Our favorite post of the week: FDA authorizes experimental drug remdesivir for emergency use in COVID-19 patients
Written and collected by Zia H Shah MD, Chief Editor of the Muslim Times
Today is April 5, 2020, more than 1.25 million cases of infection have been documented and more than 68,000 have died worldwide due to Covid 19 infection. I have marked the timeline for this post in our Twitter account and shared it with some popular news sites.
The novel coronavirus has ravaged the coastal Ecuadorian city of Guayaquil, which has struggled to cope with the number of corpses as hospitals, morgues and funeral parlors have been overwhelmed. Some social media videos show unattended bodies lying on the street with nowhere else to go.
The outbreak in Ecuador has sickened at least 3,100 people, according to Johns Hopkins’ latest data map. The epicenter in the country is in Guayaquil, where residents have criticized the government’s response.
Please locate Ecuador in the map below and then in the map on the top:
Ecuador has been the only South American country that now does not have universal BCG vaccination policy. It is the only country in the continent in category ‘B’ in the above map rather than ‘A.’
The Wall Street Journal reported, “Coronavirus ravages Ecuador’s largest city,
with morgues full and residents fearful of the virus, families have begun leaving the deceased outside their homes or on street corners.”
According to the CBS news, the city’s mayor, Cynthia Viteri, announced in Twitter message Wednesday that three refrigerated trucks have been deployed to help store corpses.
She also blamed the federal government for not doing more.
“What is happening is with the public health system in his country?” she said in a recent video message. “They’re not recovering bodies from homes. They’re left in the sidewalks. They fall in front of hospitals. No one wants to recover them.”
Ecuador’s Vice President Otto Sonnenholzner told reporters earlier this week, “The government’s intention is that everyone who passes away these days in Guayaquil, not just those who have died from COVID-19, can have a dignified burial.”
According to the Los Angeles Times, municipal officials said 400 bodies have been recovered over the past few days. While majority of deaths are believed to be coronavirus-related, it has been difficult to confirm because of limited virus testing in the country.
In Europe there have been only two countries that have never had universal BCG vaccination and one of them is Italy, which has had the highest Covid 19 mortality in the world, standing at more than 15,000 till date.
One can quickly study the details about the BCG vaccination in each country in the website of an atlas linked here.
The world has seen enough evidence for the BCG vaccination for possible benefit against Covid 19 to: TB Vaccination Trial Started in Melbourne, Australia.
I merely want to take the next leap of faith and state that time is of the essence and we need to act now to save lives. I recommend universal BCG vaccination of every human of our global village; all 8 billion of them, except those with absolute or relative contraindications to the vaccine.
As a physician I do know that the studies being done in Melbourne and else where will be of tremendous help and prospective data is the most helpful but given the obvious time constraints we need greater analysis of the retrospective data of BCG vaccination that is already available to us, by the experts in epidemiology and statisticians.
Bloomberg website has reported:
Countries with mandatory policies to vaccinate against tuberculosis register fewer coronavirus deaths than countries that don’t have those policies, a new study has found.
The preliminary study posted on medRxiv, a site for unpublished medical research, finds a correlation between countries that require citizens to get the bacillus Calmette-Guerin (BCG) vaccine and those showing fewer number of confirmed cases and deaths from Covid-19. Though only a correlation, clinicians in at least six countries are running trials that involve giving frontline health workers and elderly people the BCG vaccine to see whether it can indeed provide some level of protection against the new coronavirus.
Gonzalo Otazu, assistant professor at the New York Institute of Technology and lead author of the study, started working on the analysis after noticing the low number of cases in Japan. The country had reported some of the earliest confirmed cases of coronavirus outside of China and it hadn’t instituted lockdown measures like so many other countries have done.
Otazu said he knew about studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions. So his team put together the data on what countries had universal BCG vaccine policies and when they were put in place. They then compared the number of confirmed cases and deaths from Covid-19 to find a strong correlation.
Among high-income countries showing large number of Covid-19 cases, the U.S. and Italy recommend BCG vaccines but only for people who might be at risk, whereas Germany, Spain, France and the U.K. used to have BCG vaccine policies but ended them years to decades ago. China, where the pandemic began, has a BCG vaccine policy but it wasn’t adhered to very well before 1976, Otazu said. Countries including Japan and South Korea, which have managed to control the disease, have universal BCG vaccine policies. Data on confirmed cases from low-income countries was considered not reliable enough to make a strong judgment.
