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Interview Today we talk with Doctor Jessie Stone, who created a clinic in Uganda on the banks if the White Nile to treat & prevent people from malaria and is therefore really aware of the use and effects of the chloroquine that we hear abou so much in thje news; Jessie also writes for kayak session in every issue and addresses issues that kayakers have to deal with. Last but not least jessie recovered from Covid19…in other words an extremely valuable point of view in today’s situation worldwide.

Published on mars 31st, 2020 | by Kayak Session https://www.kayaksession.com/img-current-issue/upload-your-video.png

Corona Diaries #9, Doctor Jessie Stone (Usa)

Outside, rivers are starting to flow and spring is around the corner, and the sun is shining high. Yet around the world, many are grounded at home and it seems likely others soon will be. Though difficult, let’s repeat it, folks this is THE THING TO DO! It is necessary and worth it!

So, we at Kayak Session decided to take the opportunity to catch up with our friends in the whitewater community and see how they are coping across the globe. Today we talk with Doctor Jessie Stone, who created a clinic in Uganda on the banks if the White Nile to treat & prevent people from malaria and is therefore really aware of the use and effects of the chloroquine that we hear abou so much in thje news; Jessie also writes for kayak session in every issue and addresses issues that kayakers have to deal with. Last but not least jessie recovered from Covid19…in other words an extremely valuable point of view in today’s situation worldwide.

You got corona virus – what was that like and how did you know?

12 days ago, Juerg (my partner)  and I got confirmation we had been exposed to corona. Many people in this part of Switzerland had already tested positive and several of them were his clients.  By symptoms alone, there was little doubt that we both had been infected – if not by known clients than by other circumstances or situations during that same time period. Many people in this area of Switzerland had been infected.   As the virus can exist on neutral surfaces like clothes, counter tops, shopping carts, tables, etc. for up to 24 hours, its makes this virus very easy to spread without knowing, as we all know now. Juerg and I had both been feeling a little short of breath with a sensation of “scratching on the lungs” as he describes it very aptly, more tired than normal with gurgling stomachs, but otherwise quite well and certainly not sick enough to stay in bed. As it turns out, our symptoms are classic for corona and indicative of a mild illness.

Jessie at home in Switzerland recovering from Covid 19.

It sounds like corona spreads so easily – are we all going to get corona? Does that mean we are all going to get really sick?

As statistics show, 83% of people infected with corona will have a mild illness or no symptoms. By the looks of things, most people will get infected. Everyone’s experience is going to be a little different, but the main point is that 83% of people that get the virus, mount a successful and effective immune response and recover from their corona virus infection with no sequelae. The bonus is they will be protected aka immunized from getting corona in its current form again.  They may or may not have symptoms of being sick. For each person, it is going to be a little different, but the classical symptoms will be common to most. The converse of this is that a small percentage of the population is at risk to get really sick, not the majority.

Who are the people most at risk of getting really sick from corona?

They are people who are diagnosed as immune compromised (HIV+ with low CD4 count for example), people on immunosuppressive therapy such as chemo therapy or long term systemic steroid therapy like asthmatics on long-term inhaled steroid therapy, elderly people with underlying health issues such as diabetes, cardiovascular disease, chronic obstructive or restrictive lung disease, and people who are long time heavy smokers. Elderly people in frail health are also at risk. There will be a few exceptions to this, but they will be exceptions, not the rule!

“The converse of this is that a small percentage of the population is at risk to get really sick, not the majority.« 

Why do we all have to limit our activities and contact so much? All of this seems very unnecessary!

Our job as the healthy proportion of the population is to help protect those more vulnerable people from getting sick by limiting our movements, exposure and spread of the virus. This is why these extreme measures are in effect almost everywhere. Since corona is a very smart virus, that is, it has figured out how to spread itself very well by keeping its host – us – in good shape, most of us will stay quite healthy and active and keep doing what we do and continue to spread corona while being simultaneously “ill”. Ebola by contrast is a dumb virus – its kills off its host quite quickly and cannot spread itself well – luckily for all of us – as ebola has a much higher mortality rate closer to 90% whereas corona’s is between 4-5%, what we are seeing around the world right now.

Wait a minute, what about Italy? There are so many sick people and dead people and people in their 40’s who died, I don’t understand?!

In countries like Italy whose health care systems are already overloaded, corona has pushed things over the edge. All the Italian hospital deaths are not just the results of corona – they are a culmination of a maxed out healthcare system (why the system is maxed before corona arrived is a subject for another time) who were experiencing many sick people from peak flu season, plus other serious illnesses plus corona on top of all that. All things converged at the same time and this is exactly why we have seen such terrible things unfold there. Right now is peak flu season – of the regular old flu that kills 650,000 people per year around the world. But because it’s a known commodity and we have a vaccine every year for it, people are not afraid of the flu. Though this known commodity can also be deadly for a similar segment of the population as corona, we are not afraid of it. It is important to remember that age is not the only consideration here. There are unfortunately many people who have cardiovascular disease and diabetes for example and are in their 40’s so are more susceptible to corona than say a perfectly healthy 65 year old with no underlying medical issues.

