Diagnosis and Therapy of COVID-19
(Continuation of “China’s Influence on Pathogenesis, Diagnosis and Therapy of Covid-19”)
Latest news from WHO is, the recommendation of all PUI and PUM to be recorded as COVID-19 patients if they died. With that, the process of burial will also be done as stated in COVID-19’s protocol.
Even though if we take a look on the criteria of PUI and PUM as instructed by WHO, they are very loosely made. On the other hand, 95% of COVID-19 symptoms is light. The logic with that is with light symptoms, then the death rate that stems from COVID-19 will be low either. But because the PUI and PUM criteria are very loosely made, then the death rate will then increase as well.
People with fever lasting for 1 day and coughing symptoms will be easily included into PUI criteria. Because almost every place in this world has local transmission already. These PUI will then undergoing isolation in their own home. If they died while in the isolation, then they will undergo burial in accordance of COVID-19 procedures, which will involve them to be put inside acasket or plastic. We can’t think that the cause of death can stem from heart disease, stroke or even simply falling from stairs in their home, etc. Not only that, other people that live inside of this home, practically will be considered as people without symptoms. Even when the dead hadn’t undergoing the throat swab beforehand. Negative rapid test for people without symptoms (PWS) like that won’t make the label that they received as PWS disappear. Meanwhile positive rapid test will then strengthening the PWS label that they already have. And if there is someone between these people without symptoms that suffers from cough and runny nose, then he will also be included into PUI category, and need to be isolated as soon as possible. If he died, then, the same thing continues.
For example if these PUI are not dead but suffering from severe diarrhea for more than 20x a day or yellow sclera or shortness of breath or lethargy or pass out, then these people will be brought into hospital and then be treated as PUM. The laboratory result will no longer plays any part. The thing needed is to search for pneumonia radiology imaging or GGO (Ground Glass Opacity). If CT-Scan is not available, then the x-ray will be repeated continuously until GGO finally appear.
For me, what has been written above is like devil’s regulation. Vey chaotic and terrifying. Fact shows that only 5% of case is showing severe symptoms, but the rest 95% of light cases will automatically become PUI and be buried in a casket or plastic if they died. Fact shows that 95% of all cases are only showing light symptoms, but if there’s a patient with fever and shortness of breath or other severe clinical symptoms this in turn will then make them as COVID-19 patients. They believe the existence of cytokine storm as the cause of those severe symptoms. Something that is not coherent with facts that we already comprehend about COVID-19. And they neglect the facts that cytokine storm is not supported by strong knowledge foundation and inside of it is also strong laboratory examination. They are not able to prove the spread of vast immune complexes in the blood. They are not successful in proving the increase of various types of complements. Even when we believe the finding of various types of interleukin, cytokine storm will still not happen. Because the cytokine amount unleashed is not big enough to call it as a storm (http://renungan-tmudwal.com/pengaruh-cina-dalam-patogenesis-diagnosa-dan-terapi-covid-19/).
There is nothing that can be used as a standard to diagnose COVID-19. The existence of lymphopenia or Absolute Lymphocyte Ratio (ALC) <15% from total leukocyte, neutrophil/lymphocyte ratio (NLR) >3,13, leukopenia (leukocyte < 4.000 u/l), increased CRP (>10 mg/l) can happen because of various types of viruses.
But there is something that we have to believe in, something that can become a standard, which is Ground Glass Opacity (GGO) in the thorax X-ray or CT-Scan. Chinese researchers in Wuhan acknowledge that 100% of COVID-19 cases gives GGO appearance. But what actually is GGO? Can other disease causing this kind of appearance?
GGO is a radiology term where its appearance indicates the increase of cloudy area in lungs, where blood vessels and bronchial structure can still be seen. This thing is less opaque if we compare it with consolidation where previous structures are nowhere to be seen. More commonly, diffuse GGO is associated with wide spread of inflammation or lung infiltrative disorders (European Respiratory Journal 2009, 33:821-827).
