CHILDREN with each passing day that this facemask psy-op goes on.  How many children are now deeply terrified of OTHER HUMAN BEINGS in se, because of this, with the mask being a visible, frightening vector of this terror?

How many children are right now, as we speak, telling themselves internally, in simple, childish terms that they themselves could not yet articulate, but feel with tremendous force, that OTHER PEOPLE ARE SOMETHING BAD, AND THAT TO LOVE ANOTHER HUMAN BEING IS SOMETHING BAD THAT THEY MUST NEVER DO? Because other human beings are dangerous and will hurt you if you get anywhere near them.

Agreed. The unknown psychological damage right now could end up being terribly manifest in the months ahead.

Let’s now go to Technocracy, which has an article with quotes from Dr Russell Blaylock, a physician: ‘Blaylock: Face Masks Pose Serious Risks To The Healthy’. It is scientific, with medical terms and health conditions described the way they would be in medical school.

Blaylock notes America’s Center for Disease Control’s about-face with regard to masks (emphases mine):

As for the scientific support for the use of face mask, a recent careful examination of the literature, in which 17 of the best studies were analyzed, concluded that, “ None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.”Keep in mind, no studies have been done to demonstrate that either a cloth mask or the N95 mask has any effect on transmission of the COVID-19 virus. Any recommendations, therefore, have to be based on studies of influenza virus transmission. And, as you have seen, there is no conclusive evidence of their efficiency in controlling flu virus transmission.

It is also instructive to know that until recently, the CDC did not recommend wearing a face mask or covering of any kind, unless a person was known to be infected, that is, until recently. Non-infected people need not wear a mask. When a person has TB we have them wear a mask, not the entire community of non-infected. The recommendations by the CDC and the WHO are not based on any studies of this virus and have never been used to contain any other virus pandemic or epidemic in history.

He summarises the possible dangers of mask wearing to healthy people:

Several studies have indeed found significant problems with wearing such a mask. This can vary from headaches, to increased airway resistance, carbon dioxide accumulation, to hypoxia, all the way to serious life-threatening complications.

He discusses these dangers in terms of the type of mask worn:

There is a difference between the N95 respirator mask and the surgical mask (cloth or paper mask) in terms of side effects. The N95 mask, which filters out 95% of particles with a median diameter >0.3 µm2 , because it impairs respiratory exchange (breathing) to a greater degree than a soft mask, and is more often associated with headaches. In one such study, researchers surveyed 212 healthcare workers (47 males and 165 females) asking about presence of headaches with N95 mask use, duration of the headaches, type of headaches and if the person had preexisting headaches.2

They found that about a third of the workers developed headaches with use of the mask, most had preexisting headaches that were worsened by the mask wearing, and 60% required pain medications for relief. As to the cause of the headaches, while straps and pressure from the mask could be causative, the bulk of the evidence points toward hypoxia and/or hypercapnia as the cause. That is, a reduction in blood oxygenation (hypoxia) or an elevation in blood C02 (hypercapnia). It is known that the N95 mask, if worn for hours, can reduce blood oxygenation as much as 20%, which can lead to a loss of consciousness, as happened to the hapless fellow driving around alone in his car wearing an N95 mask, causing him to pass out, and to crash his car and sustain injuries. I am sure that we have several cases of elderly individuals or any person with poor lung function passing out, hitting their head. This, of course, can lead to death.

A more recent study involving 159 healthcare workers aged 21 to 35 years of age found that 81% developed headaches from wearing a face mask.3   Some had pre-existing headaches that were precipitated by the masks. All felt like the headaches affected their work performance.

As for the elderly and infirm, masks can pose far greater problems:

Unfortunately, no one is telling the frail elderly and those with lung diseases, such as COPD, emphysema or pulmonary fibrosis, of these dangers when wearing a facial mask of any kind—which can cause a severe worsening of lung function. This also includes lung cancer patients and people having had lung surgery, especially with partial resection or even the removal of a whole lung.

He goes on to explain the dangers of low oxygen levels in the bloodstream — hypoxia — which can debilitate the immune system:

While most agree that the N95 mask can cause significant hypoxia and hypercapnia, another study of surgical masks found significant reductions in blood oxygen as well. In this study, researchers examined the blood oxygen levels in 53 surgeons using an oximeter. They measured blood oxygenation before surgery as well as at the end of surgeries.4 The researchers found that the mask reduced the blood oxygen levels (pa02) significantly. The longer the duration of wearing the mask, the greater the fall in blood oxygen levels.

