More on Sweden, Plasma Therapy and Surgisphere

I have follow-up information to provide to you on three topics . 

The first relates to Sweden which has been one of the strongest proponents of a more progressive approach to coronavirus management. Their concept was to allow young people who have minimal risk from coronavirus to have wide freedom of movement, not social distancing, while protecting the elderly population which is at risk. This presumably would develop herd immunity more rapidly and prevent the economic shortcomings of restrictive social distancing.

I have been an advocate of something along these lines although I’ve emphasized that if you’re going to allow people at low risk to normalize their activity one has to be sure to protect people who are at risk.

Recently Sweden’s death rate has increased even in comparison to other European countries. The reason for this, however, was not the freedom afforded to young individuals. The Swedish prime minister, Stefan Löfven, told the Aftonbladet daily that the country’s overall approach “has been right”, but it had failed to protect care homes where half of all Sweden’s Covid-19 deaths have occurred. Anders Tegnell, head of Sweden’s program, stated they made mistakes in not protecting the elderly better.

Annike Linde, Tegnell’s predecessor as chief epidemiologist from 2005 to 2013, said last week that she had initially backed the country’s strategy but had begun to reassess her view as the virus swept through the elderly population. “There was no strategy at all for the elderly, I now understand,” Linde told the Swedish state broadcaster. “I do not understand how they can stand and say the level of preparedness was good, when in fact it was lousy.”

Clearly, if you’re going to broaden activities of people not at risk you need to make sure that people who are at risk are safe. No other place in the world has had half of their COVID deaths in nursing facilities!

A second update involves the use of plasma donations from recovered COVID patients to treat acutely ill coronavirus patients. The first major, placebo-controlled study of this approach was published in the JAMA yesterday. The study was cut short because the pandemic is reduced in China and did not show any statistically significant benefit from plasma as compared to placebo. Whether this was due to the early termination remains a topic of debate, but this was a well-done study otherwise and did not back up some of the wildly enthusiastic anecdotal reports on this treatment.

An accompanying editorial in JAMA from an advocate of plasma therapy highlighted some indications that there could be improvement in the treated group. Since there are significant side effects with this therapy, it would be important to definitively show benefit. In addition, human monoclonal antibodies against the virus are now being made and may provide a more effective adoptive antibody therapy in COVID-19.

Finally, concerns about Surgisphere’s activities, outlined in yesterday’s blog, have increased. 

An investigation in the Guardian (UK) Newspaper has revealed additional concerns about this company:

• A search of publicly available material suggests several of Surgisphere’s employees have little or no data or scientific background. An employee listed as a science editor appears to be a science fiction author and fantasy artist. Another employee listed as a marketing executive is an adult model and events hostess.
• The company’s LinkedIn page has fewer than 100 followers and last week listed just six employees. This was changed to three employees as of Wednesday.
• While Surgisphere claims to run one of the largest and fastest hospital databases in the world, it has almost no online presence. Its Twitter handle has fewer than 170 followers, with no posts between October 2017 and March 2020.
• Until Monday, the “get in touch” link on Surgisphere’s homepage redirected to a WordPress template for a cryptocurrency website, raising questions about how hospitals could easily contact the company to join its database.
• Desai has been named in three medical malpractice suits, unrelated to the Surgisphere database. In an interview with the Scientist, Desai previously described the allegations as “unfounded”.
• In 2008, Desai launched a crowdfunding campaign on the website Indiegogo promoting a wearable “next generation human augmentation device that can help you achieve what you never thought was possible”. The device never came to fruition.
• Desai’s Wikipedia page has been deleted following questions about Surgisphere and his history, first raised in 2010.

The Wall Street Journal also wrote an editorial on the study as they felt it had been used inappropriately as a political weapon against the Trump administration and argued for science to be independent of politics; an appropriate goal.  As I was posting this the other authors not associated with Surgisphere have retracted The Lancet publication.

On the other hand, scientific data around hydroxychloroquine did not get better as a large study in the New England Journal evaluating if it could be used prophylactically to prevent COVID showed no evidence of efficacy.

Although again there were concerns about how the study was performed, in an accompanying editorial Dr. Myron Cohen of the University of North Carolina at Chapel Hill wrote that the results “are more provocative than definitive,” and the drug may yet have prevention benefits if tried sooner or in a different way.