From that definition it means that GGO can happen because of various viruses, bacteria or even malignancy/caner. Thorax photo result that used to be normal at first, then change into what looks like as GGO after thorax x-ray was redone is not a certain sign in saying it as COVID-19. In Dengue infection or bacterial infection that thing can also happen. So repeating thorax X-ray multiple times is not needed. The same with doing CT-scan examination to search for GGO. Thorax photo/CT-scan can be repeated if the patient changed from not having shortness of breath into suddenly having one. And if GGO appearance was seen, only then COVID-19 diagnosis can be put into equation. Or COVID-19 mixed with other viral or bacterial infection. With that in mind then the GGO appearance shows lower diagnostic level compared to RT-PCR (Reverse Transcriptase Polymerase Chain Reaction). GGO examination as the significant tool for helping to diagnose COVID-19 can only work in a situation of outbreak, just like what happened in Wuhan yesterday or in New York right now.
2 cases as examples (these ones were taken from webinar):
1. A man, 55 year old, admitted to the hospital with symptoms of fever lasting for 3 days before admission, epigastric pain, headache, serology Dengue (+), negative NS I Dengue antigen, normal thorax roentgen, diagnosis at that time is Dengue fever. At day 6-7, about to enter recovery phase, where fever is not yet prominent. In day 8 patient experiencing fever once more and coughing becoming prominent. But there’s no shortness of breath, fine rhonchi can be found in both lungs. After re-anamnesis, it was found that patient’s family was once sitting beside a person that’s confirmed as COVID-19 in a religious activity. In that 8th day it was found that procalcitonin result was approaching normal, CRP was 283, lymphopenia and leukocyte count was slightly increased. CT-scan examination was performed and showed GGO appearance with wide consolidation in both lungs hemisphere. Patient was then treated as PUM and transferred to isolation room. Throat swab was performed and ventilator was attached to the patient because of desaturation in the oxygen level.
2. A woman aged 35 year old, with fever that already lasting for 7 day, came to the hospital, dysuria (+), no respiratory tract symptoms was seen. Patient is a housewife and only had contact with closest family. Laboratory check, platelet was decreased, normal leukocyte count, neutrophilia, lymphopenia, high CRP, NS-1 antigen (-), Dengue serology (-), thorax photo was normal. CT-scan was performed and GGO appearance could be seen. Patient was then categorized as PUM and entered isolation room, after that swab throat examination was performed.
In both cases, throat swab results are not yet able to be acquired by the writer
3rd case (outside webinar):
3. A patient came to a private clinic, a man aged 38 year old with fever and coughing that already lasting for 4 days, no history of shortness of breath but there’s history of travelling from Jakarta 10 days ago. There is no contact history with COVID-19 individual. Patient came bringing thorax roentgen photo and laboratory result. Thorax x-ray showed both lungs and heart are within normal range. Laboratory result: Hb 15,4 gr%, leukocyte 12.000, erythrocyte 5,8 million, platelet 377.000/mm3, hematocrit 45,7%, MCV 78,3, MCH 26,4, MCHC 33,7, basophil 0,66%, eosinophil 0,5%, neutrophil 76,2%, lymphocyte 14,8%, monocyte 7,9%. That patient was then sent to the hospital with diagnosis of PUI. In hospital after CT-scan examination and GGO appearance was seen in the basal of both lungs hemisphere. Patient was then diagnosed as PUM and entered isolation room. The throat swab examination result is not received yet until today.
Case number 1 and 2
The GGO appearance in CT-scan or thorax photo seems to be an important message from that webinar. It seems it has become a gold standard to say that someone as PUM, before swab throat result is received. It has been written above that viruses, bacteria or cancer can give GGO appearance. In Dengue infection that thing can also happen. The occurrence of plasma leakage and destruction of immune complexes in lung can give GGO appearance.
In the first case, usually it’s indeed that on the fifth day that Dengue usually will enter into recovery phase. Something that’s marked with the loss of fever and increase in platelet amount. But it may not always happen.