One of the first to conduct the trial of BCG vaccine’s effectiveness against coronavirus is Mihai Netea, an infectious-disease expert at Radboud Universty Medical Center in the Netherlands. Netea’s team has already enrolled 400 health workers in the trial—200 got the BCG vaccine and 200 received a placebo. He doesn’t expect to see any results for at least two months. He’s also about to start a separate trial to study the effectiveness of the BCG vaccine on those older than 60. Other trials are taking place in Australia, Denmark, Germany, the U.K. and the U.S.
One of the important messages in this publication is, “Otazu said he knew about studies showing the BCG vaccine provided protection against not just tuberculosis bacteria but also other types of contagions.” BCG vaccination is like war games. You do not win a war during military exercises or war games but your military or your immune system becomes better prepared at the challenges ahead.
It is interesting to note the differences between Spain and Germany. In Germany there have been 1448 deaths so far whereas 12,418 have succumbed to it in Spain. It is interesting to note the BCG history of the two countries. In Spain vaccination was started in 1965 and stopped in 1981, while in Germany BCG vaccination was started in 1961 and continued till much later in 1998.
The second most populous country of the world, India, with 1.38 billion has reported only 99 deaths due to Covid 19 so far. They have been giving BCG vaccination at birth since 1948.
Table 1 in this publication shows the countries that stopped the BCG boosters and these include China and Iran. It is very possible that even those who had vaccination at birth may be deserving of a booster now.
If the governments and health care agencies approve of universal BCG vaccination and try to implement it then I am sure a large segment of the population will follow suit. Those who are purist and will oppose this recommendation, for one reason or the other, will serve as a suitable control for this global study. As more and more data piles up and a universal registry is maintained I do believe that the recommendation will be vindicated.
What has been good enough for all the countries labelled as ‘A’ in the topmost map over the years should be good enough for every country namely to get universal BCG vaccination, with the additional benefit of possible even if not definite protection against the pandemic.
One of the arguments advanced for not using BCG vaccine in the developed countries in the past has been to maintain the benefit of a diagnostic skin test PPD to find those who have been significantly exposed to tuberculosis. That argument no longer holds true because now we have a much better blood tesst to find those who have been exposed, namely Quantiferon Gold TB Test. Unlike PPD this test is not affected by BCG vaccination.
The USA government has been slow to accept the benefit of facial masks in public sphere but the leaders have come around. Likewise, I believe that as statisticians pile up more and more information along the lines highlighted above, the governments will come around and this is more pressing for USA, Canada and Italy, where the populations have not seen any significant BCG vaccination over the years and decades.
If nothing else, while the governments wait for the results of the numerous studies being done for the BCG vaccination they should get ready for large scale production of the BCG vaccination.
If I have my way, I will start BCG vaccination until specific Covid 19 vaccines become available in a year or more.
Additionally, the data highlighted here would give some guidance to the Asian and the African countries like Pakistan, in terms of how much and for how long would they need to limit their economy and need not blindly follow countries like Italy, Spain and USA.
What has been good medicine for the whole of Asia and Africa for decades is likely to be saving grace for Europe, Americas and Australia.
Additional suggested reading
Coronavirus: What Have I Learnt So Far
Can a century-old TB vaccine steel the immune system against the new coronavirus?
Corona Fear’s Cure: Chanting from the Bible and the Quran
All of humanity are intimate neighbors: Coronavirus proves it once again
Praise be to God for the Miracle of Our Immune System
- Most of the references are linked in the article.
Categories: coronavirus, Health, Highlight, Medicine, Preventive Medicine, The Muslim Times, Vaccine
Jazakallah Dr. Zia Shah for an excellent and comprehensive article for the benefit of all.
Thank you for the feedback.
I will document some of the other useful information for statisticians to analyse:
Denmark stopped general BCG vaccinations in 1986, Finland had long official discussions before ending the vaccination of newborn infants in 2006 and Norway finally stopped it in 2009. Iceland has never offered general BCG vaccinations.
Germany has relatively low mortality due to Covid 19 especially compared to Italy and here is their history of BCG vaccination:
Sweden (discontinuation of BCG vaccination since 1975) and in both parts of Germany (FRG discontinuation since 1975), as well as from the favourable tuberculosis situation in both parts of Germany (low tuberculosis incidence and very low infection risk) that general vaccination of babies is no longer warranted. For this reason the German Central Committee for Combatting Tuberculosis is considering in consultation with the Federal Bureau of Health to abstain from continuing to recommend general BCG vaccination of all newborn. BCG vaccination should be recommended only in enhanced-risk groups (children of foreign parents and children sharing their living quarters or household with a person suffering from acute, i.e. infectious tuberculosis).
