But the virus hadn’t wrecked Dowd’s lungs. In fact, she had only mild pneumonia. Instead, SARS-CoV-2 had ruptured her heart.
A lot of the early part of the article rehashes basics, like how viruses replicate. If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
I have been reading less about the virus of late, but this fits with everything I know. It causes blood clots. Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).
Later in the article, it talks about impacts on the feet suspected to be a side effect. Feet issues are commonly associated with blood/circulation issues. This is why diabetes can lead to feet being amputated.
The blood issues are well established and this has been known for some time. I'm somewhat aghast to see this article talking like we don't already know that detail.
This is the feature article in a special series of articles on combating the virus. As such it's presenting a summary of what we know about it so far, and references a lot of sources, some going back several months. Given that context I think that's exactly what I'd expect it to do.
Not everyone has done as much research as you, and the public perception and debate is still awash with "just a bad flu" disinformation, so its really important a clearer and more accurate picture is put out as widely as possible.
The stuff about blood clots began coming out about the time I concluded I probably had it and had been mostly asymptomatic and about that same time I ran into a researcher on HN who said something about the blood that I didn't follow and I asked questions and that went weird places and then they said something else about zinc.
And that led to an epiphany for me and I turned to my son and kind or recounted the exchange with the researcher and then I said "We've been eating a lot of zinc-rich foods. I am going to go get a cheese pizza because cheese has zinc." So I got a pizza and then he felt vastly better.
So the whole blood angle is cemented in my mind like "Clearly, this is a hard fact and everyone knows it." But it's probably just me in my little bubble and that's it.
It's worth remembering that just because you have a bubble of belief/knowledge it doesn't automatically make it scientific fact rather than anecdotally coinciding with some science.
For example, yes there is some research suggesting zinc (and related, vitamin D) may be very relevant with covid-19, but there isn't yet definitive understanding among experts yet alone us HN commenters.
Anecdotally: I often feel better after eating a pizza, dating back to before covid-19 existed, and despite my zinc levels being fine. I just really fucking love pizza.
All of us, whether we are trying to read every research paper released or not following anything except newspaper headlines, need to keep reminding ourselves that just as the experts will keep revising their beliefs to fit new findings, we need to keep checking if our own knowledge is correct, or if it might be either outdated and/or based on cognitive biases.
Personally I'm recommending friends/family to make sure that they are getting enough of various vitamins/minerals, while being very clear that my suggestion is a "can't do any harm to have the right levels of whatever" rather than "I'm sure this will help with covid".
It's worth remembering that just because you have a bubble of belief/knowledge it doesn't automatically make it scientific fact rather than anecdotally coinciding with some science.
I'm well aware of that. I'm just trying to say that it made an especially big impression on me because of my personal experience, not that my anecdote makes it scientific fact.
I'm still appalled that they know it causes blood issues and are not connecting the dots between that and the feet issues. The article doesn't explicitly say that feet issues of that sort are consistent with blood issues, though that is an extremely well-established scientific fact.
I paid accident claims for five years. As part of that job, I read medical records all day. I paid for foot amputations and we had to sometimes try to decide "Was this really an accident? Or was this really a complication of diabetes?"
So I'm not just talking out my ass here. I completed a Certified Life and Health Insurance Specialist certificate. I also just do a lot of reading of medical stuff because of my own health issues.
I'm pretty confident the blood issues are very well established at this point and have been for some time.
> I'm still appalled that they know it causes blood issues and are not connecting the dots between that and the feet issues.
I feel like you're jumping to conclusions prematurely. If you as health insurance specialist can connect these dots, you can be sure that researchers did, too. However, having a hunch is only the first step of a thorough scientific investigation, and those take time. Until we have collected and analyzed the evidence, this remains speculation, and scientists shouldn't go off spouting half-researched speculations. That leads to only more fake news. If you look through the Lancet or JAMA, you might find first articles on this connection (if there is one). But until there are peer reviewed papers about this, most researchers know that it's better not to speculate when talking to the press.
I feel like you're jumping to conclusions prematurely.
I honestly don't think I am. I am currently a freelance writer by trade. I sometimes write health articles. I'm familiar with protocols for how to carefully qualify things to keep them factual and avoid wild speculation and suggest confidence levels for various tidbits while being informative.
I am not super impressed with the quality of the medical information in the piece.
But given that thanking someone for their remark and saying "Oh, that makes sense to me" is getting me so much flak, it's probably best for me to bow out of this discussion at this point.
