Encephalitis may explain the high COVID-19 deaths in China

Posted on by Jesse Santiano, M.D.

This article presents a study that may explain China’s high number of COVID-19 deaths. In the end, you will find a drug that can prevent that.

France News 24 reported a morgue filled with the dead. The Tweet below says, According to experts, China totals 9,000 #Covid_19 deaths per day.

Jennifer Zeng’s Twitter also reports the massive backlog of bodies that need cremation. The excess deaths have been so high that there are 2400 cases where people have resorted to burning their deceased relatives by themselves.

A hotel is being converted into a crematorium with 200 cremators.

What is causing the deaths? There were even rumors that the original stain had come back. This prompted the World Health Organization to ask China to share more information on Dec 2022.

SARS-CoV-2 Omicron subvariants in China

As per request, China shared more than 2000 genomes. On Jan 10, 2013, GISAID (Global Initiative on Sharing Avian Influenza Data) presented the latest report about genome sequence data.

Source: GISAID

According to the World Health Organization’s Technical Advisory Group on Virus Evolution, BF.7 and BA.5.2 account for 97.5% of COVID-19 cases in China.

BF.7 and BA.5.2

The Omicron BF.7 is highly infectious. Global Times quoted  Li Tongzeng, a medical expert at Beijing’s Xiaotangshan Hospital. According to Li, BF.7 has “more immune escape capability.”

The basic reproduction number (R0) for Delta variant is around 5 to 6, that of Omicron BF.7 has exceeded 10.

R0 is the secondary attack rate and represents the number of people that can be infected with one case. The R0 of the current Omicron BF.7 in Beijing can reach anywhere between 10 to 18.6 persons, according to Li.

BF.7 is short for BA.5.2.1.7 – a sub-lineage of the Omicron variant BA.5 and was first detected around the globe in July 2022.

Researchers from the Center for Retrovirus Research of The Ohio State University found that the BF.7 and BQ.1, BQ.1.1, BA.4.6, and BA.2.75.2 could resist the neutralizing antibodies from 3-dose vaccinated healthcare workers, hospitalized BA.1-wave patients, and BA.4/5-wave patients.[1]
Sinar Daily reported that BA.5.2 was first detected in China in a 49-year-old Chinese male who had arrived in Shanghai from North Carolina, US. He received three doses of Moderna’s mRNA vaccines in the U.S.
In Yanqing district, he caused an outbreak with 16 cases within seven days involving 12 males and four females; 12 received a booster shot, and four were not vaccinated.
A study showed that BA.5 displayed increased evasion of neutralizing antibodies from triple-vaccinated individuals and individuals who developed a BA.1 infection after vaccination. (Natural and vaccine-induced antibodies)[2]
However, mutations that increase transmission does not necessarily mean increased lethality. Recall that the BF.7 and BA.5 are Omicron subvariants.
When it first came out, Omicron was known to have a low infection fatality rate. That is because it typically does not infect the lungs to cause pneumonia but stays in the upper respiratory tract to make it more infective.
I talked about that in my previous articles;  

BA.5 causes encephalitis and has a higher mortality

This brings us to the featured study of this article, Omicron BA.5 infects human brain organoids and is neuroinvasive and lethal in K18-hACE2 mice. The preprint study was released in December 2022.[3]

BF.7, aka BA.5.2.1.7, is a sublineage of BA.5. In the study; the researchers inoculated Omicron BA.5 into mice humanized with ACE2 receptors (K18-hACE2). 
They found that BA.5 can easily infect the mice’s brains, particularly the cortex, and cause encephalitis and death in all mice. This lethality is similar to the ancestral SARS-CoV-2 in the early part of the pandemic.
It is interesting to note that there were fewer isolates of BA.5 in the brain compared to the ancestral isolate, even though it is more invasive.
They also infected a human organoid brain to know if encephalitis could also happen to humans. Results showed inflammation of the brain cells.[3]
Harvard University defines an organoid as tiny, self-organized three-dimensional tissue cultures derived from stem cells.
Their findings show that even though the Omicron BA.7 has fewer respiratory symptoms, its ability to cause disease in the brain makes them deadly.

