PETER BRUCE: Dan Moyane, have I got news for you!

ENCA news anchor Dan Moyane is one of the nicest guys in journalism. I always watch him if I spot him on screen because he’s cool and collected and I know I could never do that with a camera pointing at me. But I had a bit of a chuckle on Monday morning when he was either starting or ending a shift. He and his co-anchor had been talking about lockdowns and stuff and Moyane leant back and remarked, in a casual, almost clubbish way, that “do you know I’ve even heard people think smoking might help with this virus” and almost rolled his eyes in dismissal.

So, Dan, this whole column is dedicated to you my friend, in the nicest possible way. I’ve gone and dug up some really interesting material I hope you get your producers to make some calls on, and get doctors and researchers to come into your studio and answer questions about why these things are being talked about overseas but not here.

You were quite right, by the way. There are people who think smoking, or perhaps nicotine, might somehow inhibit (rather than the conventional SA Command Council view) the progress of Covid-19.

They cite statistics that show smokers are quite significantly underrepresented in Covid-19 hospitalisations when compared with the people who smoke in a particular society. I mean, if Covid-19 is a respiratory disease why is it not killing more smokers rather than less? For instance, The Economist reports in its current issue that “a quarter (25%) of French adults smoke. Many people were surprised, therefore, when researchers reported late in April that only 5% of 482 Covid-19 patients who came to the Pitié-Salpêtrière hospital in Paris [it is one of Europe’s biggest and most famous hospitals] between February 28 and April 9 were daily smokers.

“The ratios of smokers to nonsmokers in earlier tallies at hospitals in America, China and elsewhere in France varied,” the magazine said, “but all revealed habitual smokers to be significantly underrepresented among those requiring hospital treatment for the illness. Smokers, the authors of the report wrote, “are much less likely” to suffer severely from SARS-CoV-2, the virus that causes Covid-19. Rarely, they added, is such a result seen in medicine.”

There’s a thing Dan. I wonder whether we could have a count in this country of the number of hospitalised Covid-19 victims who smoke? Do we ask them? Would the government release the results if they didn’t fit the prevailing “wisdom”? The Economist piece is behind a paywall normally but I think if you register you can get to their coronavirus coverage for free.

Even the hyper politically correct Guardian in London has seen something at least interesting in the story.

The study itself, is a bit beyond me, to be honest, and it is obviously a translation. But I did catch this arresting quote in announcing the test programme: “Nicotine may be suggested as a potential preventive agent against Covid-19 infection. Both the epidemiological/clinical evidence and the in silico findings may suggest that Covid-19 infection is an nAChR disease that could be prevented and may be controlled by nicotine. Nicotine would then sterically or allosterically compete with the SARS-CoV-2 binding to the nAChR. This legitimates the use of nicotine as a protective agent against SARS-CoV-2 infection and the subsequent deficits it causes in the CNS. Thus, in order to prevent the infection and the retro-propagation of the virus through the CNS, we plan a therapeutic assay against Covid-19 with nicotine (and other nicotinic agents) patches or other delivery methods (like sniffing/chewing) in hospitalised patients and in the general population.”

I’d pay attention to that if I were making the rules but that’s just me.

But there’s more, Dan. The smoking thing is a sort of fun fact but far more serious has been the slow and then, in the past few days, rapid flurry of reports pointing out that the prevailing “wisdom” (again) of the disease we call Covid-19 being a respiratory disease may be completely, or mostly, or often, wrong!

Does it attack the lungs? Yes. But then why are most people being put on ventilators not recovering? Why are they dying? Could it be because they don’t have the pneumonia the ventilators are there to fix? Why are Covid-19 patients dying of strokes and heart attacks? It may be because the disease is clotting their blood, triggering thrombosis in the lungs or heart or brain and not blocking the air passages in their lungs at all. Or it may be doing all of those things to some people.

The Chinese were the first to notice the unusual way people were dying of this pneumonia they called Covid-19 but this is the first report I could find in The New York Times, a paper that rightly prides itself on its coverage of science. This is from March 27, a lifetime ago. 

Then it was the turn of The Washington Post, weeks later, on April 25, with another version of the same story.

Then, on April 29, last week the always reserved NPR (National Public Radio in the US) did a majestic job on the clots associated with Covid-19. The clots, it seems are in the blood vessels in the lungs. Doctors in New York seem just stunned.

“It’s still not clear precisely how Covid-19 is causing blood clots,” the NPR reported. “It could be from the infection itself or the immune system’s response to the virus. [Dr J]

Mocco [a professor of neurosurgery and director of the cerebrovascular centre at Mount Sinai Health System in New York] suspects the virus is damaging the cells that line blood vessels, allowing blood to come in contact with substances in the body that cause clotting.

“And some hints about how Covid-19 affects clotting are coming from lab tests of patients,” says Dr Tiffany Osborn, a professor of surgery and emergency medicine at Washington University in St Louis. “We are seeing lab values that are off the wall,” she says.

“For example, doctors are seeing levels of a protein fragment called a D-dimer that are more than 100 times normal levels, Osborn says. This suggests the presence of lots of blood clots that the body is trying to break down. Some patients also have very high levels of thrombin, an enzyme that causes blood to clot.

And there’s growing evidence that blood clots associated with Covid-19 are causing problems through the body.

See the NPR story from April 29.

Science Daily reports an Irish study on April 30 on clotting: “Our novel findings demonstrate that Covid-19 is associated with a unique type of blood clotting disorder that is primarily focused within the lungs and which undoubtedly contributes to the high levels of mortality being seen in patients with Covid-19,” said Professor James O’Donnell, director of the Irish Centre for Vascular Biology, RCSI and Consultant Haematologist in the National Coagulation Centre in St James’s Hospital, Dublin.

“In addition to pneumonia affecting the small air sacs within the lungs, we are also finding hundreds of small blood clots throughout the lungs. This scenario is not seen with other types of lung infection, and explains why blood oxygen levels fall dramatically in severe Covid-19 infection.”

That study was also picked up by a genetic engineering website genengnews.com, which I think contains a little more of the Irish report. 

By May 2, again in The Guardian, doctors are almost awed by what this virus can do. “How is this possible?”, asks the headline.

The Daily Telegraph on May 2 suggests our knowledge of the virus in fact borders on the primitive, which doesn’t say much for the chances of a vaccine by the end of next year. The virus is in your vascular system, clotting your blood, says the Telegraph. And it’s in your brain, just as it was in the brain of the woman way back in the April 25 story in The Washington Post earlier. 

Lastly, a cautionary tale. My excellent mother-in-law, former ANC MP and Black Sash stalwart Judy Chalmers in Port Elizabeth, tested positive for the virus back in March. She spent three difficult weeks in total self-quarantine getting through it. The thing I remember, apart from her constant nausea, was that she said she had completely lost her sense of taste and smell, which it turns out are almost certain signs that you’re infected. Yet those questions form no part of any of the “screening” we do here in SA. The University of California San Diego Health now includes loss of smell and taste as a screening requirement for visitors and staff, as well as a marker for testing patients who may be positive for the virus. So should we. Science Daily again.

That’s me done Dan. I doubt either of us smokes anymore but hell, maybe we should start again. A couple of fags and an aspirin a day might even keep the virus away while we don’t know what we don’t know. Stay well.