Welcome to another MedCram COVID-19 update. Here in the United States we have a slight
increase in the daily new cases nationally, daily deaths are still on the decline at this point.
In the United Kingdom, daily cases are still on the rise
whereas daily new deaths in the United Kingdom are still relatively small. In Canada, the daily
new cases seem to have reached a peak. We'll have to see here what direction it goes with more time,
and while there's been some recent activity in terms of daily new deaths in Canada, this may be
on the way down. In Brazil the daily new case rate seems to be going down here every single week, and
we're seeing a similar trend as well in terms of daily new deaths in Brazil, and if we look at
Finland, which we looked at a number of months ago in terms of their hydrotherapy and their
proclivity to use saunas, we can see here that the number of daily new cases is on the rise,
but there's really been a paucity of actual deaths on a daily basis here in Finland.
If we try to compare that to Sweden, we see here that the daily new cases are on the rise,
but in terms of the daily deaths in Sweden, there really hasn't been an
increase since August 1st, so that's very encouraging news for Sweden.
So the question always is, what's the point if the cases are going up, but the deaths
aren't going up? And well of course there's a lot of real estate between cases and deaths, right?
There's hospitalizations, morbidity, etc. and so for that, we go to a website that's actually keeping
track of this, at least in the United Kingdom, where we can see since the pandemic started what's going
on with testing and with cases, and clearly you can see here that there is just a dramatic --
more than three or even four-fold -- increase in not only the capacity of PCR testing,
but also in PCR tests that have been actually processed, and so because of that, you can see here
it's no surprise that the amount of cases has gone up, because the testing has gone up.
But you may want to notice something here. These are linear y-axes going from zero at the bottom
to one hundred thousand, two hundred thousand, three hundred thousand. Here, we have cases
in the very similar type of progression, right? It's not logarithmic and clearly you can see here
that the amount of testing has linearly increased, whereas here on this graph the amount of cases has,
it seems, non-linearly or maybe even exponentially increased. And so while I think it's reasonable
to say that the amount of cases that we're having now at least in Europe and maybe even just the UK,
the reason why these cases have gone up in comparison to the peak that we had in May
is probably a result of increased testing, but we can't say that the week-over-week increase
here in the last month or two is just because of that testing. That would be my hypothesis.
Now if we go through and look and see what's going on here in terms of healthcare, here we
have hospitalizations that are occurring in the beginning around April and May. You can see very
very high and then it's dropped off considerably and only now is it starting to pick up. So there
has been an increase in hospitalizations, although nowhere near the height that we saw back in April
and May in the United Kingdom, and fortunately patients in ventilator beds and patients being
admitted to the hospital -- so again this gray bar is the number of patients total that are in the
hospital, the dark blue bar are the patients that are being admitted to the hospital, and then this
lighter blue are the patients in ventilator beds, and of course these are all patients with COVID-19.
Over here on the side we see the deaths, and these here are deaths within 28 days of a positive test,
so of course there's going to be some patients which have deaths that are not related to COVID-19,
but nevertheless we wouldn't expect those to change dramatically here since April, and here's
a deeper dive into the number of patients that are being admitted from the different countries that
make up the United Kingdom, and you can see here that the majority of these cases are in England,
and of course that also goes for the deaths, most of them seem to be in England. I wanted to talk
about an interesting development that really has some unknown and potential insights into coming up
with therapeutic options, and that is this paper that was published in Science called "Free fatty
acid binding pocket in the locked structure of SARS-CoV-2 spike protein." So what they're
saying basically in this article is that there's a fatty acid called linoleic acid which actually is
an essential fatty acid. It's an essential fatty acid that also happens to be an omega-6
fatty acid, and apparently what they found is that there are binding sites on the spike protein. Spike
protein is part of the SARS-CoV-2 outer layer which binds to the ACE-2 receptor on human cells,
and so what they find is that if the linoleic acid binds to the spike protein at particular areas,
it causes the confirmation of that spike protein to be in what they call a "tight configuration,"
and essentially what that does is it prevents, in some fashion, the binding of that spike protein
to the ACE-2 receptor. They say here in the abstract that their 2.85 angstrom cryo electron microscopy
structure of SARS-CoV-2 spike glycoprotein reveals that the receptor binding domains -- or the
RBDs -- tightly bind the essential free fatty acid linoleic acid or LA in three composite binding
pockets. The pockets also appeared to be present in the highly pathogenic coronavirus's SARS-CoV
and MERS-CoV. LA binding stabilizes the locked S conformation giving rise to reduced
ACE2 interactions in vitro. In human cells LA supplementation synergizes with the
COVID-19 drug Remdesivir, suppressing SARS-CoV-2 replication, as well. So here you can see where
this binding site is in the spike protein, and you can see that there's a pocket, and when that binds,
it locks the protein into a conformation that does not really encourage binding to the ACE2 receptor.