The importance of these findings is that a drop in oxygen levels (hypoxia) is associated with an impairment in immunity. Studies have shown that hypoxia can inhibit the type of main immune cells used to fight viral infections called the CD4+ T-lymphocyte. This occurs because the hypoxia increases the level of a compound called hypoxia inducible factor-1 (HIF-1), which inhibits T-lymphocytes and stimulates a powerful immune inhibitor cell called the Tregs. This sets the stage for contracting any infection, including COVID-19 and making the consequences of that infection much graver. In essence, your mask may very well put you at an increased risk of infections and if so, having a much worse outcome.5,6,7

People with cancer, heart conditions and strokes must be very careful if they choose to wear masks:

… cancer grows best in a microenvironment that is low in oxygen. Low oxygen also promotes inflammation which can promote the growth, invasion and spread of cancers.8,9  Repeated episodes of hypoxia has been proposed as a significant factor in atherosclerosis and hence increases all cardiovascular (heart attacks) and cerebrovascular (strokes) diseases.10

In addition, when we wear masks, especially for hours at a time, we are breathing in our own bacteria, creating an incubator effect for the sinuses and lungs. For someone unknowingly harbouring COVID-19, he says, their recovery time might be prolonged, because their own immune system is compromised by cytokine storms, which occur when the body goes into overdrive trying to fight off illness:

When a person is infected with a respiratory virus, they will expel some of the virus with each breath. If they are wearing a mask, especially an N95 mask or other tightly fitting mask, they will be constantly rebreathing the viruses, raising the concentration of the virus in the lungs and the nasal passages. We know that people who have the worst reactions to the coronavirus have the highest concentrations of the virus early on. And this leads to the deadly cytokine storm in a selected number.

He reminds readers that COVID-19 is relatively benign for most of the population, therefore:

we need to protect the at-risk population by avoiding close contact, boosting their immunity with compounds that boost cellular immunity and in general, care for them.

One should not attack and insult those who have chosen not to wear a mask, as these studies suggest that is the wise choice to make.

Lisa Williams, a reporter for the Telegraph, described six things no one says about wearing a mask.

She felt cut off from people because they could not see her face, but the mask was also uncomfortable to wear:

The mask tickled my nose, felt hot and damp almost instantly, and I was constantly having to reloop it back around my ears. I found it a challenge to wear one for this short trip, let alone while performing heart surgery.

It also distracted her:

It feels suffocating, and the noise of your breath on fabric becomes distracting. You never realised your breathing was so LOUD.

Furthermore, one size does not fit all:

Although many masks have a degree of stretch, there is a big difference in how our heads are built and the average mask does not account for this.

While she says that homemade fabric masks could be useful, I rather doubt that — unless they are for short periods of time — because fabric is often treated with chemicals that should not be near our mouths or noses, or the fabric is much too thick. As Ann Barnhardt and Dr Blaylock say above, they can give us potentially fatal C02 levels.

In conclusion: beware of — rather than wear — masks unless instructed to do so by a medical professional, or mandated by law.

We have been told that our coronavirus lockdowns will not end until a vaccine has been successfully developed.

Meanwhile, in France, Professor Didier Raoult has been successfully using chloroquine, where suitable, on his COVID-19 patients at the IHU Méditerranée Infection facility, where he is the Director.

Professor Raoult is also a physician. A number of his fellow doctors oppose his use of an anti-malarial drug, which is cheap as chips, to treat this novel (new) coronavirus, said to have no known remedy, much less cure, at this time.

Raoult describes himself as a ‘renegade’ physician. Other doctors in France certainly agree. They doubt his claims. Now they want to suspend him from France’s national medical association, l’Ordre des Médecins (The Order of Physicians).

On Saturday, April 25, Geopolintel (French language, translated below) reported that the ANSM (French National Agency for Medicines and Health Products Safety), INSERM (French National Institute of Health and Medical Research) and the biopharmaceutical drug company Gilead are out to get Raoult.

The article is an open letter to Raoult’s critics:

The Covid-19 crisis shows the destructive ideology of your policies as well as that of the health institutions of our country.

Given the sums of money involved, it takes any and all costs to transfer the professor from Marseille for the generalized vaccination agreement between Macron and Bill Gates to be realized.

Censors, you have lost public opinion and you cannot regain it by threatening Professor Raoult with suspension by the Order of Physicians.

