Holiday Injection … Done! Getting “Pfizered” for Greece

 

Some parts of the world are trying to get back to some sort of Covid normal, while others are in crisis.  Where we live 40% have been vaccinated and likely 50% have already had the virus.

Monty, aged 17 with ASD, is a big fan of swimming in the sea and where we live that means crossing borders.  Crossing borders is much easier if you have had a Covid-19 vaccine and it looks like for children the best option is the one from Pfizer-BioNTech.  BioNTech is the clever company set up by a Turkish husband and wife team in Germany. They licensed their vaccine to Pfizer for distribution outside of China, in China they have a deal with Fosun Pharma.

Last week Monty had the opportunity, at very short notice, to go and get the Pfizer inoculation. I collected him from school and took him to a clinic in the city centre, that he has never been to and which undoubtedly would have a long line of people queuing outside it.

Monty knows all about injections and syringes, courtesy of his dental marathon a couple of years ago. He even knows about antibodies from Biology classes. The most rational explanation I came up with while driving, for why he was going to see the “doctor” was that it was for his “holiday injection”.  Monty’s school assistant had some more scientific explanations, but the problem is then you are left wondering why you still need to wear a mask at school, after you have been “Pfizered”.

“Do you like swimming in the sea, on holiday?” …   “Yes” was reply.

“This year, because of Covid, you need to get a holiday injection in your arm.  It doesn’t hurt and we’ve all had ours.”

“After 2 holiday injections, you’re ready for summer holidays.”

Bad news became good news.  Holidays … nice!

 

Children traveling without a covid Vaccine

In many cases children can travel without a covid vaccine, but you may need a PCR test before the trip out and the trip back.  You might well develop covid whilst you are abroad and then you are stuck.

A classmate of Monty was traveling with his vaccinated parents and the border policeman was not sure whether to let him through, since he had no PCR test, or vaccine certificate.

The Pfizer vaccine does look the best choice for a healthy 17-year-old.  For them, safety is more important than efficacy, because they are at almost zero risk from the current variants of the virus.  This may very well change in the coming years.

  

Covid risk for those with autism

Whether you are at elevated risk from Covid depends on what kind of autism you have.  I think my son is at even lower risk than his peers; he very rarely gets sick and another reason is his steroid inhaler for asthma; this actually reduces the chance of mild covid becoming severe covid.  Steroids are now widely used in hospital treatment, but really should be started before you even think about going to hospital.

People with MS (multiple sclerosis) taking disease modifying therapy may be another group who are protected from severe Covid.  These therapies block the cytokine storm that takes you from mild covid to severe covid.  The studies are somewhat contradictory, so you can believe whichever you want.   

The expensive drug Remdesivir, was approved as a therapy even though it has no effect on mortality, which makes you seriously wonder about its benefit.  Not surprisingly, the cheap oral steroid drug, Dexamethasone, substantially reduces mortality.

What happened to hydroxychloroquine (HCQ) and Didier Raoult, the French Professor who promoted it?  He still thinks he is right, even though great efforts were made to prove him wrong, including using data later shown to have been faked.

A recently published study looking at 28,759 adults with mild COVID 19 in Iran actually supports Raoult:

https://www.sciencedirect.com/science/article/pii/S1567576921002721

Early administration of HCQ reduced the odds of hospitalization by 38%.

Early administration of HCQ reduced the odds of death by 73%.

Serious HCQ adverse drug reactions were not reported in any of the age groups with or without comorbidities.

 

Does hydroxychloroquine have an anti-viral benefit in Covid-19?  Only you can decide.  The scare stories about dangerous side effects were evidently grossly overstated, which makes you wonder what else was made up by the naysayers.

I think this shows that you can find data to support whichever side you favour.  This seems to happen quite often, when a medical issue becomes politicized.

My own Covid therapy was hydroxychloroquine as the antiviral, to which I would have added prednisone if necessary.  As a local doctor told me, you do not want to go to hospital with Covid.

Back to autism.

Some types of autism are associated with comorbidities elsewhere in your body.  These can include problems with your lungs, as in the case of Down syndrome. If you have Prader Willi syndrome, you will present with autism and obesity.  The obesity is the covid risk.

Intellectual disability is put forward as a Covid risk, which makes sense.  People with ID/MR are likely to live in group homes or institutions, where they may be exposed to the virus and they may not follow all the protective measures.  People taking psychiatric drugs are likely to be overweight, which is a bigger risk factor than age.  People with ID/MR are likely to get worse healthcare than typical people, even when there is no health crisis.  The study below seems very credible'. 

After old age, intellectual disability is greatest risk factor for death from COVID-19, study finds

The results showed that those with intellectual disabilities were 2.5 times more likely to contract COVID-19, were about 2.7 times more likely to be admitted to the hospital and 5.9 times more likely to die from the infection than the general population.

