Below is my column in The Hill on calls for increased censorship on the Internet and social media due to the pandemic. While academics are writing that “China was . . . right”, China was celebrating World Press Day by sentencing journalist Chen Jieren to 15 years in prison for “picking quarrels and provoking trouble, extortion, illegal business operations and bribery.” It is an ironic moment to herald China’s censorship of the media when the evidence mounts that China concealed and censored information on the virus outbreak in January.
Here is the column:
Almost everywhere you turn today, politicians are telling the public to “get used to the new normal” after the pandemic. For some people, this means public health precautions from social distancing to banning handshakes. Others have quickly added long standing dreams for everything from the guaranteed basic income advocated by Representative Alexandria Ocasio Cortez, which was also recently raised by House Speaker Nancy Pelosi, to mailed voting elections advocated by many Democrats.
The most chilling suggestion, however, comes from the politicians and academics who have called for the censorship of social media and the internet. The only thing spreading faster than the coronavirus has been censorship and the loud calls for greater restrictions on free speech. The Atlantic published an article last week by Harvard Law School professor Jack Goldsmith and University of Arizona law professor Andrew Keane Woods calling for Chinese style censorship of the internet. While Goldsmith and Keane are obviously not calling for authoritarian abuse, they are advocating control over the Internet to regulate speech — crossing the Rubicon from free speech to censorship models.
They declared that “in the great debate of the past two decades about freedom versus control of the network, China was largely right and the United States was largely wrong” and “significant monitoring and speech control are inevitable components of a mature and flourishing internet, and governments must play a large role in these practices to ensure that the internet is compatible with society norms and values.”
The justification for that is the danger of “fake news” about coronavirus risks and cures. Yet this is only the latest rationalization for rolling back free speech rights. For years, Democratic leaders in Congress called for censorship of “fake news” on social media sites. Twitter, Facebook, and YouTube have all engaged in increasing levels of censorship and have a well known reputation for targeting conservative speech.
Hillary Clinton has demanded that political speech be regulated to avoid the “manipulation of information” and stated that Facebook founder Mark Zuckerberg “should pay a price for what he is doing to our democracy” by refusing to take down opposition postings. In Europe, free speech rights are in a free fall, and countries such as France and Germany are imposing legal penalties designed to censor speech across the world.
Many of us in the free speech community have warned of the growing insatiable appetite for censorship in the West. We have been losing the fight, and free speech opponents are now capitalizing on the opportunity presented by the pandemic. Representative Adam Schiff sent a message to the heads of Google, Twitter, and YouTube demanding censorship of anything deemed “misinformation” and “false information.” Schiff told the companies that they needed “to remove or limit content” and that, “while taking down harmful misinformation is a crucial step”, they also needed to educate “those users who accessed it” by making available the true facts.
YouTube did just that by removing two videos of California doctors who called for the easing of state lockdown orders. The doctors argued that the coronavirus is not as dangerous as suggested and that some deaths associated with the disease are actually not accurate. There is certainly ample reason to contest their views but, instead, YouTube banned the videos to keep others from reaching their own conclusions.
Facebook will not only remove posts it considers misinformation about the coronavirus but will issue warnings to those who “like” such postings. Facebook said that it wants to protect people from dangerous remedies and false data. Ironically, the World Health Organization praised Sweden for its rejection of the very restrictions criticized by the two doctors. The group declared that Sweden is a “model” country despite its rejection of lockdown measures being protested in the United States.
Moreover, many mainstream media sources have reported information that is now known to be false from the lack of any benefits of wearing masks to the failure in trials of drugs like remdesivir to the shortage of thousands of ventilators. Despite those being wrong, related opposing views were often treated as either fringe or false positions.
This subjectivity of censorship is why the cure is worse than the illness. The best cure for bad speech is more speech rather than regulation. The fact is that the pandemic, as Clinton reminded voters, is a “terrible crisis to waste.” Yet the waste for some would be to emerge from the pandemic with free speech intact. Even former Democratic presidential candidate Howard Dean, who has falsely declared that hate speech is not protected under the First Amendment, recently boycotted MSNBC until it stopped airing press briefings by President Trump as “fake news.”
Ocasio Cortez has called for action against Facebook for not censoring false or misleading political ads. In a confrontation with Zuckerberg, she dismissed concerns over censorship of speech and demanded, “So you will not take down lies or you will take down lies? I think that is a pretty simple yes or no.” Whether contesting lockdown orders by officials or challenging the views of politicians, you can just declare an opposing view as “misinformation” and demand that others not see it.
This crisis is a chance to redefine free speech to allow greater ability to control what opponents say and what the public reads. Academics have been laying the foundation for an anemic form of free speech for years. Even college presidents a few years ago had declared that there is no protection for “disingenuous misrepresentation of free speech.”
Goldsmith and Woods wrote that the public should resist those “urging a swift return to normal,” and the “extraordinary measures we are seeing are not all that extraordinary.” So this is the new normal that some leaders and academics want the public to accept. After all, it is hard to get people to give up freedoms. It takes a crisis to convince them that notions like free speech are no longer relevant. After spending years seeking to convince Americans to follow the European trend against free speech, these folks are using the pandemic to claim that free speech could kill you.
Censorship works in a country much like the coronavirus. Initially, you feel better from silencing those views that you consider lies. Then comes the crash as others demand more and more censorship, including views that you consider to be true. That is what has happened in Europe, where an expanding range of speech is being criminalized or censored. Without uncensored speech, the political system is left gasping for air.
China has been particularly eager not to “waste” the opportunity of this crisis. Chinese professor Xu Zhangrun is one of many citizens arrested after publishing criticism of Xi Jinping on his handling of the crisis. The government deemed such criticism to be fake news causing panic. It has censored accounts of its concealing the source of the original outbreak, including censorship on popular Chinese apps such as WeChat.
Citizens now will have to decide, as Goldsmith and Woods insist, if “China was right.” For my part, I remain hopelessly wedded to old-fashioned notions of free speech before the pandemic. You see, this “new normal” seems a lot like the old normal that the Framers changed with the First Amendment. China may be right for many in Congress and academia, but it remains on the wrong side of history. Not even a pandemic will change that.