Completely fine to bow out, and if you don't reply to this comment I won't infer that it means you agree I'll assume you're still bowing out.
But if you sometimes write health articles, I feel it worth saying: health articles should be written having understood the proven science and convey it to people in an easy to understand way of what is or isn't proven, not by people who assume their connecting the dots is right before the research shows that.
I haven't read any of your articles, for all I know you're a fantastic writer on those subjects. But your HN comments specifically have not been written in the way that health articles should be, which is why people are giving you flak. And on that subject, sorry that you feel attacked here - it certainly wasn't my intention, nor I think the others', we just aren't in agreement.
I get your point, but I think Doreen is actually being reasonable here. Even if you just consider children, the link between covid-19 and Kawasaki Syndrome is well-established (https://www.cdc.gov/kawasaki/about.html).
But, it's not like there hasn't been additional coverage on covid-19 as a circulatory disease rather than a respiratory-first one.
There's plenty of primary and secondary research out there. The problem, I think, is that mainstream media headlines have been -- and continue to -- present covid-19 as a respiratory virus.
Perhaps like Doreen, my family have been tracking the circulatory effects more closely than most, given we have a toddler with a heart condition and family with diabetes.
I feel you are missing the point of my comments. I wasn't arguing anything about the disease itself, only about how to approach understanding and talking about it.
Additionally... the article submitted that we're all commenting in response to specifically makes the case that this virus is affecting more than the respiratory system.
I don't disagree with anything in your comment, but I also don't see how any of your comment disagrees with anything I said or with the original article.
Not because I specifically agree (or disagree) with them. Personally, I also consider myself in a pretty good position to judge this stuff, however I decided a while back that even when I think I'm sure I'm not going to tell it as a fact, especially online where other readers can't easily tell if corin_ or doreenmichele are making great points or deluded idiots. (A quick edit here: I didn't mean that to imply one or both of us are deluded or idiots. Just that neither of us are coming into this thread with "here are my qualifications and/or research to make me more than a random commenter".)
My reply wasn't that you were wrong in your beliefs, however this part in particular:
"And that led to an epiphany for me [...] So I got a pizza and then he felt vastly better. So the whole blood angle is cemented in my mind like "Clearly, this is a hard fact and..."
My point is that even if you are 100% correct about the blood issues and zinc, you have literally described a one day process of epiphany to pizza to fact proven. Whether you're right or wrong overall, that's not how people should be forming opinions on fighting covid.
My point is that even if you are 100% correct about the blood issues and zinc, you have literally described a one day process of epiphany to pizza to fact proven. Whether you're right or wrong overall, that's not how people should be forming opinions on fighting covid.
You are wildly misreading my comment.
A professional researcher stated their opinion that there was something blood related -- that I didn't understand so I asked for clarification -- and then said something about zinc. I then went over our consumption habits, realized that we were eating a lot of zinc-rich foods we don't normally eat in large quantities and felt it was worth betting on "It's the zinc, like the researcher said." And that bet paid off for us -- though me and my oldest son both have a genetic disorder, so I'm absolutely not inclined to generalize from that.
So I'm not recommending anything about how to fight covid. It's a personal anecdote about how this got cemented in my mind so clearly. That's it. Nothing more.
Apologies for misreading your comment, but you did describe a pizza cementing your view.
We all have cognitive biases, including the most intelligent, accomplished people anywhere.
Plenty of research shows that the placebo effect is a very real phenomenon (even when we are told we're being given a placebo pill it can still help!)
I wasn't trying to change your mind on anything covid related; just about how we all let anecdotes convince us of pre-existing beliefs.
And even if you personally didn't need that lesson, I still think it needed to be explained for anyone reading your comments considering their implication that a one off pizza event was enough to impact your views (even if that's not how you intended the comment to mean).
Edit to add: of course, the mechanisms behind cognitive biases can be helpful! If a doctor says X will help and then X does help, it's good that our brains automatically process that as being more likely true than if it hadn't worked. But they can be unhelpful, too.
You don't know that, since you don't know that you have Covid-19, nor do you know that your zinc consumption had anything to do with whether or not you had it, or recovery from it.
I know that because it wasn't a one time incident. We continued to consciously and intentionally consume zinc-rich foods at a greater rate than normal and it successfully alleviated symptoms that had us concerned. It did so consistently for some period of time until those symptoms finally resolved. We pay very close attention to our diets because of the medical situation. So I know we were consuming abnormally high levels of zinc for some weeks.
Your framing seems to suggest you think I am saying zinc helped "cure" us of the infection. That's not what I'm saying. I'm saying it helped mitigate the worst of our symptoms, which is a completely different claim.