Nowadays most people diagnosed with autism do not have any intellectual disability, so it makes sense that in some countries they have made people with intellectual disability, rather than just autism, as a priority group for vaccination.  

On a practical level, an overstretched hospital is not going to be a good place for an adult with intellectual disability, with or without autism.  They should indeed be prioritized for vaccination

When it comes to autism parents there seem to be three groups: -

1.     Desperate to get the vaccine

2.     Desperate to avoid the vaccine

3.     Desperate to go on holiday

 

 

 

 

Spring in Beijing

The Great Wall of China, two hours north of Beijing

Monty, now aged 15 with ASD, continued his travels recently with an Easter visit to China. Long haul travel can be much more demanding than shorter trips because of the change in time zone and simply the fact that you are stuck on the plane for such a long time.

Many people with autism, and indeed Asperger’s, have problems with air travel, while some other people even with severe autism have no issues whatsoever.  Some people with severe autism never go on holiday, travel being such a problem.  Some people repeat the same holiday every year.  It does not really follow any pattern.

One issue I came across at the recent conference in London was that some people cannot even consider a far-away medical specialist or enroll in a clinical trial, due the travel required.  But what to do if the autism doctor does not make house calls? Some people do take their child thousands of miles to see a specialist, but many cannot.

Monty has been flying since he was a baby, but he did have his share of problems from time to time.  For the last few years, with autism under control with his Polypill, travel has not been difficult. The only issue remaining is not really an autism issue, it is an ear popping issue. Some people’s ears just do not seem to pop after changes in air pressure and it does not matter what tricks you use, it can take a few hours for ears to go back to their normal state.

Random enhanced airport security checks very often seem to select Monty; even that is no longer an issue.  China has automated fingerprinting and facial scanning/recognition at the airport, so you have to follow the instructions carefully.

The only issue Monty had with the plane was not being willing to lock himself in the toilet. He expects something larger and with a proper door, not one that folds in the middle. No bumetanide the day of a long flight.

In-flight entertainment was fully appreciated along with all the food you get in nice little packages when you travel long haul.  For kids it is like a 10 hour party, full of surprises, like the unexpected ice cream and chocolate bars.

On arrival in Beijing we found that four people with three bags was too much for the local taxis.  Soon this became four bags and we became a two taxi family.  In Shanghai, which is much more market-driven, we all fitted in a single taxi, as we do everywhere else in the world.

Trains and the metro/underground/subway are excellent in China. The high speed trains run at 330 km/h (200mph) and within big cities the public transport is excellent. All the motorbikes/scooters are electric and the bicycles that were omnipresent when I first visited Beijing have pretty much disappeared.

I was asked how I manage Monty’s Polypill while traveling. It mainly remains the same, I just omit one or two things for practical reasons. For example, I took the Ketoforce liquid BHB, but omitted C8 caprylic acid. Next trip I will bring the C8 as well.

On our trip to Israel where they rummage through all your checked baggage before your departing flight looking for explosives, it was clear they had looked in detail at Monty’s supplies, but it was no issue.

Food in China is different and Chinese food in China is not quite like the Chinese food outside China.  The Chinese do like fried chicken and KFC is everywhere. That was appreciated by Monty and his big brother.

Monty likes noodles, rice and all kinds of soup, so eating was not a problem.

China blocks many Western internet sites like Google and Facebook, so if you are a fan of YouTube like Monty, you need to use a VPN (Virtual Private Network); but we knew about this in advance.

There are plenty of interesting things to do and see in China and independent travel really is very easy, as long as you do not expect people to speak English. In big cities many of the signs are in Chinese and English.

Monty’s big brother is a fan of military history, so we paid a visit to Beijing’s military museum. It is vast and even though it is packed with exhibits, it feels very spacious. They have a U2 spy plane that they reassembled after shooting it down over China, and a photo of it lined up with three others they shot down and reassembled. That was something new to me, I only knew about Gary Powers, the US pilot of a U2 shot down over Russia.  

The U2s were operated for the Americans by the Taiwanese in the Black Cat squadron. In the early 1960s they were flying over mainland China and the Chinese shot several down.  The pilots who survived had to wait till 1982 to go home.  China still wants to get Taiwan back.

The indigenous population of Taiwan were not Chinese. After a period of rule by the Dutch, came rule by China and mass immigration in the 17th century. Today only 2% of the population are indigenous.

China lost Taiwan to Japan in 1895. After being a Japanese colony for 50 years, when world war two ended the Chinese took back control of the island.   At the end of the 20 year civil war in China in 1949 the Communist Party of China (CPC)  held the mainland and the Kuomintang (KMT)-led government of the Republic of China (ROC) fled to Taiwan. China regards Taiwan as a renegade province that must be reunited with the Mainland.