Jonathan Turley is the Shapiro Professor of Public Interest Law at George Washington University. You can find his updates online @JonathanTurley.
156 thoughts on ““China Was Right”: Academics and Democratic Leaders Call For Censorship Of Social Media and The Internet”
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What are your thoughts on Na+-K-ATPase channels being disrupted and thus contributing to poor oxygenation in coronavirus patients?
Na-K-ATPase is important in helping ciliated cells move edema out of the lungs. However, ATP is not biologically active without magnesium, which would impair this function.
ACE2 is important for preventing pulmonary edema. ACE2 is decreased in people with comorbidities, and, ACE2 activity is further decreased by the SARS-Cov2.
Many coronavirus patients have comorbidities (like diabetes and heart disease) that have undergirding deficiencies in magnesium (in addition to the previously established zinc deficiencies).
there is an update from today’s WSJ on the reliability of current SARS-CoV-2 RT-PCR tests. The findings are not surprising for those who have kept an eye on the data as to sensitivity and specificity of these tests. See NEJM March 11 article pasted below today’s WSJ excerpt
Behind a paywall:
Updated May 5, 2020 4:18 pm ET
What We Know About Coronavirus Tests, Treatment and Vaccines
Are tests accurate?
• Health experts say they now believe nearly one in three patients who are infected are nevertheless getting a negative test result. They caution that only limited data are available, and their estimates are based on their own experience in the absence of hard science.
• That picture is troubling, many doctors say, as it casts doubt on the reliability of a wave of new tests developed by manufacturers, lab companies and the CDC. Most of these are operating with minimal regulatory oversight and with few robust studies amid the call for wider testing.
March 11, 2020
Detection of SARS-CoV-2 in Different Types of Clinical Specimens
There were 1070 specimens collected from 205 patients with COVID-19 who were a mean age of 44 years (range, 5-67 years) and 68% male. Most of the patients presented with fever, dry cough, and fatigue; 19% of patients had severe illness. Bronchoalveolar lavage fluid specimens showed the highest positive rates (14 of 15; 93%), followed by sputum (72 of 104; 72%), nasal swabs (5 of 8; 63%), fibrobronchoscope brush biopsy (6 of 13; 46%), pharyngeal swabs (126 of 398; 32%), feces (44 of 153; 29%), and blood (3 of 307; 1%). None of the 72 urine specimens tested positive (Table).
Those clamoring for censorship are intellectual children. They want a benevolent, fatherly government to “protect” them from having to research and decide for themselves.
A human monoclonal antibody blocking SARS-CoV-2 infection
In conclusion, this is the first report of a (human) monoclonal antibody that neutralizes SARS-CoV-2. 47D11 binds a conserved epitope on the spike RBD explaining its ability to cross-neutralize SARS-CoV and SARS-CoV-2, using a mechanism that is independent of receptor-binding inhibition. This antibody will be useful for development of antigen detection tests and serological assays targeting SARS-CoV-2. Neutralizing antibodies can alter the course of infection in the infected host supporting virus clearance or protect an uninfected host that is exposed to the virus4. Hence, this antibody—either alone or in combination—offers the potential to prevent and/or treat COVID-19, and possibly also other future emerging diseases in humans caused by viruses from the Sarbecovirus subgenus.
Wang, C., Li, W., Drabek, D. et al. A human monoclonal antibody blocking SARS-CoV-2 infection. Nat Commun 11, 2251 (2020). https://doi.org/10.1038/s41467-020-16256-y
Estovir, that is good news. Since you have an interest in the virus I would like your opinion regarding the treatment plans discussed at https://www.powerlineblog.com/archives/2020/05/how-treatable-is-covid-19.php
As a teaser I quote: “The above pathologies are not novel, although the combined severity in COVID-19 disease is considerable. Our long-standing and more recent experiences show consistently successful treatment if traditional therapeutic principles of early and aggressive intervention is achieved, before the onset of advanced organ failure. It is our collective opinion that the historically high levels of morbidity and mortality from COVID-19 is due to a single factor: the widespread and inappropriate reluctance amongst intensivists to employ anti-inflammatory and anticoagulant treatments, including corticosteroid therapy early in the course of a patient’s hospitalization. It is essential to recognize that it is not the virus that is killing the patient, rather it is the patient’s overactive immune system. The flames of the “cytokine fire” are out of control and need to be extinguished. Providing supportive care (with ventilators that themselves stoke the fire) and waiting for the cytokine fire to burn itself out simply does not work… this approach has FAILED and has led to the death of tens of thousands of patients.”
A while ago I had an online exchange with Prairie Rose where I provided a link to an article indicating the cytokine storm is part of the pathology involved in COVID-19 patients. It is fairly common knowledge in medical circles that monoclonal antibody drug, Tocilizumab, tones down the immune response in these patients. While treating with an anti-viral is helpful before the virus undergoes shedding, it will be of less benefit after shedding. We need to suppress the cytokines released by the immune system as response to the viral shedding. Another issue is the immune response complement activation. Cytokines & complement proteins are elevated in these patients.
The immune system sometimes over reacts and consequently causes great harm. Diseases like Psoriasis, Rheumatoid Arthritis, Lupus, Crohn’s Disease, Multiple Sclerosis, and Type 1 Diabetes are all autoimmune diseases. Sometimes the body does what it does too well to our detriment.
this might help you Allan
COVID-19: immunopathology and its implications for therapy
SARS-CoV-2 infection can activate innate and adaptive immune responses. However, uncontrolled inflammatory innate responses and impaired adaptive immune responses may lead to harmful tissue damage, both locally and systemically. In patients with severe COVID-19, but not in patients with mild disease, lymphopenia is a common feature, with drastically reduced numbers of CD4+ T cells, CD8+ T cells, B cells and natural killer (NK) cells1,2,3,4, as well as a reduced percentage of monocytes, eosinophils and basophils3,5. An increase in neutrophil count and in the neutrophil-to-lymphocyte ratio usually indicates higher disease severity and poor clinical outcome5. In addition, exhaustion markers, such as NKG2A, on cytotoxic lymphocytes, including NK cells and CD8+ T cells, are upregulated in patients with COVID-19. In patients who have recovered or are convalescent, the numbers of CD4+ T cells, CD8+ T cells, B cells and NK cells and the markers of exhaustion on cytotoxic lymphocytes normalize6,7. Moreover, SARS-CoV-2-specific antibodies can be detected.