You are correct that I don't know for absolute certain that we had Covid-19 because that was never verified by testing. I've already made that clear and also made it clear that I'm not suggesting treatment to anyone else.
I'm aware there are people promoting zinc as a means to cure Covid-19. I'm not remotely suggesting that.
Even if you accept that I'm correct about having it and I'm correct about zinc helping us, the only takeaway here is that zinc may mitigate some symptoms in some populations, especially populations prone to nutrient deficiencies.
If you have any reason to believe you are zinc deficient, zinc is a good thing to take to treat your deficiency. If you aren't deficient, I'm not recommending it for any purpose.
This is a consistent stance of mine and has been for many years: It's a good thing to determine if you have deficiencies and redress those deficiencies. Otherwise, I absolutely don't recommend any kind of supplement at all. I think it's a dangerous practice to take supplements if you aren't deficient.
Again, you don't know that. You can't establish causation, particularly when N=2, and even more so when you do not know whether or not you had Covid-19.
Yes, I understand you fully acknowledge you may not have had it, but that acknowledgement contradicts that claim that zinc consumption alleviated its effects. What you can say is that you may have had Covid-19, and increased zinc consumption may have helped.
I have a genetic disorder. My son has a genetic disorder. We use diet to mitigate health issues regularly.
I do know for an absolute fact what I have stated as clearly as I can figure out how to state: that increased zinc consumption mitigated the unusual problems we were having that aren't typical for us and which we firmly believe were due to Covid-19.
I have stated clearly that we were never tested, so, no, I can't prove we had it. I can still believe we had it and I don't think it should be anywhere near this much drama to say I believe we had it when I've stated clearly that this is a belief unverified by testing, so I certainly cannot prove it.
I have stated clearly -- and repeatedly -- that my anecdote isn't a recommendation for treatment.
I think it did mitigate symptoms from Covid-19. I admit I can't prove it was Covid-19. I've stated that repeatedly.
And whatever was wrong with us, zinc helped.
You are entirely free to think it's worthless data because we were never tested. I've done everything in my power to distinguish as clearly as I can my opinion from verifiable fact. I am telling you "zinc helped" is in the category of fact in my mind and what it helped with was "probably Covid-19" is my opinion.
I'm planning to walk away at this point. It never ceases to amaze me how much other people have some big problem with me having opinions about my own health status like me thinking about my own health is some kind of serious crime on the order of impersonating a surgeon.
The disconnect is that we disagree on how to establish causation. I follow what I believe to be the generally accepted standard that when dealing with only two people, it’s not valid to assume that medical intervention x, later followed by health status y is not enough to establish that x causes y. It appears you do think that’s a valid way to establish causation, hence we disagree.
That's a reasonable position. The problem here is you and other people hound me and insist I must be wrong and have no right to state my opinion about my health, no matter how carefully I qualify it.
That's not a reasonable position.
I get that you disagree. I expect people to not be convinced that I'm right. Skepticism is warranted.
What's not warranted is harassment.
Repeatedly insisting that I cannot possibly know what I believe to be true when I have already agreed with you that my statements are opinion, inference, etc and unverified by testing is harassment.
I have my reasons why I am confident in my conclusions. No one cares to hear those reasons. They just want me to capitulate, admit defeat and announce that I'm wrong and stupid -- both factually and morally -- for engaging in the same behavior many other people engage in on a regular basis without being similarly mistreated. (That behavior being telling an anecdote about my health and stating a personal opinion about my own experience.)
I'm not capitulating. No one is required to agree with me or be at all interested in what I think about my own health or about health generally. But, like any other human, I am entitled to have an opinion about my own health. I'm not going to pretend that I think you are right when I don't think you are right just because you insist over and over again that my opinion is, in your opinion, factually wrong.
You are not more right than me. Just as I cannot prove I had Covid-19, you cannot prove I did not. Thus you cannot prove my opinion is factually wrong anymore than I can prove it is factually right, yet you feel some strange compulsion to try to insist that your unprovable opinion about my life is somehow more right than my unprovable opinion about my own life.
The article clearly establishes that the medical research community is aware of the potential link between blood and feet issues. From the article:
Recently, there’s been speculation that some of COVID-19’s seemingly disparate symptoms may stem from trouble in the blood. Blood clots, for example, are showing up in cases of COVID-19 frequently enough for clinicians to take notice. “There’s something unique about the coagulation system in these patients,” says nephrologist Kathleen Liu, MD ’99, PhD ’97, MAS ’07, a UCSF professor of medicine. In caring for COVID-19 patients on dialysis machines, she’s been surprised to see blood clots block dialysis tubes more than usual. Clotted tubes are common, she says, “but this is extreme.”