He makes fun of your stories of cash and corruption, unlike you, he treats and does not bear responsibility for death by organized shortage.

What displeases you in him is his indifference to lobbies and sirens of glory and as a professor, researcher and doctor; he cares while you polish your the seats of your trousers on the leather armchairs of the circles of initiates who have done nothing in their lives other than lying and earning dirty money.

There have been major pharmaceutical scandals in France in recent years, yet the establishment is going after Raoult, who has provided patient relief in an inexpensive prescription anti-malarial drug available at pharmacies. The medical establishment has accused the professor of employing ‘illegal medical research protocols’:

Regarding the “illegal clinical research protocols” which are attributed to Didier Raoult, what about the scandals of the Pick (Médiator), Depakin and other drugs approved in the so-called respect for randomized trial protocols?

As for his possible suspension by the Order of Physicians:

The Council of the Order of Physicians threatens Professor Raoult with immediate suspension of activity, because his clinical trials “do not comply with official procedures”, and he risks up to a year in prison and 15,000 euros in fines.

Yet, President Macron visited Raoult in Marseille recently to find out more about the doctor’s success with his COVID-19 patients. About this, the article says:

As a reminder, Professor Raoult presented Emmanuel Macron with the results of his work on 1,061 patients.

Almost 92% of patients cured in ten days,
Nearly 5% of patients cured “late”
Less than 5% of “patients with complications”.
Or 31 patients hospitalized for more than ten days,
10 transferred to intensive care,
and 5 deaths. On 1061: do your accounts and compare to the rest of France…

The abstract and summary table of the data in our article on the treatment of 1061 patients are online!
The abstract and the summary table of our paper on the treatment of 1061 patients are online! https: //t.co/mTWj6aGpTk https: //t.co … pic.twitter.com/PLdygNolxG
– Didier Raoult (@raoult_didier) April 10, 2020

These are the full results of Raoult’s study:

The article concludes:

The first reaction of the simple man that I am, in the delusional French context that I observe from afar, is this: Raoult heals while the profession flounders. It has no response, no treatment, adding the humiliation of the mandarins to the resentment of the rascals. In short, Raoult must be suspended. It is urgent: he risks treating even more people.

Now, it must be said that chloroquine doesn’t work on everyone. Nor does a similar drug, hydroxychloroquine, often combined with azithromycin (which contains zinc), in COVID-19 treatment. The latter is the treatment that President Trump has been championing for weeks.

Both should be used with caution and under medical supervision. They can harm patients with certain types of heart ailments. Never self-medicate!

As is true in France, the American medical establishment is eager to pour cold water on Trump’s claims.

On April 16, 2020, MedRxiv published an abstract of one such study: ‘Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19’, which ends as follows:

CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

Yet, nearly half of America’s 50 states are stockpiling the drug, as Axios reported on April 25 (emphases in the original):

At least 22 states and Washington, D.C., are building up stores of the anti-malarial drug President Trump previously touted as a possible solution for the novel coronavirus, AP reports.

Why it matters: The Food and Drug Administration advised doctors Friday against prescribing hydroxychloroquine or the related drug chloroquine to coronavirus patients as it appears to be causing some serious and potentially life-threatening side effects.

    • ‘The warning comes as doctors at a New York hospital published a report that heart rhythm abnormalities developed in most of 84 coronavirus patients treated with hydroxychloroquine and the antibiotic azithromycin, a combo Trump has promoted,” AP notes.

What they’re saying: “While clinical trials are ongoing to determine the safety and effectiveness of these drugs for COVID-19, there are known side effects of these medications that should be considered,” FDA Commissioner Stephen Hahn said.

The state of play: Some health experts worry the public could misuse the drug if it is made more widely available.

The FDA has authorised use of hydroxychloroquine under the following conditions, summarised on page 4 of their guidelines:

The hydroxychloroquine sulfate may only be used to treat adult and adolescent patients who weigh 50 kg or more hospitalized with COVID-19 for whom a clinical trial is not available, or participation is not feasible.9

South Dakota is the first state to participate in a trial of the drug:

Kudos to their governor, Kristi Noem, who ignored calls for lockdown. South Dakotans rewarded her with a parade:

But I digress.

Health Feedback is a site that debunks current coronavirus remedies or possible cures. Another is Poynter. Both must be busy.

There has been much talk of using ventilators on ICU patients with COVID-19. However, in some cases, ventilators do not always work and, in some instances, have worsened patients’ outcomes.