Cao, X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol 20, 269–270 (2020). https://doi.org/10.1038/s41577-020-0308-3
All the above is interesting but that is for the lab and considerations as to what is happening to the patient. I am interested in the patient presently in the hospital and potentially enterring a downward spiral. My question involved the use of corticosteroids and anticoagulation. A secondary question is how you interpret reports of low SO2 with muscle fatigue.
This is a good exchange with Allan.
“While treating with an anti-viral is helpful before the virus undergoes shedding, it will be of less benefit after shedding. We need to suppress the cytokines released by the immune system as response to the viral shedding.”
Zinc would interfere with the replication of the virus, and, thus, the shedding. Zinc is also important in regulating immune function. The autoimmune diseases you mentioned are diseases deeply associated with various and sundry micronutrient insufficiencies. That is not the only thing that provokes them, but it is an element.
Not to harp on zinc, but it seems to be the elephant in the room in some ways.
Nutrients. 2012 Jul; 4(7): 676–694. Zinc and Regulation of Inflammatory Cytokines: Implications for Cardiometabolic Disease. Meika Foster and Samir Samman*
“Cells are dependent on plasma to supply them with a constant supply of zinc to sustain normal function. In zinc deficiency, immune cells may be the first to respond to a change in zinc status even before plasma zinc concentrations fall below the normal range .”
“In vitro zinc deficiency studies have found that zinc depletion disrupts cell membrane barrier integrity and induces increases in the secretion of IL-8 and neutrophil transmigration .”
“In humans, NF-κB activation and the mRNA levels of the NF-κB-regulated IL-2 cytokine and IL-2Rα receptor were found to be decreased in the peripheral blood mononuclear cells of elderly subjects with plasma zinc concentrations below the normal range (110 ± 10 µg/dL (16.8 ± 1.5 µmol/L)) compared to those with normal plasma zinc values. These effects were corrected with zinc supplementation of 45 mg/day Zn gluconate .”
Is anybody checking the zinc levels of incoming patients?
I read your explanations to Prairie and thought them of general value to all. The cytokine storm and a minimal understanding of immunology with regard to antibodies seems to exist most places. The major interest for the patient gravely ill at this moment is treatment.
The question involved the particular treatments being used by this group of doctors based on what they have seen and based on the problems they noted with ventilators where the lung doesn’t seem to react the same as seen in ARDS. I was questioning what your thoughts were on that and more particularly what you thoughts were in the use of anticoagulants and corticosteroids. The idea of anticoagulation seems to be quite out of the box unless pathology specimens have demonstrated what they believe they are encountering. The reports of low SO2 without muscle fatigue is interesting as well.
I hope you can add to these ideas provided by the doctors involved.
The immune system is comprised of 2 prongs: innate and adaptive immune systems. The innate system includes self-protective mechanisms such as epithelial barriers (e.g. skin), secreted antimicrobial proteins (many types from diverse cells or as Mespo agrees, “diversity is our strength”), and the complement system (antimicrobial proteins specifically synthesized by the liver that engulf (phagocytosis) or lyse – poke holes – in the invading pathogens). Phagocytes (cells that eat) include innate immune cells Macrophages and Dendritic Cells. Both of these release cytokines. Many cells in the body release cytokines but for our purposes, we will stick to immune cells.
Cytokines are proteins that elicit signals to neighboring cells to perform a specific behavior. They are “bullies” or directors. They call the shots. They boss other cells at a genetic level which is crucial for our discussion. Once they get to work, you can not stop their products. Tinkering with genetics never is reversible in the immediate. There are various types of cytokines. The cytokines relevant to our discussion include pro-inflammatory cytokines. Cytokines of this family, at a genetic level, cause the synthesis of both innate & adaptive immune cells which include Macrophages, Mast Cells, Neutrophils, B Cells, T Cells, NK Cells, etc. You might recognize the names of some of these. Every time the body senses an invasion from a pathogen, cytokines get working at the genetic level. Cytokines will continue to direct the synthesis of more immune cells in an effort to rid the body of the offending agent. In other words, inflammation is part of the plan and it has 3 essential functions. The first is to deliver killer or “effector” cells from throughout the body to the site of infection and thus kill the pathogen. The second is to induce blood clotting, to answer your other question. So blood clotting is also part of the plan. Blood clotting creates a barrier so that the infection can not spread beyond its initial site. Inflammation, thirdly, also promotes repair of the injured tissue
Bringing it around to COVID-19, there are symptoms and then there are symptoms. Not everyone has the exact same constellation of symptoms. In brief, people over the age of 65 with comorbidites suffer the most because their lungs, circulation, heart and / or kidneys are already damaged. As you know obesity does grave damage to all of these organ symptoms.
Thus a patient with COVID-19 may or may not have the symptoms listed in the article you provided. Coagulpathy is part of the plan but obviously not a good thing when you are at death’s door. The body doesn’t care if it is at death’s door: it wants to get rid of the pathogen. Sometimes systems in the body work at the expense of other systems. However, coagulpathy can be difficult to reverse. Add to this a hyper-inflammatory response. In these scenarios, the organs start to fail.
Should a ventilator be used? It depends. Should you remove the Ventilator and simply infuse blood? That would be ill-advised. You administer blood when there is blood loss only. For every time blood is infused, hemodynamic properties change. Blood has many components and you do not adjust one without adjusting the others. Everything gets changed. You have to have a balance of pressure, volume, pH, substances like oxygen, carbon dioxide clotting factors, and so forth. Look up disseminated intravascular coagulation (DIC) . DIC is an occasion for administering blood because there is perfuse bleeding. COVID-19 does not cause perfuse bleeding. Anyone who has dealt with DIC will tell you it is hell. few patients make it past DIC. I say this because I am aware that several lay sources are advocating the administration of blood in lieu of using a Ventilator. You can’t prescribe a cookie cutter approach for everyone with COVID-19. you have to account of the presenting symptoms and underlying problems.