“Based on what we know from treatment regimens in Chinese hospitals that successfully treated corona, chloroquine and hydroxychloroquine – both formerly very effective antimalarial medicines, helped very ill patients with corona get better.”

What’s really scaring people?

Fear of the unknown is scaring the heck out of most people! This is to be expected, it is human nature! Think of the first time you run a river you have never seen before, especially if its difficult and there are consequences!  In the last 102 years, we have not seen or dealt with a pandemic so its natural we don’t know what to do.  We don’t know what will happen and we don’t have consensus on what works to treat corona though there are some good possibilities out there. Based on what we know from treatment regimens in Chinese hospitals that successfully treated corona, chloroquine and hydroxychloroquine – both formerly very effective antimalarial medicines, helped very ill patients with corona get better. We don’t have big numbers, but we do have some very positive results. And at a time like this, we need to start thinking preventatively, preemptively and outside the box.

Anti-malarian treament. Jessie has been running malaria  prevention & education campaigns in Uganda for the past  20 years
Anti-malarian treament. Jessie has been running malaria
prevention & education campaigns in Uganda for the past 20 years

You have been treating people in Uganda for malaria and other diseases for the past 15+ years; even creating a clinic out there! You are as a consequence really well aware of the malaria treatments such as quinine and chloroquine and their  effects. What is your take on chloroquine and hydroxychloroquine as we hear from some it is the miraculous treatment, and for others a vague option that needs to be proven still…? 

Malaria is the most common infectious disease we treat in at the Soft Power Health Clinic and has been since we started. It remains the biggest infectious disease killer in Uganda.  Malaria treatment has evolved considerable since I first worked in Africa 30 years ago guiding rafts on the Zambezi and substantially since I first came to Uganda in 2003. Chloroquine was the mainstay of malaria treatment and prophylaxis for a very long time until resistance by the malaria parasite developed. Chloroquine’s grandparent, quinine remains the treatment of last resort for malaria if all other treatments fail.  Chloroquine is still used today to help prevent malaria in a small subset of patients who have sickle cell anemia and its used in the developed world to treat people with autoimmune disorders such as rheumatoid arthritis and lupus. While both chloroquine and quinine have side effects and these are well known, in general, they are both well tolerated drugs, otherwise their use would not continue up to the present day. Their individual use must be decided on a case by case basis according to each person’s unique situation as evaluated by a doctor familiar with that person’s health.

“Their individual use must be decided on a case by case basis according to each person’s unique situation as evaluated by a doctor familiar with that person’s health.”

In mid-February, a paper was published in a medical journal that reported successful treatment of hospitalized patients in China who had corona virus with chloroquine. The authors recommended that future treatment regimens for corona virus should include chloroquine or its sister drug, hydroxychloroquine. As it turns out, anti-malarial medicines have been researched and continue to be researched as possible treatment options for viral infections in general. This is mainly because we don’t have anything else to help treat viral infections at the moment. The studies have provided some very positive results including the possibility that chloroquine and hydroxychloroquine can stop corona from entering the lungs and GI tract through its chosen portal of entry, ACE2 receptors in these tissues.

Vaccination against viral infections is definitely the best option to protect against getting sick, but at the moment, we don’t have a vaccine for corona apart from self vaccination ie getting infected and going through the 3-week prodromal period, illness, and recovery period, at which point you are effectively vaccinated against getting corona again in its current form!

“We have a good 6-8 weeks until this has really peaked around the world so we need to keep that in mind and take care of our mental and physical health and help those around us stay healthy.”

What can we expect going forward? Anyway to know how long this is going to last?

Worldwide there are, as of this writing, 788,522 recorded cases of corona and 37,878 deaths along with 166,768 recovered cases of corona. There are likely many more people infected who don’t know they have corona and/or have mild or no symptoms. Its entirely possible that they never realize they have corona but they can continue to spread the virus during the prodromal and active phase of the illness – even though they are not actively sick. These people – ie most of us – need to limit our behavior so we don’t keep spreading the virus.  We have a good 6-8 weeks until this has really peaked around the world so we need to keep that in mind and take care of our mental and physical health and help those around us stay healthy. Though the current number of cases and deaths is for today, the combined deaths due to the regular flu and malaria will likely kill more people. (Malaria reliably kills 1 million people – mostly children – every year). But both are known foes, easier to understand and not so scary.

What can we do to stay healthy and sane?

With limited ICU (intensive care unit) beds both in the developed world and in the developing world (Uganda has a population of 41 million and 15 ICU beds), we healthy people need to do our best not to add to the problem of ending up putting a burden on the healthcare system by hurting ourselves or infecting others. If you can go outside and not impact others negatively, do!  Staying sane, is really important. If you want to go paddling alone, for example, do something that involves very low risk. Depending on where you are, this might be a flat water paddle or a class 2 paddle or a park and play session, but make sure that you are doing something that you can easily manage and be sure won’t add to the burden of ending up at an already overloaded emergency room. Full disclosure, I went paddling alone last week on a very short class 2 float – I was trying to take care of my mental health and it did help a lot. I was careful not to come in contact with anyone though I passed people while driving!

For most people, the hardest part of all this is going to be taking care of your mental health while being mindful of your impact on others! 

Good luck and email us with any questions – Jessie will happily get back to you! Info @ kayaksession . com

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