TMPRSS2

In their discussion, Stewart and colleagues mentioned that a drug that can inhibit TMPRSS2 could block the entry of BA.5 (BF.7) into the brain and potentially prevent damage or death.[3]

Transmembrane serine protease 2 (TMPRSS2) is a cell surface protein that the SARS-C0V-2 uses to enter and infect human cells. Omicron variants tend to use TMPRSS2 more than ancestral variants.

One drug that can inhibit TMPRSS2 is nafamostat which is a prescription medicine. However, there is an over-the-counter drug that can do the same.

Bromhexine

Bromhexine is a mucolytic commonly known as Bisolvon™. It is available without a prescription. Studies have shown the efficacy of bromhexine against SARS-CoV-2.

A randomized controlled trial by Ansarin et al. on 78 patients showed that the early administration of oral bromhexine 8 mg three times a day plus standard of care reduced intensive care unit transfer, intubation, and mortality rate in patients with COVID-19.[4]

Another study combined bromhexine 8 mg 4 times daily and spironolactone 50 mg daily in patients with mild and moderate COVID-19. Spironolactone is a prescription water pill.[5]

Their result showed faster clinical recovery and lowering of the fever, lower viral loads, and shorter hospital stays. [5]

The third research was conducted in Spain when the BA.5 was predominant.[6]

It assessed the effect of bromhexine in those with mild to moderate COVID-19 symptoms. They conclude that there is no difference between the bromhexine and the control group’s viral load on days four and 14.

However, when I read the body of the report, I found that the control group had more episodes of ageusia or loss of taste and joint pains.[6]

Notably, one subject in the non-bromhexine group had to be admitted to the hospital due to worsening COVID-19 and severe lung clots!

To me, the study looks like a win for bromhexine. The third study reminded me of a hit study against ivermectin. I wrote about it in The many problems of the Ivermectin study in the NEJM.

I wrote about the benefits of Bromhexine for COVID-19 on Dec 29, 2021 — Bromhexine for COVID-19

For some crazy reason, bromhexine is not available in the US, even though it is available in many countries. You can look up the brand names of bromhexine in your country at Drugs.com.

Right now, the percentage of BF.7 is still low in the US at 1.6 to 3%. to

Source: https://covid.cdc.gov/covid-data-tracker/#variant-proportions

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References:

  1. Qu P et al. Enhanced neutralization resistance of SARS-CoV-2 Omicron subvariants BQ.1, BQ.1.1, BA.4.6, BF.7, and BA.2.75.2. Cell Host Microbe. 2022 Nov 22:S1931-3128(22)00568-6. doi: 10.1016/j.chom.2022.11.012. Epub ahead of print. PMID: 36476380; PMCID: PMC9678813.
  2. Cao Y et al. BA.2.12.1, BA.4 and BA.5 escape antibodies elicited by Omicron infection. Nature. 2022 Aug;608(7923):593-602. doi: 10.1038/s41586-022-04980-y. Epub 2022 Jun 17. PMID: 35714668; PMCID: PMC9385493.
  3. Stewart R et al. Omicron BA.5 infects human brain organoids and is neuroinvasive and lethal in K18-hACE2 mice.
    bioRxiv 2022.12.22.521696; doi: https://doi.org/10.1101/2022.12.22.521696
  4. Ansarin K et al. Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial. Bioimpacts. 2020;10(4): 209-215. https://doi.org/10.34172/bi.2020.27
  5. Yu M et al. Results of Open-Label Non Randomized comparative Clinical Trial: “Bromhexine and Spironolactone for Coronavirus Infection Requiring Hospitalization. Cardiology. Vol. 60. No. 11
  6. Vila Méndez ML et al. Efficacy of Bromhexine versus Standard of Care in Reducing Viral Load in Patients with Mild-to-Moderate COVID-19 Disease Attended in Primary Care: A Randomized Open-Label Trial. J Clin Med. 2022 Dec 24;12(1):142. doi: 10.3390/jcm12010142. PMID: 36614943; PMCID: PMC9821213.

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2 Replies to “Encephalitis may explain the high COVID-19 deaths in China”

    1. Thanks for the question, doctor. I wrote an article about your question. The short answer is yes.

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