In truth, a patient who is in a state of coagulpathy, an exaggerated cellular inflammatory state, and has impaired exchange of gases in the lungs for whatever reasons, be it fibrous lung tissue damage from underlying medical conditions like obesity or due to a virus, or their heart is damaged, or their kidneys are weak, or they never took care of themselves and at the age of 65 they are lucky to be alive…..this patient is difficult.
in general you would treat the presenting symptoms: manage the cytokine storm, try to undo the coagulopathy, and try to restore normal gas exchange which may or may not be possible due to the many aforementioned factors.
COVID-19 and Coagulopathy: Frequently Asked Questions
Now can you can do something for me, Allan. Please say a Rosary for my family and me tonight. Deal? Deal
I’ll say a prayer for you, too. I hope all is well.
Your comment (“impaired exchange of gases in the lungs for whatever reasons”) made me wonder whether there was some problem with how gases are exchanged (I think H+ voltage-gated channels in the alveoli are involved–what are the necessary keys for that gate–K? Na? Zn?) OR might there a problem with the RBC blood count?
I found this article out of UCDavis Health:
“The leukoerythroblastic picture reflected normal shaped and sized RBCs but in lower than normal levels (normocytic anemia), occasional immature RBCs (nucleated), a mild presence of RBCs with different sizes (anisocytosis) and rare tear-drop shaped cells known as dacrocytes.”
Zinc is important for RBC formation. Perhaps a deficiency is causing anemia?
Int J Mol Sci. 2018 Sep; 19(9): 2824. Zinc Supplementation Stimulates Red Blood Cell Formation in Rats. Yen-Hua Chen,1 Hui-Lin Feng,2 and Sen-Shyong Jeng2,*
That said, nucleated RBCs are seen in chronic hypoxemia. Could that mean that oxygen is entering the lungs fine but not getting through the doors to the capillaries, as speculated above? Which side of the alveoli is the problem? Acidosis? A problem with the gate key? What allows the diffusion to open the channels?
Also, I saw that ACE2 expression is reduced by SARS-CoV. Because the function of ACE2 is to convert a pro-inflammatory molecule into an anti-inflammatory one, could that pro-inflammatory-tilt due to the reduced ACE2 expression be sufficient to induce the cytokine storm?
Your comment (“impaired exchange of gases in the lungs for whatever reasons”) made me wonder whether there was some problem with how gases are exchanged
Thanks for the prayers. Thomas Merton believed the prayers of monks are what kept the world together during World War II. Prayer offers many graces. At home we are fine. No sickness, no one has comorbidities, though I do believe our surrounding milieu is impacting all of us mentally, physically, spiritually.
The cause of mortality in patients with COVID-19 is multifactorial. The lungs succumb to what is known in physiology as hypoxemic respiratory failure. As the name implies, low oxygen is at play. Hypoxemia occurs in part because the virus, as I stated earlier, causes fibrosis.
Fibrosis is the physical deterioration of the alveoli. You need to understand what the alveoli do in terms of pulmonary physiology gas exchange in normal conditions. There are 2 variables to consider in respiration: ventilation and perfusion. One involves anatomy, the other physiology. Both affect gas exchange. You can not perfuse oxygen efficiently through damaged alveoli. If ventilation is occurring but hypoxemia is present, perfusion might be the problem. However anatomy can mitigate perfusion. Red blood cells are severely hampered in acquiring oxygen from damaged alveoli that have rich oxygen stores. Like hanging fruit from a tree, oxygen is dangling from alveoli. The RBCs can not grab the oxygen from the alveoli because the alveoli are hopelessly damaged. The oxygen is never handed off to the RBCs. Hypoxemia ensues. Imagine performing CPR on your child and notice there exists an object in her mouth. Naturally you wish to remove that object before performing mouth to mouth. However you can not remove the object in the mouth. Your child begins to turn blue due to lack of oxygen in spite of you performing efficient CPR. That is what fibrotic lungs are like.
The virus additionally causes the immune system to respond as I wrote earlier. Cytokines promote inflammation, coagulation and vascular permeability within the blood vessels (i.e. endothelium). I stated there are 3 functions to inflammation. These are normal processes and important. However, the cytokines can also cause fibrosis via an increase in immune cells like Macrophages and Neutrophils. The immune cells rushing to the site of infection where SARS-CoV-2 is located (the lungs) are resulting in damage to the alveoli ny releasing their toxic granules. Innate immune cells and Adaptive immune cells kill pathogens in part by releasing toxic molecules like bleach (hypochlorite) and hydrogen peroxide, among other proteases.
Acute respiratory distress progresses in part because of all of these factors. Add to these heart failure, obesity, hypertension, Type 2 Diabetes and the physiological pathologies these cause, and you have a very difficult patient to manage. Using anti-viral drugs at that point is pretty much useless. The virus has done its damage and the body is now responding to the virus also causing damage.
The remedy is undoing all of the above problems: getting around fibrotic damage, inefficient gas exchange (due to impaired alveoli), over active immune response (inflammation and coagulopathy), permeability of vascular vessels from cytokines, resulting in various end stage problems: strokes, hypoxemic respiratory failure, multiple organ failure, death. These are known to happen in many pathogenic illnesses not just COVID-19.
Allan referenced an article that physicians at EVMS are advocating. I visited EVMS once last year for a forum. Quaint school, small, driven, dedicated physicians.
Their approach seems very common sense with the exception of poor O2 perfusion. They recognize that some patients can not be saved. For those patents who progress to hypoxemia conditions, anti-inflammatory and anticoagulant therapies are too little too late. They know that.
A sub-group of patients with COVID-19 deteriorates very rapidly. Intubation and mechanical ventilation may be required in these patients.
