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Thoughts from Pontevedra, Galicia, Spain

Random thoughts from a Brit in the North West. Sometimes serious, sometimes not. Quite often curmudgeonly.

Thoughts from Pontevedra, Galicia, Spain: 12 October 2020
13 October 2020 @ 09:15

Night’s candles are burnt out, and jocund day stands tiptoe on the misty mountain tops.

Spanish life is not always likeable but it is compellingly loveable.  

        - Christopher Howse: 'A Pilgrim in Spain'* 

Covid

From immunity to 'long' Covid: the key dates in the human body's battle against coronavirus: See the article below

Living La Vida Loca in Spain/Galicia

I could swear that Storm Alex smashed into Spain a week or two ago. Indeed, I see there are several Youtube videos which confirm my recollection. And yet the Guardian talks only of France, Italy and the UK being hit by it. I mentioned years ago that there's an inequality of  media treatment between the UK and Spain. News re the UK features far more in the Spanish media that Spain does in the UK media. Perhaps it's because of Brexit these days.

I'm reading through my regular Newsletters to my family during my first four and a half years here - not to mention this. I have to admit that - among the many positive comments - there are also those which sound rather familiar to the negative comments of Dutchman Vincent Verner in his book It is not what it is.  I also have to confess that the question  keeps cropping top - Has much changed in almost 20 years?   

María's Fallback chronicle: Day 28    

The UK

The USA

Writing from Spain and seeing how well things turned out, it's very hard to believe that Attorney General Barr’s vision is an Americanized version of something akin to Franco’s Spain. Click here for the rationale for this statement. And much, much more. Fascinating but shocking.    

The Way of the World 

Well, I never . . . Seeking a partner just for the winter used to be called ‘cuffing’. But doing it as lockdown looms, it's dubbed ‘coving’ and  it has taken on a new urgency . . . 

English/Spanish

Three more less-common refranes:- 

- Married people need a home of their own: El casado casa quiere.

- Never give advice unasked: Consejo no pedido, consejo mal oido.

- Never spend  your money before you have it: A quien no le sobra pan, no crie can.

THE ARTICLE

From immunity to 'long' Covid: the key dates in the human body's battle against coronavirus: As Donald Trump returns to the campaign trail after infection, here's what we now know about how the virus travels through our bodies: Anne Gulland  

Donald Trump is returning to the campaign trail today having made a seemingly miraculous recovery from Covid-19. 

The US president said contracting the disease, which has killed more than 200,000 Americans, was a “blessing from God” and pledged the “miracle cure” he received would be available to all in the United States free of charge, while a tweet in which Mr Trump claimed to have developed immunity to the virus has been labelled misleading by Twitter.

But contradictory statements from his doctors last weekend, plus the administration of therapies usually reserved for much sicker patients, has left many wondering how ill the president actually was and at what point he was infected with the virus.

What is for certain is that in a man of Mr Trump’s age and weight - he is 74 and in the obese category - the coronavirus is a risky illness. So how does Covid affect the body at different stages of the disease and at what stage does recovery happen?

Covid-19 spreads between people through direct, indirect or close contact. As an infected person coughs, sneezes or speaks they release droplets - these are then transmitted to others through close contact or may land on a surface. A passer by may brush their hand on the surface, pick up a droplet and then touch their face, allowing the virus to enter the body through their mouth, nose or eyes.

At this point the virus begins to replicate in the upper airway and the carrier may be infectious but not displaying any symptoms - known as pre-symptomatic. It is thought that 40% of infections are asymptomatic - so you may have had the virus but not know about it. 

Viral load - how much virus you have in your body - starts to build and this is the time when “peak shedding” or the point when you are most infectious occurs. This is why self isolation is so important if you have come into contact with someone who has the disease to avoid passing the virus further.

This is when symptoms typically begin. Most people report a cough, loss of taste and smell, fever, fatigue and aches and pains. Other symptoms include stomach pains, confusion and laboured breathing. 

Researchers at King’s College, London who track coronavirus symptoms and infections via the Covid Symptom app, which has been downloaded by more than four million people, report that symptomatic individuals fall into six broad categories. And those with severe fatigue, confusion and respiratory or abdominal problems are most likely to develop a severe form of the disease and be hospitalised. 

However, 80% of those who develop symptoms are able to fight the virus on their own and do not need any treatment. 

Whilst not yet in widespread use it is at this point that monoclonal antibodies could be administered. These are the first treatments developed specifically for the virus and hailed by the US president as “key” to his recovery. 