If immune complexes are spreading widely and in great number through all over body, fever might still happen until the 7th or 8th day or even until 9thday. Drastic change from normal thorax photo into wide worsening of CT-scan of the lung, highly possible because of the possibility of mixed infection between Dengue and COVID-19. Dengue infection can do that. But COVID-19 can also do the same thing. The occurrence of contact history with someone diagnosed with confirmed COVID-19 is making the probability of diagnosing it as COVID-19 as highly probable. I agree that this patient should be included into PUM. But the administration of adequate liquid and corticosteroid therapy in immunosuppressive dose still have to be considered, just like what has been explained on the matter of pathogenesis of COVID-19 in front. Cytokine storm is not happening in COVID-19, but in DHF it happens. That’s why corticosteroid that’s given, it’s given in large dose (immunosuppressant) (http://renungan-tmudwal.com/chinas-influence-on-pathogenesis-diagnosis-and-therapy-of-covid-19/)
In the 2nd case, with the occurence of fever and decreased platelet, then the starting diagnosis logically should be Dengue infection. But the negative Dengue serology on the 7th day, should nullify the diagnosis of Dengue infection. Whereas NS 1 Dengue antigen on the 7th day can be ascertained as negative. Because positive NS-1 antigen on the 0 or 1st day of sickness before Dengue virus can be caught by antibody. In primary Dengue infection then IgM can be negative on the 7th day, but IgG can be positive on the 14th day above.
With that as it may, making someone to change his status to be categorized as PUM because of GGO appearance can’t be accepted.
As for the 3rd case,
Seeing the reality of 70-80% of Dengue cases in the world is the donation from Southeast countries (especially Indonesia), then it should be logical that every patient with fever should be considered as Dengue patient firsthand. Because of that it is a must if the patient that comes should be undergoing rumple leed test beforhand. If rumple leed is negative in one hand, we should test it again on another hand. If rumple leed test is positive, then Dengue infection as the cause of infection in this person is very much likely. In hospital situation the rumple leed test should be done too. The occurence of lymphopenia, ALC < 15% from total leukocyte, N/L ratio 5,14 (>3,13), the GGO appearance in CT-scan, can happen in various types of virus, including Dengue virus. Dengue serology (Dengue Blot), should also be tested. Just like what have been explain in front, in primary infection IgM can be negative on the 5th day, but IgG can be positive on the `14th day. Or it will be very hard to set aside Dengue infection in patient with fever in Southeast Asia especially in Indonesia.
Dengue infection should not always be accompanied by trombocytopenia, because the iceberg phenomenon in Dengue infection. So diagnosis of probable Dengue can exist even without thrombocytopenia. Leukopenia too may not always exists. But if there is a patient with fever and accompanied by leukopenia and lymphopenia then the cause of infection in this case 100% should be virus. And for Indonesia the biggest probability is Dengue virus. Jakarta at this moment can’t be treated as a benchmark for someone’s possibility of contracting COVID-19. Because it can be said that all cities in Java have alreadygot their own local transmission.
Indonesia has the highest Dengue infection cases in the world but at the moment it also experiencing COVID-19 pandemic just like any other countries in the world. Based on what have been explained in front, only 1 thing that can make diagnosis of COVID-19 to be treated as a strong possibility. It is when a patient that’s experiencing no shortness of breath when first admitted to the hospital, change into having one on the later day of treatment. In this situation, we need to repeat thorax photo or CT-scan to see the GGO. If GGO appearance is positive then the explanation should be the same as in case number 1.
With what has been explained above, the death of young population in Indonesia (<50 year old), which they said was caused by COVID-19, should be criticized and put under monitor. The possible cause of death because of Dengue infection or combination of Dengue infection and SARS CoV-2, can very much happen. WHO predicts the total Dengue infection in Indonesia is 2% of Indonesians total population (5.400.000 lives/ Indonesian Potential Dengue infection).