They also state what I stated weeks ago no magic bullet exists
It is important to recognize that COVID-19 patients present with a variety of phenotypes, likely dependent on genetic heterogeneity, age, viral load, immunological and nutritional status, and co-morbidities. ….Finally, it is important to acknowledge that there is no known therapeutic intervention that has unequivocally been proven to improve the outcome of COVID-19. …Furthermore, it is likely that there will not be a single “magic bullet” to cure COVID-19. Rather, we should be using multiple drugs/interventions that have synergistic and overlapping biological effects that are safe, cheap and “readily” available.
It is hard to refute any of what they wrote.
I applaud your desire to understand. However you have to start at the beginning. Understand anatomy and physiology in normal conditions. Understand microbiology like viruses and how they work. Then advance to pathology. Then treatment. Keep searching. Hit the books I have referenced. This requires dedication, focused studying, and a long haul approach. It is there for anyone who seeks understanding.
I have heard conflicting reports as to whether or not the virus causes fibrosis.
Are doctors now finding that most patients are suffering from fibrosis? I had not seen this update.
If that is the case, then could the pathophysiology resemble the onset of Idiopathic Pulmonary Fibrosis?
Check the following for a visual tour on this topic including what fibrosis looks like in COVID-19 patients on radiology films.
Published: 19 March 2020
Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review
CT manifestations of fibrosis or fibrous stripes were also observed in COVID-19 (Fig. 4c). Pan et al  reported 17% COVID-19 patients with fibrous stripes in their study. Fibrous lesions may form during the healing of pulmonary chronic inflammation or proliferative diseases, with gradual replacement of cellular components by scar tissues. Currently, the relation between fibrosis and patients’ prognosis is debatable. Some researchers suggested the presence of fibrosis indicates good prognosis of a COVID-19 patient with stabilizing disease status . However, others argued that fibrosis might indicate a poor outcome of COVID-19, reporting it may subsequently progress to peak stage or result in pulmonary interstitial fibrosis disease [20, 32].
Ye, Z., Zhang, Y., Wang, Y. et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06801-0
Estovir– Thank you for taking the time to cover this. No magic bullet for treatment but one hopes a vacine will not be too long in coming.
Again, thank you.
Young wrote: Estovir– Thank you for taking the time to cover this. No magic bullet for treatment but one hopes a vacine will not be too long in coming.
Again, thank you
You’re welcome Young, and Allan, Rose and the lurkers. It is my pleasure to offer my services on this timely and worrisome issue for all of us
Rose wrote Also, I saw that ACE2 expression is reduced by SARS-CoV. Because the function of ACE2 is to convert a pro-inflammatory molecule into an anti-inflammatory one, could that pro-inflammatory-tilt due to the reduced ACE2 expression be sufficient to induce the cytokine storm
ACE2 is Angiotensin-I-Converting Enzyme 2 and is involved in the renin-angiotensin system (RAS): cardiovascular and renal systems. ACE2 balances the vasoconstrictive, proliferative, fibrotic and proinflammatory effects of the ACE/angiotensin II axis.
ACE2 Cell Biology, Regulation, and Physiological Functions
You ask a good question, Rose. There is much to learn about SARS-CoV. It would have been fortuitous if the WHO and President Bush in 2002, or President Obama in 2012-16 who had more data than Bush, had done something about SARS-CoV when it threatened the world. Now we are paying the price for their lack of urgency. As data evolves these next few years, we should know more then. Until then, keep reading those textbooks and the many sources I provided you. A good physician spends 20% of his/her time reviewing the basic medical sciences they learned (and forgot) in medical school.
time for family and prayers
Blessings to all
“say a Rosary for my family and me tonight.”
Estovir, the essentials of what you desired were performed in my own fashion.
“You can’t prescribe a cookie cutter approach for everyone with COVID-19.”
Not using a cookie cutter approach is not unusual for me. You will note that in at least some of the comments I make, that are meant to be intelligent, I advocate the opposite of the cookie cutter approach especially when dealing with the unknown.
The vast majority of deaths where ventilators were required primarily involved the lungs though with all death there is eventually complete organ failure.
Isolating the problems to the cases where the lung is mostly involved I understand what I think you are trying to point out in the relationship between DIC and a Covid coagulopathy along with the numerous ways the body can react to certain stimuli. The embolization reported in Covid can be mostly limited to the lung and the lung can be considered the weakest link in the chain. I want to separate the weakest link from the rest. Since the Covid patient isn’t bleeding all over it appears that the properties of the patient’s blood contains the necessary platelets and clotting factors ( even though 71% might meet DIC criteria as stated in the supplementary FAQ).
Some reports say that there are favorable results with the use of anticoagulants indicating that such use is not occurring all over. (You say: “coagulpathy can be difficult to reverse” so that would be an indication to start anticoagulants early.) We might have some tens of thousands more deaths to come and to date we are not sure of what works and what doesn’t. My initial question was, what is your opinion of that group of physicians who, as reported, and based on observation and their specialty, started using anticoagulants? (As an aside, I also take note of the two different specialties involved, intensivists and ER physicians)
The FAQ says anticoagulation is not “required” which is not a very exacting word. Then it states “Prophylactic dose LMWH is recommended for all hospitalized COVID-19 patients despite abnormal coagulation tests in the absence of active bleeding” which means to me that the question raised (by the news media) shouldn’t have been raised, but I (not at all involved with this disease) didn’t hear that. I heard the opposite. I heard a recommendation to use anticoagulation where it wasn’t being used (barring significant contraindications). (You say: ” try to undo the coagulopathy,” but do not say whether or not you would use anticoagulants.) What is the difficulty in providing a direct answer?
This leads to the possibility that the wrong impression was being reported: The impression was some groups were using the anticoagulants and some were not. Perhaps you can explain what caused the wrong impression and what the correct impression should have been. (My original interest was where and how new ideas in Covid treatment came from along with the variability of treatment across the country. I am quite familiar with variability in treatments and medical care.)
The second question remains untouched. Since there is an inflammatory chain of events what is your opinion of that same group of physicians using corticosteroids which can be used in sepsis which can cause the cascading events of DIC?
