Our favorite post of the week: FDA authorizes experimental drug remdesivir for emergency use in COVID-19 patients

A: The country currently has universal BCG vaccination program. B: The country used to recommend BCG vaccination for everyone, but currently does not. C: The country never had universal BCG vaccination programs.

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.[1]  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.

Dr. Zia H Shah, Chief Editor of the Muslim Times and author of this article

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

References

1. https://infographics.channelnewsasia.com/covid-19/map.html
2. Most of the references are linked in the article.