Other causes that can cause young individuals to die if infected by COVID-19 is if that person has suffered from asthma. If he at the time of COVID-19 infection has suffered from asthma attack then the attack that happen will be very hard on the person’s body. Mucous hipersecretion can happen massively and will be sticky. Bronchoconstriction can happen severely. Ventilator will be useless in that situation. Intubation should be done immediately. COPD in elderly (>70 year old), can also causing a quick death for those infected by COVID-19.
There is no data in double blind trial on a drug that can treat SARS CoV-2 convincingly. Because of that COVID-19 treatment is supportive in nature.Moreover, if we take a look at the data that 95% of clinical symptoms that happen is actually light. Something that needs to be noted comprehensively and carefully is if COVID-19 happen at the same time with other infectious or chronic diseases. Plasmapheresis therapy in this case from people that already have immunity from SARS-CoV-2 may improve their situation if given to COVID-19 patients with pneumonia.
For young people without immune deficiency, therapy in acute asthma attack should be done very aggressively. Intubation should be done immediately. For Southeast Asia, mixed infection with Dengue infection should be considered. Adequate liquid therapy and administration of corticosteroid in immunosupressive dose should be done as quickly as possible. In elderly, the treatment of bronchial obstruction because of COPD should also be receiving quick and serious attention. The same with other chronic disease, like Diabetes Mellitus, hipertension, heart disease, etc.
The conclusion and afterthought from article tittled “China’s Influence on Pathogenesis, Diagnosis and Therapy of Covid-19”.
It is irrefutable that COVID-19 pandemic is really happening on this world. For people that observe this disease seriously since the beginning then questions might arise.
How this corona virus can appear massively in Wuhan and then spread and infecting all humans in this world in such a short period of time?
It creates another question, why the basic of pathogenesis for COVID-19 is so absurd and even violates standard medical textbook on the matter of virus infection?
Becoming question, why medical experts all over the world just kind of agreeing with all these absurd pathogenesis theories being released?
Becoming question, why COVID-19 looks so horrific, no matter the fact shows that people that suffer from severe symptoms only averaged on 5%?
All doctors in this world are being forced to think like what has been wanted all along by the supreme Gods that rule this world. The supreme Gods that told WHO so that all diseases should be diagnosed as COVID-19. The same with death from all types of diseases. All those should directed towards COVID-19 as its cause of death (The Thousand Faces Disease).
Becoming a question on why all countries on this world are agreeing on undergoing lockdown for months in their own countries. No matter if it’s making their people suffer and even making their countries poorer in turn. Systemic horror that’s created by these supreme Gods that causes all countries in this world, trying their hardest to get people with positive SARS-CoV-2 from tens of million or even hundreds of millions of their people They don’t care how much of their money will they spend to fulfil this goal. Countries leaders all over the world should be in their highest consciousness that it’s not acute upper respiratory tract syndrome caused by COVID-19 that they should fear, what they should fear is when their people suffer from Diabetes Mellitus, hypertension, cardiovascular disease, kidney disease, liver disease, and nutrition deficiency. Getting rid of nutrition deficiency because of hunger and economic crisis is the main goal of a true country leader. Not just spending billions of dollar just to search people with COVID-19, even though almost all of them are only giving acute upper respiratory tract syndrome. (coughing, runny nose, throat inflammation and light shortness of breath).
My deepest thanks to dr. Mukovits from United States and dr. Ericson from Sweden that are giving us great information regarding the enforcement that doctors all through Europe and US have to undergo to diagnose their patients who are dead or sick as COVID-19 patients. I’d also like to give my thanks for Italian senator Vittorio Sgarbi that has given us facts regarding the astonishing number of COVID-19 deaths in Italy is in reality happen because of other diseases rather than COVID-19. Based on information that we get from them, and the obedience that we’ve seen from doctors all over the world to follow the teaching of this thousand faces disease then the number of people that’s infected by COVID-19 and death rate that’s caused by that disease just like what the world has reported, is something that can’t be proven scientifically. The persecution of doing a criminal act in the court of Allooh the God of the universe in the afterlife is certain.