Third and final question what do you understand about the pulmonary compliance issues noted by some of these same doctors. My understanding is that they are holding off the use of ventilators (or at least they were…things can move fast) for longer periods of time and permitting the SO2 to drop lower than the guidelines suggest.
Now you can pray in a different fashion for my and my wife’s families that departed earlier than intended by nature.
Allan, the following is a very good review on our topic. I will address your questions later today
Thanks for your prayers. As a family we pray for everyone: Trump, Pelosi, Fidel Castro, our (worthless, pathetic, cowardly) Bishop and everyone on this blog.
Thromboinflammation and the hypercoagulability of COVID‐19
Jean M. Connors Jerrold H. Levy
First published:17 April 2020
Allan, regarding your 3 questions…..
This is an exciting time to be a physician and researcher if you practice evidenced based data (EBD). On that note, there is currently no available EBD from randomized clinical trials to inform clinical use. So physicians are treating empirically with a paucity of data. You already know how political animals and the news media are jockeying to influence their audiences even if they largely ignore EBD or cherry pick it. Physicians have no such luxury.
Anticoagulants make sense when coagulopathy presents. The circulatory system is a closed system. Dosing is based on very tight formula (body weight, body surface area, renal function, liver function, drug-drug interactions, etc). In an effort to reverse coagulopathy you can push too much of the anti-coagulant / platelet therapy and that presents another problem. Likewise with inflammation. Corticosteroids are work-horses for inflammatory responses. However, when an infectious agent presents, you do not want to suppress the immune system. Corticosteroids halt the immune system. Thus it is a double edge sword.
Since these patients are seen in intensive care units, the discussion the public is having is irrelevant at the national level because these patients are being monitored by physicians and nurses 24/7 in the hospital. Use whatever it takes to address the presenting problems knowing you must keep your eye on them very closely.
Ventilators are used based on specific needs. As the EVMS paper noted, sometimes you have to use them but if you do use them, monitor closely. Again, this is just common knowledge in the ICU. It does make for fodder for lay people to wage jihads on the internet.
“This is an exciting time to be a physician and researcher if you practice evidenced based data (EBD).”
As an aside EBD can be used for good or bad. For decades managed care organizations used EBD to save money on good medical care based on EBD to the disadvantage of patients. Some of that stopped when health care organizations were sued and lost millions of dollars while gaining a lot of the wrong type of publicity.
EBD can create divides in the medical community and in society when information is poorly interpreted. I pray for the clinicians because they have to look into the eyes of the patient dying in front of them. I don’t pray as much for the academics et al., not because they aren’t worth it but because they don’t have to live with such a memory where one after another they see the eyes close forever.
“Anticoagulants make sense when coagulopathy presents. ”
The only thing I have to say is based on the rapid downhill spiral. Anticoagulants likely need to be started relatively early if they have an effect. The dosage is pretty well understood as many people end up on prophylactic anticoagulation in hospitals and even for short periods of time at home.
The two edged sword corticosteroid problem exists elsewhere so it is not unknown but the immune system seems to take over with a rapid decline. This drug, however, strikes me as more problematic since it is not commonly used for stable individuals without systemic problems.
The ventilator issues created additional interest in my mind because it took time to recognize a potential difference in treatment between most patients with ARDS and the Covid patient.
I thank you for the articles especially the FAQ.
Read the Connors / Levy article I referenced above your comment. It makes suggestions in response to a key study on this topic, i.e. Ranucci study. Now read the Ranucci study found in the same journal as the Connors / Levy article.
The Ranucci study was based on very sick patients (i.e. not under the realm of prophylaxis). “The patient population comprised 16 patients with a diagnosis of COVID-19-associated pneumonia and ARDS, admitted to our ICU under tracheal intubation and mechanical ventilation.”
Now read the Discussion section where they wrote:
“The main finding of our study is the pro-coagulant profile of COVID-19 ARDS patients and its progression toward normalization after an increased thromboprophylaxis.“
Additionally the last paragraph in the Ranucci paper is instructive:
“The main limitations of our study are the small sample size and the lack of direct data on thrombin generation and fibrinolysis. Being a nonrandomized trial, our hypothesis that the patients may benefit from a pronounced anticoagulation needs to be confirmed by adequate randomized controlled trials.“
Lastly all authors agree that the thrombotic events are largely caused by cytokines, e.g. IL-6. To wit, Connors / Levy state:
“The major cause of mortality in patients with COVID-19, progressive hypoxemic respiratory failure and ARDS, is mediated by lung injury caused by the invading pathogen. Viral
infection has been demonstrated in multinucleated cells on autopsy in the alveoli of COVID-19 infected patients. The primary infection initiates alveolar injury and the resulting in
inflammatory response, including production of inflammatory cytokines, including IL-6 which has been demonstrated to be significantly elevated in COVID-19 patients, as well as activation and recruitment of mononuclear cells and neutrophils causing more tissue damage, including damage to the capillary endothelium. In addition to the procoagulant effectors derived as the result of inflammation (including cytokines, NETS, polyphosphates) the usual thrombo-protective state of the vascular endothelial cells is disrupted; both pathophysiologic changes lead to the development of microvascular thrombosis. Over time the pathology of ARDS progresses to a proliferative and then ultimately a fibrotic state, which is ultimately fatal”
How does all of the above reconcile with your statement?:
“Anticoagulants likely need to be started relatively early if they have an effect.”
Of course they have an effect.
“The dosage is pretty well understood as many people end up on prophylactic anticoagulation in hospitals and even for short periods of time at home.”
Apples and oranges. The patients we are discussing are not the patients you are referencing as to “many people”.
Keep digging. You are doing the right thing by pushing, asking questions and seeking better outcomes for patients, all admirable
The key is preventing thromboembolism which can be done by suppressing those immune system cascades like IL-6. Do that and you might solve the problem. However, a clinical randomized study would be needed to confirm such a finding.
“DIC is an occasion for administering blood because there is perfuse bleeding. COVID-19 does not cause perfuse bleeding.”
‘Perfuse’ should be ‘profuse.’