That may be because, as growing evidence suggests, SARS-CoV-2 can infect cells in the walls of blood vessels that help regulate blood flow and coagulation, or clotting. If true, this behavior could explain some of the virus’s weirder (and rarer) manifestations, such as heart attacks, strokes, and even “COVID toes.”
>I paid accident claims for five years. As part of that job, I read medical records all day. I paid for foot amputations and we had to sometimes try to decide "Was this really an accident? Or was this really a complication of diabetes?"
How long has it been since you last worked in insurance?
> If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
Well maybe you skimmed a little too much, because the article clearly talks about the negative effects of an overactive immune system response being characteristic in some patients, and there was plenty of evidence of that in some people's wrecked lungs. Part of the therapy is to guide and even suppress the complex immune system response to keep people's bodies from destroying themselves.
Your comment didn't mention any of that and might be read by some as a "move along, nothing to see here." I think this is definitely not the case and people would be better served to read the article itself instead of your comment dismissing it and instructing them to skip over the section about immune system response.
I wasn't instructing anyone to do any such thing. Another way to frame my point: If the start of the article bores you to tears, hang in there. It gets meatier.
> If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
I replied to your comment because I read the article first and actually did learn this bit about the immune system response which is in the first half. If I had read your comment first I would likely would have skimmed the article (or even skipped it altogether) and missed it. In that situation your comment would have directed me away from learning something new. I'll continue to try to read articles before comments in the future.
Nasim Taleb had a good point on the most recent EconTalk [0] about covid: We kinda know what the morality rate is, but we have no idea what the morbidity of covid looks like.
All the co-morbidities are essentially unknown and are likely to stay that way for a while. These side effects take time to suss out; more than the nine months we've had with covid.
With the unknown and potentially unbounded risks we are staring at, Taleb says that over-reaction is the best strategy. He and Russ Roberts go on to talk about the basic issues with statistics in these cases, a good trip back to the first week of any stats course that everyone promptly ignores.
Has been speculated on since as early as March (that I've seen) with more evidence in support since then that this strain of human coronavirus is behaving like that.
Explains the majority of symptoms. Low pulse ox, feet, brain, lung, kidney, etc etc.
> Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).
That's not right. It causes cytokine storms just like any other major repiratory virus. Ventilators do help, lots of people survive on them. They are a critically important piece of the treatment puzzle.
I don't think statements like that are very helpful. It's on the spectrum toward conspiracy nonsense.
> I'm somewhat aghast to see this article talking like we don't already know that detail.
It's not a scientific study, it's a review piece for general readers.
Yes, COVID-19 is a bad one but it’s just another virus at the end of the day. I feel they act as we rediscovering everything about viruses for sensationalism.
Yes, but downplaying the fact that it’s new and that there’s a lot of unknown unknowns about it and its effects mid/long term is dangerous. Not all viruses are the same, and it takes time to observe and study them.
This is IMO the other important reason why it’s important to stop the spread, besides overloading hospitals.
Another way to look at it is that many people who were previously ignorant regarding most things we know about viruses are learning quickly and because they are novel to them, they find them sensationable.
Blood clots might be caused by a change in angiogenesis that appears to be correlated with COVID-19. I found this autopsy analysis by an MD to be very enlightening:
I'd previously read that COVID-19 might be a cardiovascular disease, which would account for the blood clots and heart stuff.
From the OC:
Marcus plans to also start collecting data from wearable devices, including Fitbits and Zio patches, which wirelessly monitor heart rhythms. “There may be large numbers of people who are suffering from cardiovascular effects of COVID-19 in the absence of other symptoms,” Marcus says. “I’m worried we’re missing those cases.”
I have no idea what it means to regard COVID-19 in cardiovascular vs respiratory terms. I'm just repeating what I think I've read. I really don't understand this stuff.
If I get Covid19, my plan is to take aspirin wile at home. If I need to go the Emergency Room, then I'll leave it to the doctors to decide what I should get, but before I need urgent care, I'll use aspirin.
That link specifically states don't take it every day as a preventative measure in case you might end up getting Covid-19, not don't take it when you know you have it, like the grandparent said they were going to do.
It says don't do it because there are risks of gastrointestinal and brain bleeding, which would be a bad thing to risk if you don't currently have an illness.