As of Friday, Ecuador’s National Service of Risk and Emergency Management Department reports 3,368 confirmed coronavirus cases and 145 fatalities nationwide, of which 102 are registered deaths in Guayas province, where Guayaquil is located. But some citizens are concerned that confirmed positive cases of infection are higher than what is being reported by the Ecuadorian government, and they are demanding action, something happening in other countries too as delays and lack of testing cause frustrations.
To look at statistics of individual countries:
Table 1 in this article shows the countries that stopped the BCG booster; it includes 33 countries among them are China and Iran. Turkey is also one of them:
There have been only 45 deaths in Pakistan according to Dawn.com till date. If those numbers are to be trusted how do they play with the BCG vaccination story.
Infants in Pakistan are vaccinated with bacille Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children.BCG vaccine prevents tuberculosis or TB, and it has been used since 1921 globally. While it does not provide 100% protection against TB, it significantly decreases the chances of your baby getting this serious disease.
A single dose of BCG vaccine is administered routinely at birth in Pakistan. The vaccine is administered just beneath the skin. If the child misses the dose at birth, it can be administered later on as well.
Worldwide cost‐effectiveness of infant BCG vaccination
For the worst hit coastal town of Ecuador:
The task Force reported that it is collecting 100 bodies from the streets everyday.
According to local media, many families have been locked up with the bodies of their relatives for up to four days and are still waiting for forensics to remove them.
On March 30, Guayaquil City Councilor Andres Guschmer reported on Twitter that more than 400 bodies had been removed from their homes and local media said on Tuesday that almost 450 bodies were registered on the waiting list to be removed from the houses.
Authorities in Ecuador’s biggest city are distributing thousands of cardboard coffins and have created a helpline for families who need corpses to be removed from their homes.
Guayaquil has emerged as a regional hotspot for coronavirus, and hospitals and mortuaries have been overwhelmed, forcing some families to store bodies at home.
“It looks like a war zone hospital. The things we have seen are straight out of a horror film,” a doctor at the Teodoro Maldonado Carbo hospital, one of the city’s biggest facilities, told the Guardian. “My wife doesn’t want me to go to work. But if I don’t, more patients will die.”
On Saturday Ecuador’s health ministry said it had registered 172 Covid-19 deaths, 122 of them in Guayas province, of which Guayaquil is the capital. Low testing rates mean the true figure is almost certainly higher. Ecuador has officially registered 3,465 coronavirus cases, the third highest number in South America after Brazil and Chile.
One regional politician, Carlos Luis Morales, told CNN en Español that officials had been instructed not to divulge statistics about the death toll in Guayas. But he added: “Just to give you an idea, 480 death certificates have been issued since yesterday; 150 bodies are being collected each day.”
Read the following statistics and contrast their BCG record:
On Sunday Sweden reported a total of 401 deaths so far from Covid-19, up 8% from Saturday and greater than the totals of its three Nordic neighbours combined. Sweden’s toll per million inhabitants is 37, compared with 28 in Denmark, 12 in Norway and 4.5 in Finland.
For BCG record you go to:
“Every small thing gives us a ray of hope. It will be premature to say anything now. But the silver lining is that the BCG vaccine has proved quite effective against the SARS infection also,” Monica Gulati, senior dean, Faculty of Applied Medical Sciences, Lovely Professional University (LPU), Punjab, told .
“It was effective not in the sense that it was able to cure, but it was able to reduce the intensity,” Gulati said.
Gulati explained that the SARS virus is also basically ..
Read more at:
Global lockdown measures as a result of the coronavirus pandemic could lead to millions of people contracting tuberculosis (TB) over the coming years, according to a new study.
As many as 6.3 million people are expected to develop TB as cases go undiagnosed and untreated between now and 2025, a study published by Stop TB Partnership on Wednesday showed, with 1.4 million people predicted to die during this time.
It is expected to set back global efforts to fight TB by at least five years, and possibly up to eight years.
“This situation makes me sick, because (it) is totally avoidable,” Lucica Ditiu, executive director of the Stop TB Partnership, said via email. “We just need to keep in mind that TB, as well as other diseases, keep affecting and killing people every single day, not just Covid-19.”
The research, which was commissioned in collaboration with Imperial College London, Avenir Health, Johns Hopkins University and USAID, was based on a three-month lockdown and a protracted 10-month restoration period as daily life returns to normal.
It was modeled on data principally drawn from three high-incidence countries (India, Kenya and Ukraine) and extrapolated to a global level.
right. What do we say? from the frying pan into the fire?