Modeling COVID 19: The Value of Practice

The necessity of developing models that effectively organize data for the purpose of translating basic science to clinical care is being increasingly recognized. Reliance upon digital computational methods restricts the value of natural experience reportable by patients, often considered subjective. In the course of modeling phosphate metabolism in the context of clinical practice it has become evident that use of categories based on normality, as definition of health, is inconsistent with the experience of patients. Given the opportunity, patients can provide detailed observations upon their experience of heat as the principle component of metabolism. It seems logical that heat should also be the foundational principal component of models developed for the translation of data to clinical care. This strategy has been applied to modeling the role of ACE2 in the expression of variable phenotypes of COVID 19. Attempts to engage massive data and super-computing to the modeling of COVID 19 supported the assumption that ACE2 is a critical component causing disease. The finding is attributed to an influence, not on heat, but instead suggested bradykinin that has long been a proposed explanation for ACE inhibition on chronic cough. Our modeling would posit that the ACE system engages aldosterone and subsequent influence on heat and acid/base balance as the mediators of variance in the expression of individual phenotypes. This clarification has been useful for addressing complexity in the presentation of metabolic disorders including thyroid disease, Diabetes, bone health, sleep disorders, vascular disease and Chronic Fatigue Syndrome. It appears that the risk of developing ARDS shares a predisposition to chronic kidney disease mediated by excessive FGF23 effects, while the asymptomatic spreaders are more Klotho dependent. The vitamin D system is also complex and involved in the modulation of heat and phosphate. These and other components can be extended to understanding bone and the hematopoietic marrow niche governing immune responses and includes a role for modulation of the microbiome influences by ACE2. It is concluded that SARS-CoV-2 has helped to clarify the complexity of biology and has exposed the limitations of modeling strategies that do not include the application of case-based practice that can be described as “model-dependent realism” 1 as a means to discover the principle components of nature. The models are the valued product of the research that is mandated by the Helsinki accords when outcomes do not meet expectations. These models can facilitate the organization of all data in the appropriate translation to clinical care. 1 Hawking S., Mlodinow L. The Grand Design p 39–59, Bantom Books NY, 2010