On March 20, Cleveland Clinic published an explanation of the damage that COVID-19 can do to the lungs, leading to the need for intensive care and, likely, a ventilator. Excerpts follow (emphases mine):

Although many people with COVID-19 have no symptoms or only mild symptoms, a subset of patients develop severe respiratory illness and may need to be admitted for intensive care.

In a new video, lung pathologist Sanjay Mukhopadhyay, MD, lays out in detail how the lungs are affected in these severe cases. The 15-minute video walks through how COVID-19 causes a “dangerous and potentially fatal” condition known as acute respiratory distress syndrome (ARDS) while providing stark images that underscore the severity of the damage that condition can cause to your lungs.

As Dr. Mukhopadhyay explains, Chinese researchers have linked COVID-19 to ARDS. Their study examined risk factors for 191 confirmed coronavirus patients who died while being treated in two hospitals in Wuhan, China.

The researchers found 50 of the 54 patients who died had developed ARDS while only nine of the 137 survivors had ARDS

If you have ARDS, you’ll have symptoms like sudden breathlessness, rapid breathing, dizziness, rapid heart rate and excessive sweating.

But the four main things doctors will look for are:

    • If you have an acute condition, symptoms that started within one week of what they call a “known clinical insult,” or new or worsening symptoms.
    • If your shortness of breath isn’t explained by heart failure or fluid overload.
    • Having low oxygen levels in your blood (severe hypoxia).
    • Both lungs appearing white and opaque (versus black) on chest X-rays (called bilateral lung opacities on chest imaging) …

There might have been other articles like this circulating recently, ones that mention hypoxia.

Hypoxia has been mentioned often in online discourse and in some online articles, such as one from April 5, posted on Medium, ‘Covid-19 had us all fooled, but now we might have finally found its secret’, written by a non-medic whose Medium account has since been deleted.

That article has appeared all over various fora over the past few weeks.

It does sound really plausible, even though Poynter and Health Feedback have both debunked it, which I’ll get to below.

Not being a medic or have anyone in the family who is, I’m just going to throw these excerpts out there.

As such, I wonder if this is accurate, i.e. something that front line physicians will mention a year from now. Anyone with a medical background reading this should feel free to leave a comment below.

The author explains why ventilators don’t always work on COVID-19 patients. This is what caught my eye:

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.

Then the author quotes someone in the medical profession who published a paper that seems to have gone nowhere (see below). Unfortunately, there is no reference to what or whom he quotes, which is this:

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.

I only found the Medium article last week, but I have many COVID-19 links bookmarked, including this one from April 10:

The article is behind a paywall, but you can read it here in its entirety. The doctors the Telegraph interviewed seem to be saying the same as the Medium author does: no ARDS, no pneumonia, therefore, no ventilator, which can do more harm than good:

British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients.

In many cases they say the machines, which are highly invasive and require the patient to be rendered unconscious, are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings.

Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used.

At the heart of the issue was the “bizarre” and “frankly baffling” phenomenon of Covid-19 patients presenting with catastrophically low blood oxygen levels but few other ill effects.

The Telegraph says that this new protocol goes against prior received wisdom on the unknown COVID-19. Prime Minister Boris Johnson had been in intensive care that week, released back to a general ward on the evening of Maundy Thursday, April 9:

The initial recommendations from doctors in China and Italy were to ventilate Covid patients early and aggressively, with the so-called “PEEP” pressure on the machines turned up high so their lungs did not contract when they exhaled.

The initial message was treat as if you were treating for acute respiratory distress syndrome (ARDS) with a high PEEP,” said Daniels. “But now we are becoming braver. We are tolerating much lower blood oxygen levels and using lower pressures. We are learning as we go along”.

The alternative to mechanical ventilation is oxygen treatment delivered via a mask or a nasal cannula or via a non-invasive high flow device. This is the sort of treatment the Prime Minister Boris Johnson is said to be receiving in an intensive care unit at St Thomas’s hospital London. His blood oxygen levels are not known.

Increasingly doctors in the UK, America and Europe are using these less invasive measures and holding back on the use of mechanical ventilation for as long as possible

Doctors in Italy and Germany wrote to the American Journal of Respiratory and Critical Care Medicine last week making a similar point. They urged other doctors to be “patient” with Covid patients, arguing for “gentle ventilation” wherever possible

It is not known why Covid-19 allows some patients to tolerate such low blood oxygen readings without air hunger or obvious confusion. One clue may be that patients are still able to exhale carbon dioxide – a toxin – through their lungs even if they are having difficulty absorbing oxygen.