These are laboratory-produced injectable antibodies specifically created to treat Covid and work by kickstarting the immune system or giving it a boost in patients who have already started producing their own antibodies.

Like our own naturally producing antibodies the synthetic ones attach to the spikes on the outer surface of the virus and stop it entering the body’s cells.

President Trump was treated with a cocktail of two antibodies produced by US-based company Regeneron which preliminary studies show to have been effective, particularly in patients who have not started to produce antibodies of their own against the disease. 

Some patients in the UK will also be given the Regeneron antibodies as part of the Recovery trial, which is investigating a range of potential treatments for Covid-19. 

The virus enters the lungs and is the point when patients with more severe forms of the disease are most likely to be hospitalised. 

White blood cells called chemokines will start to fight the virus and kill infected cells, leaving fluid and pus behind.

The patient will develop breathing problems and may need oxygen. At this point the administration of the antiviral Remdesivir could begin. This broad-spectrum antiviral, initially developed to treat Ebola, works by blocking a key enzyme the virus needs to replicate its genetic material and proliferate in our bodies. Remdesivir is expensive and also needs to be given intravenously so is not a quick fix. Studies have not shown it to be the game changer many hoped it would be and a paper in the British Medical Journal found that it "may have little or no effect on the length of the hospital stay".  

A cocktail of several different antivirals may be the best solution for Covid-19 - a mix of different antivirals are used to treat HIV and hepatitis C - but there is nothing else promising on the horizon.  This is a crunch point for coronavirus patients - some may start to recover at this point but others deteriorate and may develop acute respiratory distress syndrome where the lungs cannot provide the body’s lungs with enough oxygen - this triggers an immune response but in some cases the patient’s immune system can go into overdrive, setting off a cytokine storm.

Cytokines are small proteins released by many different cells in the body, including those of the immune system. But in some patients, excessive or uncontrolled levels of cytokines are released which then activate more immune cells, resulting in hyperinflammation. This can seriously harm or even kill the patient as it can lead to multi-organ failure.

At this point the patient is admitted to ICU - they will be given the steroid dexamethasone, which dampens the immune system and was shown by the Recovery trial to cut the risk of death in severely ill patients by a third.

President Trump was given dexamethasone early on in his illness which many experts believe is dangerous as it may stop the immune system work. 

Blood clotting is also a problem so anti-coagulants will be administered at this point, while patients may also be given broad-spectrum antibiotics to fight any secondary infections as well as fluids. 

A stay in ICU can last days or even weeks - in the UK,  2% of patients spend more than 28 days in intensive care.

However, death rates in ICUs have improved across the world as the pandemic has progressed. One reason for this is that doctors know a lot more about the disease and have learned new techniques. For example, patients on ventilators are “proned” or laid on their fronts as this aids lung recovery, a technique that was not widely practised, particularly in the UK, at the beginning of the pandemic.  

A study published in July showed that 60%of patients admitted to ICU died at the beginning of pandemic, compared to 42% at the end of May. That study was done before the widespread introduction of dexamethasone so death rates may improve further still. However, if ICUs are overwhelmed death rates may rise again. 

Recovery, immunity and ‘long Covid’ 

Anyone who ends up in intensive care will take time to recover - regardless of whether they have had Covid-19 or not. Patients admitted to ICU tend to be older so recovery will take a while. 

Because Covid can progress into a multi-organ disease long-term consequences can include scarring of the lungs and long-term decreased oxygen function, blood clots and heart problems.

But even people who only suffered a mild form of the disease report a range of ongoing symptoms such as fatigue, breathlessness, “brain fog” and loss of appetite weeks or even months after recovering from the more acute phase of the illness. 

So-called “long Covid” is not recognised as a syndrome and Professor Trish Greenhalgh, a researcher at the University of Oxford, estimates that just one% of people who recover will still be ill six months later. Further studies into this phenomenon are beginning and scientists are hoping to build a better picture. 

There are also outstanding questions about whether an individual is immune to Covid-19 after an infection. Mr Trump landed in hot water over the weekend for his unequivocal tweet, suggesting that his doctors have given him the all clear and “I can’t get it (immune), and can’t give it”.

While experts hope that a coronavirus infection confers some immunity, at least in the short term, it’s still not clear how long this lasts for. Antibody studies have shown that immunity wanes over time, while there have been a handful of confirmed cases of reinfection, including in Belgium and the Netherlands.

 

* A terrible book, by the way. Don't be tempted to buy it, unless you're a very religious Protestant.



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