hHere's a closer look at that, and we can see here the chemical structure of linoleic acid; it's known
as an omega-6 fatty acid because if you count from the end which is the omega end of the alphabet and
you count six carbons in one two three four five six, you'll get the first double bond.
And here's another view of those trimers, so these trimers or three proteins come together
in this S protein, and you can see here the linoleic acid, which is this yellow structure here
here and here, and what that does is it causes a tight conformation of this protein as opposed to
when they're not being bound. It's a much more open conformation. It's this loose and open conformation
that can bind the ACE2 receptor better in this situation. It does not bind the ACE2 receptor
as well and the thought there is that might mitigate infectivity of COVID-19 or SARS-CoV-2.
So before you feel the need to increase your dietary intake of linoleic acid, there actually
is a nutritional quandary as published a couple years ago in this paper that was published online
in healthcare. As it turns out, apparently over the course of the last century there's been a 20-fold
increase in the consumption of vegetable oils resulting both from their increased availability
and from recommendations to consume these oils in a way of lowering the risks of coronary artery
disease from elevated cholesterol, and apparently this has reached a total of about six percent
which is pretty high of total dietary energy. The article goes on to say that there's been
meta-analyses which have disagreed about the role of dietary linoleic acid
in atherosclerosis, and recent publications indicate that linoleic acid's reduction of
blood cholesterol levels does not predict its effect on the development of atherosclerosis.
Now because linoleic acid is a precursor to arachidonic acid, which is involved in inflammation,
there is concern that there may be detrimental effects on elevated dietary linoleic acid. It's
interesting to note that in a recent survey of geographic areas around the world that have
longevity, that was actually studied by National Geographic, the five areas that met the criteria of
longevity, all of them as listed here had dietary intakes of linoleic acid that were actually below
the current intakes in the United States. Now to be fair, the authors of this study aren't really
suggesting that we increase our dietary intake of linoleic acid but rather that this novel approach
may suggest itself in terms of looking for therapeutic options that could interact with these
binding places. We shall see as time moves forward. In other news, we are looking at vaccination, and
this time the vaccine trial that is sponsored by Johnson & Johnson has just announced that their
study has been paused due to unexplained illness in one of the study's participants.
Now there are certain rules that will trip a potential pausing that would shut down the study
temporarily, so that they could figure out whether or not this illness was the result of the vaccine.
Remember now that this is a 60,000 patient clinical trial, so with that many patients in
the trial you're bound to get somebody coming down with some severe illness -- that's just
the way things are. Think about that: that's about the number of people that would come to a very
large baseball game or football game. The question though is was it the result of the vaccine or was
it a result of just chance? And so epidemiologists and clinicians are trained to look at that. I'm
sure there will be unblinding of that patient to see whether or not they got the placebo or whether
or not they actually got the vaccine, and then make a determination about whether or not the chances
of something like this happening and whether or not the biological aspects of it make sense.
And this should be somewhat encouraging, because while it's not a good thing to have someone have
a bad response in a study like this, we don't know whether or not it was caused by the vaccine yet.
It is reassuring to know that these companies are undergoing and continuing with the same
safety protocols, and we will just have to wait and see exactly what happens.
And in terms of some good news, here in California the Los Angeles Times is reporting
that Californians hospitalized with COVID-19 is at their lowest levels in six months, and that is some
good news after a very beleaguering fire season here over the last couple of months. So with that
we'll wrap things up here. Don't forget to check us out on MedCram.com; we have excellent courses on
EXG interpretation, CBC blood test interpretation, and also basic metabolic panel interpretation,
this, and many other lectures including our COVID updates, commercial free. Thanks for joining us.