“The patients in front of me are unlike any I’ve ever seen,” one American doctor working in a Brooklyn hospital told the specialist health publication STAT this week. “They looked a lot more like they had altitude sickness than pneumonia.”

Dr Daniels agreed that there were similarities with altitude sickness, itself a potentially fatal condition. “We’ve seen a lot of headache and dizziness”, he noted …

You might have heard of Drs Dan Erickson and Artin Massihi, whose two-part press briefing in California was removed last week from YouTube. The two went against the received wisdom of the WHO. I watched both videos when they came out at the beginning of April. In the second video, they warned against the aggressive use of ventilators when treating COVID-19.

Therefore, the Medium article might not be either wrong or fake news with regard to ventilators.

It has an explanation of what might be happening whereby blood gets starved of oxygen through COVID-19, and it is this which has proven to be controversial with physicians:

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 ascorbic 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 prisonsit’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.

Poynter says this is clearly wrong:

The claim that COVID-19 causes hypoxia because the causative virus binds to hemoglobin in red blood cells is unsupported. For starters, no scientific evidence demonstrates that SARS-CoV-2 can enter red blood cells. The claim that the virus binds to hemoglobin is founded on the conclusions of a single pre-print, which solely involves computational analysis, without experimental verification or peer-review. The mechanism proposed is also inconsistent with clinical evidence from COVID-19 patients.

Health Feedback posted their refutation on Wednesday, April 15. It is lengthy and thorough. Excerpts follow:

Scientists told Health Feedback that the claim was not supported by experimental and clinical evidence. “There is no direct biological evidence that SARS-CoV-2 proteins interact with hemoglobin. The claim is based on a single study performed purely in silico without proper wet lab validation,” explained Victor Tseng, pulmonologist and assistant professor of medicine at Emory University. Eva Nozik-Grayck, clinician-scientist and critical care specialist at the Children’s Hospital Colorado, stated that “without any experimental evidence, it is dangerous and misleading to make these claims.”

David Irwin, associate professor at the University of Colorado Denver, who studies hemoglobin and hypoxia, questioned the conclusions of the ChemRxiv pre-print that served as the basis for the claim. “The authors show no convincing data to suggest that the [viral] proteins of interest, such as Orf8, etc., actually bind heme other than in modeling theories. Most troubling is that there is no way that we know of to suggest that the virus accesses hemoglobin in red blood cells to attack the heme as described in the manuscript,” he said.

A Medium article authored by Matthew Amdahl, a clinician-scientist and hemoglobin researcher at the University of Pittsburgh, details the numerous problems with [Medium author] Gaiziunas’ hypothesis. Notably, he pointed out that SARS-CoV-2 is larger than the entire hemoglobin protein, but according to Gaiziunas’ hypothesis, would somehow manage to fit into “a space barely large enough for two-atom molecules like oxygen (O2)” in order to eject iron from hemoglobin and bind to porphyrin:

To put it charitably, this would be an entirely novel and seemingly impossible sort of chemistry, and there is absolutely no scientific evidence that supports such a possibility. It’s this seemingly impossible interaction that forms the foundation of the blog post’s entire argument, and so the remainder of the conclusions drawn by the blogger simply don’t carry any weight.

Furthermore, clinical evidence from COVID-19 patients contradict Gaiziunas’ hypothesis. Firstly, supposing that the virus did bind to hemoglobin and ejected iron from red blood cells, this would have produced a modified form of hemoglobin that has an altered ability to bind to oxygen, which can be detected by measuring the oxyhemoglobin dissociation constant

In summary, while scientists have not ruled out a potential link between changes in red blood cell physiology and hypoxia observed in COVID-19 patients, the mechanisms proposed by Gaiziunas are founded on little to no scientific evidence, are highly implausible given what we already know of hemoglobin and the virus, and are contradicted by clinical evidence in COVID-19 patients.

We might find out more about hypoxia in COVID-19 patients in a year’s time.

For now, I can’t help but wonder if this type of hypoxia explains why hospitals have been refusing more ventilators for COVID-19 patients.

In the meantime, returning to Prof Didier Raoult, it seems that renegades are never in vogue with the establishment.

More power to him for successfully trialling on his coronavirus patients an inexpensive, prescription anti-malarial that has been on the market for decades. Well done. Millions of us support him in his work.

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