April 6, 2020
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I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each week, I'll bring you some of my favorite facts that I picked up on the job or while out living life.
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Health and science news is at the forefront of everyone’s minds right now. I recently wrote a guide to reading new news like a science writer. You’ll need healthy amounts of skepticism and optimism. This doesn’t mean you should dismiss everything you read. It means that you remember that new information may be true, but hasn’t had time to be validated by other studies just yet—and also that scientists are doing their best. You can read the full story here:
If you’re looking for consistently good science writing about Covid-19, follow these folks on Twitter. They’re just a starter list, but they’ll give you quality information you can trust.
Laura Helmuth, Washington Post
And for a newsletter that addresses FAQs and ways that Covid-19 is shaping the world, make sure to sign up for Quartz’s Need to Know newsletter. It comes to your inbox a few times a week. I contribute regularly.
Covid-19 sneaks its way into your cells like a successful phishing attempt.
Found while reporting: The coronavirus’s survival mechanism is what makes it so dangerous.
Like spam emails, viruses often look like something our cells should let into them.
Image of a screenshot of an email phishing attempt from “sars.cov.too@gmail.com), posing as an ACE2 hormone. Credit: Daniel Wolfe.
SARS-CoV-2 has a protein around its shell of genetic material. This shell happens to look an awful lot like a hormone called ACE2, which is normally involved our temporary stress response. It helps constrict our blood vessels to raise our heart rate and blood pressure. The ACE2 receptor, a handy protein that hangs out on cells’ membranes, normally lets the ACE2 hormone in. But SARS-CoV-2 tricks this receptor, which is how our cells become infected with the virus. They replicate like crazy and burst through the membrane to find more ACE2 receptors to trick.
It’s a devilishly sneaky process—and one of the reasons that it takes is so long to get sick. SARS-CoV-2 hangs out in the throat for a while, where it can carry out this covert mission without causing us too much trouble. By the time it reaches our lungs, we may start to feel sick—but at that point, we’ve been feeling essentially fine for up to two weeks. We’ve had a lot of time to potentially infect others.
One reader recently asked Quartz “I have heard that ibuprofen has commonly been found to have been taken by Covid-19 victims and that acetaminophen is a safer choice to take. True or not?”
My answer in the Need to Know newsletter from April 1:
The concern over ibuprofen, the active ingredient in Advil, comes from one of its cellular side effects: It may raise the number of so-called ACE2 receptors throughout the body, which the novel coronavirus uses to sneak into our cells. In theory, more ACE2 receptors could lead to more entry points for the virus, leading to a more severe infection.
Researchers floated this idea in the journal The Lancet in mid-March. After that, anxiety about ibuprofen went, well, viral, despite a lack of concrete evidence that the drug worsens infections. The WHO and the European Medicines Agency have stated that ibuprofen is still an acceptable way to treat fevers and aches related to Covid-19 (or any illness) at home. So is acetaminophen, the active ingredient in Tylenol, which doesn’t lead to higher levels of ACE2.
North Korea has one lone drug manufacturing plant.
Found while reporting: How Covid-19 could disrupt pharmaceutical supply chains.
If you take any prescription drugs, it likely went through four separate exchanges of hands: One plant made the active ingredient, another put it together in a drug, another shipped it to your pharmacy, and your pharmacy gave it to you. It’s a highly globalized process, which makes sense: It’s cheaper to make some products in countries with looser regulations, and to set up specialized factories that only manufacture a particular type of drug.
This means, of course, that the whole system is incredibly fragile. How fragile? We don’t know—the US Food and Drug Administration keeps track of where these drug manufacturing companies are, but not what they do. That’s proprietary information or the drug companies. Most of these companies are in the US, but India and China have the second and third densest concentrations of plants that make either active pharmaceutical ingredients, or drugs themselves.
Image description: A bubble map of the concentration of API and drug manufacturing plants. Note: If you read this story on qz.com, you can hover over each country to see exactly how many plants it has.
Notably, in their list of over 10,000 plants, I found that North Korea has one lone drug manufacturing plant. I have no idea what the country make there, but I suppose they have to find some way to provide medications to their citizens.
Image description: the same map above, zoomed in over North Korea, South Korea, and Japan.
Covid-19 causes lung complications beyond typical pneumonia.
Found while reporting: Some of the drugs used to keep people on ventilators are in short supply.
Perhaps unsurprisingly, the American Society of Health-Systems Pharmacists started reporting shortages of some of the drugs needed to support intubated patients in March. That group counts shortages as anything that may cause a doctor to use different medication, or a hospital pharmacy to use different kinds of medications. (The FDA counts shortages as anything a manufacturing company reports; so far, there’s only been one shortage of drugs directly related to Covid-19, but there’s usually a list of some 100+ drugs that are in shortage by their standards.)
The hospital pharmacists, nurses, and anesthesiologists I spoke to for this story were particularly worried about a drug that isn’t in shortage yet, but could be: propofol.
Propofol is a drug officially brought to market in the 1980s by the company that is now AstraZeneca. It’s one of the best anesthetic drugs around: Doctors give it through an injection instead of a mask (which can cause feelings of suffocation), it doesn’t build up in the body (which would mean patients couldn’t receive a constant flow of it), and even though it’s stronger than the previously used anesthetics, its effects wear off quickly.
Propofol is important for people on ventilators because it also works to temporarily paralyze muscles. This way, the person being intubated (getting the breathing tube down their windpipe) doesn’t fight it, and they don’t gag or vomit.
Some ventilators allow people to breathe a little on their own; but that’s not necessarily what people with Covid-19 need. The virus damages the lungs so quickly and severely, it causes ARDS, or acute respiratory distress syndrome. With ARDs, the lungs need to be completely paralyzed to heal, while the machine breathes for them. In this case, doctors would want to keep someone on propofol (and other drugs) for longer.
Propofol is the only drug in its class. No other drugs have the exact effects that it does. While pharmacists and clinicians may be able to find workarounds, these substitutes come with compromises that make treatment a lot harder.
Animal of the week: Corvids
Image description: A crow squawking and shirking its head back into its body.
I have a weekend shift yesterday, so I wrote this quiz about the underrated family of songbirds that include crows, ravens, jays, magpies, and nutcrackers. That’s a hint to one of the questions!
That’s all for now—stay curious, friend ❤️
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Top image by E. Y. Smith, headshot drawing by Richard Howard.