Dr. Cameron Kyle-Sidell noted that he observed that people were hypoxic but had high compliance. Their lungs were ‘ventilating’ fine but the oxygen did not seem to be crossing from the alveoli in to the bloodstream. They needed more oxygen, not ventilation.
“When I initially started treating patients, I was under the impression, as most people were, that I was going to be treating acute respiratory distress syndrome (ARDS), similar in substance to AIDS, which I saw as a fellow. And as I start to treat these patients, I witnessed things that are just unusual. And I’m sure doctors around the country are experiencing this. In the past, we haven’t seen patients who are talking in full sentences and not complaining of overt shortness of breath, with saturations in the high 70s. It’s just not something we typically see when we’re intubating some of these patients.”
“we’re going to take our approach differently from the traditional ARDSnet protocol in that we are going to do an oxygen-first strategy: We’re going to leave the oxygen levels as high as possible and we’re going to try to use the lowest pressures possible to try to keep the oxygen levels high. That’s the approach we’re going to do, so long as the patients continue to display the physiology of a low elastance, high-compliance disease.”
I found an interesting on article regarding lung injury:
J Biomed Res. 2012 Jan; 26(1): 59–65. Zinc-deficient diet aggravates ventilation-induced lung injury in rats. Xiaoyu Chen,a Jieyu Bian,b and Yingbin Geb,*
“However, mechanical ventilation in zinc-deficient rats resulted in significant damage to the lung, increased pulmonary permeability, and enhanced neutrophil recruitment (Table 1).”
Regarding coagulation, zinc is involved in the regulation of coagulation, anticoagulation, and fibrinolysis pathways. Interestingly, the little bit of the paper I could read noted that zinc is impaired in low pH plasma (acidosis).
Thanks Prairie I am familiar with compliance and elasticity. This is interesting.
That’s a fantastic development. I recall a Tucker Carlson interview a month ago with an immunologist investigating monoclonal antibodies to treat Covid-19.
I hope that we get the treatment ironed out, as people are really starting to push back against quarantine.
“China Was Right”: Academics and Democratic Leaders Call For Censorship Of Social Media and The Internet
Then they should pick up their stakes and move to China – better yet they can move to the Democratic Peoples Republic of Korea – where they can censor dissenting views/speech to their pitch-black hearts and low-brow troglodyte minds content.
They will not be missed.
The reason these censorial thugs clamor for squelching free speech (as have all tyrants/autocrats in human history) is that their vilely contemptible and morally repugnant ideologies can not withstand any scrutiny in the public square.
The only way they can win the debate is by shutting it down.
‘In An Election Year”
The democrats comprehensively grasped their destiny of loss in November, 2020. The democrats’ one-world, globalist, communist leaders are in Beijing. One call does it all. Was it Obama, Pelosi, Hillary, Schumer, Perez., the Globalist Deep Deep State..?
The “2020 China Flu” was deliberately released in an election year as a last resort against President Trump who was on his way to an historic, landslide, presidential election victory in November. The “2020 China Flu” was released from a secure, fail-safe, research lab which employed multiple redundant safety systems. The coronavirus could not get out. It was deliberately released in the 2020 election year.
China has a long history of influenza “outbreaks” including the “1918 Spanish Flu,” the “1957 Asian Flu” and the “1969 Hong Kong Flu” in which 1 million people died – 100,000 of them Americans. China has long been securely “perfecting” viruses at the Wuhan Institute of Virology. China and many other countries are capable of fully safeguarding facilities.
America was shut down due to hysterical and incoherent demands by democrats in 2020. America was not shut down during the “1969 Hong Kong Flu.” Why?
Fukushima was hit by two natural disasters. Wuhan was hit by none.
The “2020 China Flu” was released…
“In An Election Year.”
Accepting the First Amendment concerns, doesn’t someone like Turley feel these Internet companies should be held liable under Tort law for the “foreseeable misuse” of the information their platforms supply?
The “control” in free enterprise is competition. Wherein competition is impossible, the entity must be subsumed as an enterprise of “…general Welfare…” and operated as a state-regulated monopoly, the same way electricity, water, roads, sewers, trash pick-up, etc. are regulated as monopolies by the state.
After WW1 Germany was severely punished. The country was an economic basket case. This led to Hitler and WW2. Because of that one child policy the Chinese have a surplus of young men to go to war with. Just saying.
China’s known military expenditures amount to 1.9% of their gross domestic product. Their propensity to spend on their military is not particularly elevated.
China’s surplus of males between the ages of 19 and 45 sums to about 1.7% of the population. I doubt that’s going to generate a social crisis.
the PRC has a conscription system, in name only. The reality is the PLA is a volunteer force. And they don’t take all comers, either. Being a PLA enlisted rank soldier is not considered a favorable job.
These unattached males in China are hardly suffering, in the cities where the young Chinese women apparently want to stay single more and more, it’s not clear many of them from either sex care so much about Confucian family values anymore. Nor even the countryside, where a rural Chinese guy can secure an overseas Chinese wife for a modest bride price from large poor Chinese communities in places like Indonesia or Malaysia.
If there’s a military conflict with the PRC it won’t be because of a bunch of poor Chinese guys itching to go eat hot lead and drown on the dangerous beaches in an amphibious assault on Taiwan. They are not really an adventurous culture in that way.
And the time for invasion is now pretty much past until October when the straights clear up again.
Lefties love the communist governments of China, Venezuela, and Cuba. Surely, these countries would be happy to take them in.
The virus has further exposed the totalitarian, un-American nature of the modern left. Turley and Dershowitz are the notable, honorable exceptions…but who knows for how long they’ll wish to associate themselves with the marxists.
Ivan, are you kidding here?? ‘Turley is part of the American ‘left’..??
Part of the sane and honorable left, a rapidly shrinking population.
China must pay.
China must have its global assets frozen.
“China Flu” tariffs must be imposed globally.
Global demands against China for $25 trillion and growing must be made.
China must be sued or effectively sued into insolvency.
The “1918 Spanish Flu”
The “1957 Asian Flu”
The “1969 Hong Kong Flu”
The “2020 China Flu.”
