KANSAS CITY, MO. – During the coronavirus (COVID-19) pandemic, it has become standard practice for many people inside the meat industry and beyond to contact colleagues, friends and family to find out how they are coping with the “new normal.” Working from her home in Fort Collins, Colo., Temple Grandin, PhD, the world’s leading expert on animal welfare, recently shared her experience and unique perspective during the global crisis.
The longtime author of MEAT+POULTRY’s “From the Corral” column and professor of animal science at Colorado State University said that even in early March, well before many states issued “shelter-in-place” mandates and while many people were still traveling, she began practicing social distancing, especially in airports and at her many book-signing events. Since then, all her scheduled appearances and presentations have been canceled, postponed or have been adapted to web-based video platforms. She transitioned her CSU classes to an online learning format including video-based lectures made just before the campus closed. Her last in-person appearance was March 11, and since then she’s been grounded and is sheltering in place.
More time at home has given her time to work ahead on other projects, such as writing her next book. She’s also immersed herself in following the ever-changing COVID-19 coverage, and more importantly, scouring pharmaceutical research and websites to learn all she can about possible treatments for the virus. At 72 years old, Grandin is considered high-risk for being infected with the virus and she is searching for a treatment that could save her life.
“I’m in maximum problem-solving mode,” she said, and as a visual thinker she is using her unique perspective to formulate solutions, almost obsessing about finding a successful treatment for COVID-19.
“I’m looking for what can we use that already exists,” she said of the medications she is researching that have been used to treat other diseases.
“What are the drugs that are already on the shelf that we can use?”
She agreed to share her personal experience during the COVID-19 outbreak and what she’s learning that she hopes could save her life and possibly others.
MEAT+POULTRY: How are you coping with the coronavirus?
Temple Grandin: All my trips have been canceled and all non-essential stores around my home in Fort Collins are now closed. These measures will slow the spread of the coronavirus and prevent the hospitals from becoming overwhelmed. Staying home has given me the opportunity to spend hours surfing the internet to look at the use of existing drugs and repurposing them to treat COVID-19.
M+P: You are a prolific problem solver and a visual thinker. When you read updates about COVID-19 and think about possible solutions, how is it similar to how you approach your work and are you worried about what people might say about your qualifications for offering solutions?
Grandin: In my equipment design work, I have always told myself to “think simple.” I think about the whole system and I’m putting a lot of pieces together. I think about what can we use that already exists? Some people may say to me: “You are not a medical professional so you should not be discussing this.” I’m not a medical doctor but I am a scientist. The other qualifications I have are a bottom-up approach to problem solving and the ability to use visual analogies to solve problems. When a bottom-up approach is used, bits and pieces of data are put in categories to form the hypothesis. If this bottom-up approach to problem solving works, it may prevent deaths and the need for respirators.
M+P: So how does bottom-up thinking work regarding possible solutions for COVID-19 and when can you expand on what you mean by using medications that already exist?
Grandin: There are several promising candidates, such as hydroxychloroquine, an old malaria drug and Kaletra (lopinavir/ritonavir), a drug used to treat HIV. The Centers for Disease Control and Prevention (CDC) states that hydroxychloroquine and chloroquine are recommended for hospitalized COVID-19 patients in several countries. An early trial with Kaletra indicated that it did not work. There may be a simple reason for this. The drug was given to COVID-19 patients after their lungs were damaged. The whole point of using drugs is to prevent patients from progressing to the stage where they would need a respirator. Kaletra may work if it had been given after a positive COVID-19 test, before the patient got really sick. This is the same way this drug is used to prevent a person who is infected with HIV from becoming very sick. Andrew Cuomo, governor of New York, recently authorized using hydroxychloroquine and the antibiotic Zithromax azithromycin as a treatment for COVID-19. There are two ways that medications can fight COVID-19. They include using anti-virals that stop the viral invasion and medications that stop inflammation that can damage the lungs.
M+P: So where does your visual thinking come in to play?
Grandin: I use a visual analogy of how medications could work against COVID-19. Imagine that inside your body, there is a military base and your immune system contains your soldiers who defend the base and fight invaders. COVID-19 viruses are the enemy. An anti-viral drug fights the attackers and hopefully stops them before your military base and your body is completely invaded. People who have mild cases of COVID-19 may have soldiers – immune system – who successfully fight off the invader. If your body becomes overrun with numerous COVID-19 viruses, inflammation of the lungs may start. Why does this occur? Unfortunately, some of the soldiers in your immune system are stupid and when they get overwhelmed, they go crazy and start to burn down the barracks and trash the military base.
If an anti-inflammatory drug is going to work, it has to be given before the military base and your lungs are completely wrecked. Anti-inflammatory drugs would force your crazy soldiers to stop and “stand down.” There is no drug that can repair your lungs after your crazy soldiers have severely damaged them. It probably has to be given when the first barracks is burned before they wreck everything.
M+P: What are some of the existing medications that are already on the shelf that show promise?
Grandin: There are a number of old drugs that are candidates for repurposing. The $50-million question is, which ones? The gold standard of traditional clinical trials will be too slow. There are two ways to solve problems. There are top-down methods such as formal clinical trials and there are bottom-up methods where doctors determine which drugs work based on experience. Bottom-up thinking is the way that computers equipped with artificial intelligence solve problems. The hypothesis is formed from the data, by using specific examples to form concepts.
The bottom-up approach should only be used for existing drugs that are being repurposed. When an existing drug is used, doctors will know the specific safety issues associated with the drug. The repurposed malaria drug has some serious safety warnings but so does Tylenol (acetaminophen). An overdose of either one can be deadly. Formal clinical trials are essential for totally new drugs and vaccines because doctors do not know the safety issues associated with them. One example is mixing alcohol with Tylenol. It is a dangerous combination. The World Health Organization is also using the bottom-up approach. They formed a database where information on the individual patient outcomes of different drugs can be inputted. They are especially interested in Kaletra and a drug used to treat Ebola. At first, they did not want to include chloroquine or hydroxychloroquine. They had two concerns. There are shortages of the drug for treating malaria and rheumatoid arthritis and toxicity. Both types of chloroquine may be dangerous for people with health problems. Using my analogy of the military base, Kaletra should be given early to defend your body. Since chloroquine can be toxic, it would be given when inflammation first starts, before the lungs become severely damaged.
M+P: What other ideas or tools do you see helping in developing a solution for this crisis?
Grandin: The tech industry could make a phone app where health care providers and patients could input data. The interface should be simple. A statistics program would sort the data into three outcome variables: complete recovery; recovered with lung damage; or fatality.
The data that would be entered would be age, sex, pre-existing health problems (yes/no), treatment drugs and doses used and stage of illness when medications were started. The three choices on the menu of the app would be simple, just like the criteria is for the animal welfare audit I developed:
No evidence of breathing difficulties; starting to have breathing difficulties or shortness of breath; and severe lung problems requiring oxygen or a respirator. When data from hundreds of patients is put into the computer using the app, it could be sorted into categories. Mathematics is used to sort the data into drug treatments that work and ones that do not work.
That’s bottom-up thinking.