In my insight, the creation of the New World Order has been going process right now. China will become the ruler of this world, replacing US. Even though US agrees with COVID-19 vaccination but its will to lift the lockdown up as soon as possible is against the will of the supreme Gods. So Trump must quickly be sent to heaven or lose in the next presidential election. Maybe because of these fear, Trump annul his policy and agree to keep imprisoning his people until the end of September.
In the end, the main information that I can give to the doctors in all over the world is pathogenesis of COVID-19 is not based on of ACE 2 receptors that works by making it easier for SARS CoV-2 to enter all cells in the body, so that every destruction that happen in body organs will be considered as the effect of SARS CoV-2 infection (cytokine storm). My writing regarding pathogenesis in front has refuted the existence of cytokine storm. SARS CoV-2 is a weak virus. Its main strength is in infecting humans quickly, the same with flu disease caused by Haemophilus influenzae.
There is no antibody that can prevent this SARS-CoV-2 to cause the occurence of throat inflammation in human for multiple times. Because its target cell is goblet cell. Because of that vaccines that have been prepared by supremed Gods of this world, will be useless. CoVID-19 will always be here in this world, just like flu disease caused by Haemophilus influenzae.
With the basic of this virus as a weak virus, then diagnosis of a disease should still holding on to the rules that has been long proven to be true in medical field (proven medical protocol). Over diagnosis because of the fear of COVID-19 can’t be accepted and is a crime in front of the true God of the universe. Scaring others by saying that SARS-CoV-2 in each country has its own strain or specificity is a horror movie story line. Whatever the mutation will be, COVID-19 is still categorized as acute respiratory tract infection. And its target cell is still goblet cells.
Rapid test examination as a way of screening to search for COVID-19 is useless. Forcing someone to undergo isolation for 2 weeks in people with positive rapid test is a crime. The same with allowing people wit positive throat swab (RT-PCR) to do repeated examination before 14 days. If negative throat swab was found then that person should be released from isolation. Positive throat swab shouldn’t have to be negative for 2 times in a row as a reason for that individual to be isolated independently in his own home. Forcing people with negative throat swab to be examined once more using the same method to reach the total negativity of 2 times in a row is a crime. The same with people that has been proven as having negative throat swab to be forced to undergo isolation for another 2 weeks in their home.
Included as criminal acts are burying body of COVID-19 individuals following COVID-19’s protocol which is covering one’s body with plastic and casket. The crime will be even more hideous if burying all people that died in COVID-19 red zone area using COVID-19’s procedure. Scientifically, it is obviously a criminal act, because dead COVID-19 patient’s body is considered as impossible to spread the disease anymore (http://renungan-tmudwal.com/review-towards-covid-19-mode-of-transmission-an-effort-to-vanquish-world-panic/).
The repetition of thorax photo or CT-scan should be based on strong reasoning which for example can be implemented in a patient with fever and shortness of breath that increasing gradually when on treatment.
Cloroquine or other anti-virus like remdesivir and other similiar drugs haven’t yet filled up their scientific criteria in order for them to be used as SARS-CoV-2 killer drugs. Supportive therapy and other drugs to increase one’s immune system is the true drug, while waiting for further researches regardingabove drugs or other therapies that can kill SARS-CoV-2 for good.
Something that should be remembered for the head of nation that is enforcing lockdown on your citizens is, staying at home, doing nothing for too long (more than 1 month), will even decreasing immunity from your people further. So that if lockdown will be reopened in the future, those people will be infected even easier than today, not only by COVID-19 but also by other viruses or bacteria. Throat inflammation as a result of COVID-19 will keep on repeating itself till the doomsday. Freeing people after one month of imprisonment (to counter COVID-19 pandemic situation) is the best solution if we look at it in from any perspective.
Did I not enjoin upon you, O children of Adam, that you not worship Satan – [for] indeed, he is to you a clear enemy –
May Allooh SWT give us, people in jihad, the ability to win against these Dark Rulers.
May it be beneficial,
Thanks to Tuswandi Ahmad Waly for his discussion and translation of this writing into English.