Taiwan’s tallest mountain, Yu Shan, was renamed by the Japanese as Mount Niitake (meaning “New High Mountain”) because it was taller than Mount Fuji, back in Japan proper.

"Climb Mount Niitaka" was the coded order for the Japanese to attack Pearl Harbour in 1941.

I think most foreigners are not aware of Japan’s role in China, particularly in the 1930s and up to 1945. Some pretty evil things went on under the Japanese occupation of Manchuria in 1931 and later when they invaded much of the rest of China, killing tens of millions of civilians, but it does not stop today’s Chinese wearing Japanese branded fashion or driving a Toyota.

I was surprised to see quite so many luxury German cars, they seemed to be much more prevalent in Beijing than Berlin; and many were the stretched versions, to give the rear passenger more space.

There really are a lot of counterfeit products, ranging for full-sized lookalike copies of Porsche and Audi cars, to fake Lego Starwars toys. In central Shanghai the western people are constantly targeted by people selling fake Rolex watches and copies of branded handbags.  It looks like the Chinese are buying the real thing, while the younger foreigners are buying their $50 “Rolex”.  There are still relatively few foreigners in China, so in most places you are a curiosity. At the summer palace in Beijing, some teenage girls wanted Monty’s big brother to pose for a photo with them and some parents did encourage their young children to come for a close up view of the gweilo (westerners).

On my last visit to China it was the vast open spaces of Tibet in the West of China that were most impressive. During that trip in the late 1980s, which was rather more adventurous, the Chinese were still making steam locomotives and I still have a certificate from the steam engine factory in Datong that I rode in the cab. Now China has 18,000 miles (29,000 km) of high speed train lines, with more added every day. Back then for $60 I took the train from Beijing to Berlin, via Siberia. I expect it costs rather more these days.

This visit to China I was sitting with Monty on the train getting him to practice his geometry schoolwork while looking out the window at long rows of 30 storey/story  apartment buildings in cities I had never heard of.  

This time we did not make it to Hong Kong, but it is well worth a visit, because it was shaped by its colonial history and also most people do not need a visa.  Foreigners also like it because many people speak English. 

Compared to the huge mega cities in mainland China, Hong Kong has a mere 7 million inhabitants.  Being an island just across the mainland definitely adds to its charm, like Istanbul and the Bosphorus.

More speech

Speech is often a limiting factor in people with autism and very likely needs some help from biology. This is not a simple process, there is no magic supplement to trigger fluent speech.

My current effort is boosting the effect of bumetanide to lower chloride within neurons. Potassium Bromide does do this, but does produce acne spots, which has long been known to be the main side effect.

I am hopeful that another diuretic, Azosemide, will be more potent than Bumetanide at blocking NKCC1 transporters in the brain. It seems to cause minimal diuresis, which is the main side effect of Bumetanide. I found giving Bumetanide was most effective with a larger single daily dose, which is given on waking due to the diuresis caused.  Adding an evening dose of Bumetanide did not seem to have much/any additional effect and causes a second round of diuresis.  An evening dose of Azosemide does seem to produce an incremental cognitive effect and without diuresis.  It is still early days in my investigation.

Some of yesterday’s unprompted speech:

“Monty went to China and came back on the big plane from Beijing. Monty was swimming in the swimming pool and his ears popped !”

The first thing Monty did after returning from the airport was to jump in the swimming pool. That's one way to unblock your ears.

Delayed ear popping clearly is a subject currently on Monty’s mind. The reason turned out to be his upcoming school trip to the mountains; he wanted reassurance that there would be no ear popping involved. The trip is by bus and the mountains are not so high, so no danger of ears popping.

More opinions

As was discussed in a comment with our reader Maja, one effect of a low dose of clemastine, an old OTC antihistamine that also improves myelination, is the emergence of opinions. This is very noticeable. Today “I want scrambled eggs for breakfast”. The previous day he both asks and answers the question:  “what do want for breakfast? … Pancakes”

Rather than repetition, rituals, or just repeating the last part of the question as his answer, now we have opinions. No longer the docile/passive child, he now acts like a teenager with opinions and his own requests.

Conclusions

You may not have to stay close to home if you have a child with Classic Autism.

I think it pays to start travelling early. Nobody is too bothered about a screaming 3 year old, autistic or not; they may not like it and may make comments about bad parenting, but that is all.  It is soon forgotten.

A screaming teenager might get you thrown off the plane, or worse.  So best to start young. Travelling by plane is just another skill to master, like having a haircut or going to the dentist.

If you can reduce biological causes of anxiety, with targeted pharmacotherapy, traveling gets much easier. Once you have figured it out, you just need to carry a little pill box in your pocket to ensure a smooth journey.