Can you determine which renditions were spontaneous and which were deliberately released from controlled environments employing multiple, state-of-the-art, redundant, fail-safe safety systems?
China must pay.
“It’s the [Constitution], stupid!”
– James Carville
“…guaranteed basic income advocated by Representative Alexandria Ocasio Cortez,…”
Congress has the power to tax merely for “…general Welfare…” omitting and, thereby, excluding any power to tax for individual/specific welfare, charity or redistribution of wealth. General welfare meaning ALL PROGRESS WELL as in basics such as roads, water, electricity, trash pick-up, sewers, etc.
Article 1, Section 8
The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States;
The American Framers intended and imposed severe restrictions on the vote. 11.6% of Americans were intended and allowed to vote in 1788. The right to vote was generally restricted by the States to Male, European, 21, Net Worth 50 lbs. Sterling/50 acres. Citizenship was restricted to “…free white person(s)…” in 1790. The current state of hysteria and incoherence derives from the dilution and loss of control of the vote. Pure democracy is untenable, intractable and always devolves into dictatorship. Republican democracy can only persist through restriction of the vote beginning with homogeneous citizenship.
“In the composition of society, the harmony of the ingredients is all-important,…”
“The influx of foreigners must, therefore, tend to produce a heterogeneous compound; to change and corrupt the national spirit; to complicate and confound public opinion; to introduce foreign propensities. In the composition of society, the harmony of the ingredients is all-important, and whatever tends to a discordant intermixture must have an injurious tendency.”
– Alexander Hamilton
“…censorship and the loud calls for greater restrictions on free speech.”
American “politicians and academics” enjoy the freedom of speech. The Constitution must be modified only through the amendment process. Social media and internet sites which have no effective competition must be considered as entities of “general Welfare” and become state-regulated monopolies which must comport with the Constitution.
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
China is a brutal, tyrannical communist dictatorship. China is antithetical to America and its Constitution. China is the principal mortal enemy of the United States. China must never be praised or applauded for any reason. China must be destroyed.
There are three spots on the wall containing the flu. Where did they come from? Who Flung foo? It was not WHO.
Oh that’s just wong!
But we’re not laughing at woo, we’re laughing with woo!
We’re laughing at the outrageous fact that all nations around the world have not pounced immediately and sued China into insolvency; that all nations have not ostracized China back into the Stone Age.
It’s not all right.
It’s all wong!
I have very good friends who consider themselves true Americans and moral people who hate President Trump… and I mean hate. When I mention some of the troubling things about democrats, most of the time they have no idea what I am talking about for the simple reason that their only sources of news — MSM, MSNBC and CNN– do not cover those stories. What they do provide is a constant drumbeat of negative, frequently false, stories about President Trump. In other words, they have become little more than propaganda outlets. But for websites like this which provide a forum for different voices with different points of view– sometimes nasty– many more of us would know far less about what is happening in the world. I wish all Americans could understand that our lack of censorship is the only thing that has kept us free in spite of the many challenges we have had like the McCarthy era. To put it plain and simple, censorship means the death of dissent and without dissent no democracy can survive.
honestlawyermostly – here!!!! here!!!!
They have a visceral fear of losing their right to kill babies in the womb and to leech as parasites off of the endeavor of other people through wholly unconstitutional generational welfare, affirmative action privilege, etc., ad infinitum.
They are not Americans.
They are communists.
You don’t read JT much do you? If a voice on this site comes out with dissent against Trump, they are attacked personally and most of the time with no facts. They have censored themselves to the point that they don’t even believe their own eyes and ears. Which is the point, Trump has said to only trust and believe him and him only.
I do not post often but I do read this site quite a bit. I cannot remember anything I’ve read that you have posted with which I agreed, but I recognize the difference between censorship and my being unpersuaded by what you say. I don’t think I am one of those who has censored myself, although I am not sure what that sentence is supposed to mean. I have never heard President Trump say anyone should only believe him. In fact, I’ve never heard anyone on the right or left actually say that; instead, I have seen people on the left self-censored because of arguments that are based on charges of racism or xenophobia. These people feel that if they don’t agree with the argument, then they will be considered a racist or xenophobe. Remember the days when any criticism of President Obama was considered racist, at least by MSM, MSNBC or CNN? Or just a few months ago when President Trump’s decision to close the border to China was condemned as xenophobic by Senator Biden and many other democrat leaders? To that extent, I do believe many democrats have censored themselves.
I’m not sure if Trump ever said, “Believe only me”.
But Trump did say, “I alone can fix it”, which is pretty close to “Believe only me”. Here’s an article about that claim:
Seth Warner, thank you for the reply. At the time, I think President Trump was referring to the many broken systems in our government, many of which he believed were broken because of what he referred to as the swamp. Since nearly everyone else in government including the last string of Presidents from both parties were up to their eyebrows in the swamp I think he was not far off. I think he and many others did grossly underestimate the willingness of the Washington swamp dwellers to use any and all means, legal or illegal, to neutralize his presidency. It really has been astounding. Admittedly, President Trump speaks with much bravado and is far more harsh than most would like, but he actually has a number of very significant accomplishments to back it up, unlike some of his harsher critics. I don’t know of too many people who could have withstood the unrelenting and merciless daily attacks on him and even some on his family. Maybe it’s the bravado that helps him do it.
Honest Lawer, and just to show how committed he was to ‘draining’ the swamp, Trump opened a hotel 5 minutes from the White House.
So anyone seeking a favor would know just where to stay!
He owns a business. Obama hasn’t worked for a business enterprise since 1985. Pretty common story in his cabinet.
Absurd, whatever. Obama left the country in much better shape than Trump is going to leave it.
IF, you believe in a hyper slo-mo, communistic attack and genocide of the US middle-class, via the “no such agency”, then yes.
Honestlawyer, I like what you say. One leads a nation, especially in the hashest of times, with some degree of Bravado. Imagine if Churchill’s speeches to the people of London during the bombing had no bravado and he focused on all the negatives, would Britain have survived?
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