It even links to the following article from the Mayo Clinic, which goes over the pros and cons of taking aspirin daily to prevent blood clots and heart attacks, and has recommendations for classes of people that they recommend should take aspirin every day. so I'd think if you have an active illness known to cause blood clots, it's probably worth risking the bleeding risks from the other.
From the article: "Guidelines are varied between organizations, but they're evolving as more research is done. The benefits of daily aspirin therapy don't outweigh the risk of bleeding in people with a low risk of heart attacks. The higher your risk of heart attack, the more likely it is that the benefits of daily aspirin outweigh the risk of bleeding."
Anecdote is not data, but for awhile in my 20s I used to take aspirin pretty much every day just because I had constant issues with headaches. I think I did get an ulcer during that time, but it healed in time, once I stopped taking aspirin so often. Better than dying of a blood clot from a virus that still doesn't have a solid treatment, especially if you have to stay home and self-treat it.
They have no choice but to say that. Just like in criminal justice one is assumed innocent until proven guilty (beyond any reasonable doubt), in the medical field a drug is assumed harmful until proven beneficial (beyond a certain p-value). As long as the proof of the benefit is not out there (and peer-reviewed), a medical professional needs to give more weight to the known risks vs the unproven potential benefits. They might lose their license if they do otherwise.
But while they may need to think about their license, I need to think about my survival. And here I'm talking about my own survival. I'm not advising anyone else to do the same. I'm not a doctor, and even if I claimed I were one, nobody should just take a random guy's advice over the internet.
That said, my thought process is this: it is aspirin we are talking about, not cyanide. I have taken aspirin many times in my life, including several times recently. The benefit is not proven because doing medical trials is expensive. But the benefit is plausible enough that someone started just such a trial [1]. Separately, the benefits of other blood thinners are considered so great that they are part of the standard of care for Covid19 patients in some hospitals, such as MassGeneral [2]. So, my own assessment of that taking aspirin has for me a higher potential benefit than the potential risk.
But again, this is just for me, not offering advice to other people.
How is your argument different from the people claiming that Chinese medicine cures covid-19? We don't have any proof that it doesn't, but 96% of covid-19 patients in Wuhan received it and they were cured! Yay!
I don't know much about Chinese medicine or about the claim that it may cure Covid19, so I can't comment on this.
If you are alluding however that I'm committing the base rate fallacy, then I'm not. My argument is not statistical in nature.
My argument is this: I know more about my body than the FDA. The FDA makes decisions that affects hundreds of millions of people and cannot know how each will respond to a drug (like aspirin). I however know how my body responds to aspirin because I have taken it and I know I tolerate it well.
So, although both the FDA and I are making a risk-reward analysis, my problem is much more narrow and I have a lot more information about it. I do not need to employ double-blind clinical trials or know anything about t-statistics and p-values.
If I were to start recommending aspirin to HN readers, then I'd start becoming a bit like the FDA, and I would need to resort to statistical arguments. But I'm not recommending aspirin to anyone. I'm just showing people the way I'm carrying my personal risk-reward analysis. This could be useful.
I apologize for not finding a way to frame that more neutrally. I did not reply to your comment because I think you are free to do as you see fit for yourself. Me providing the link to someone else was not intended to be some passive-aggressive dismissal of your choice.
The Cleveland Clinic is a fairly big name, respected clinic. I think of it as a reliable source. I was just trying to sum up a lengthy piece briefly, which is always fraught with potential problems.
I do a lot of making my own health decisions of that sort. I'm routinely attacked for saying anything at all about my thinking about my own health. I wish it were easier to have meaningful discourse of that sort in a responsible fashion without people acting like "You are evil incarnate and practicing medicine without a license for leaving comments on the internet." I have no idea how we get there from here.
I agree with your reasoning. Also the link the parent provided was referring to taking it as a preventative measure, before you know you have Covid-19, not once you know you have it.
A lot of the early part of the article rehashes basics, like how viruses replicate. If you have basic knowledge of that sort, you can kind of skim until the mid point, where we find the above factoid.
I have been reading less about the virus of late, but this fits with everything I know. It causes blood clots. Ventilators aren't really fixing it. The lack of oxygen is probably more about what it does to the blood (than what it does to the lungs).
Later in the article, it talks about impacts on the feet suspected to be a side effect. Feet issues are commonly associated with blood/circulation issues. This is why diabetes can lead to feet being amputated.
The blood issues are well established and this has been known for some time. I'm somewhat aghast to see this article talking like we don't already know that detail.