Testing, Masks and Current Outbreaks
Here is the newest update of highly relevant information on COVID-19 pandemic and perspectives on how we can all keep safe with COVID-19.
Please visit our website www.rezilirhealth.com daily for up to date information from Dr. Tanio.
The cheaper and more widespread testing can come the better. Multiple announcements happened over the last week on the availability of point of care testing within 15 minutes which promises to be a gamechanger. We need to distinguish between PCR based testing which can tell us who immediately is infectious, and IgG and IgM based testing which can tell us who is immune. But economics and innovation and working to get cost low and availability high. Things are changing quickly. We absolutely need to have the resources and change so that every citizen can get tested at the front line when we need it. We aren’t there yet, the technology is available and now we need to ramp up production.
Multiple country experiences – Hong Kong, Singapore, Czechoslovakia – are showing us that wearing masks in this outbreak is a sign of social altruism and effective social policy. Being kind to your neighbor is so critical as social policy and social cohesion. Much of the controversy around who should wear masks stemmed from the fact that health care masks were in shortage and experts wanted to allocate supply to health care workers. Well, people can still create homemade masks which can help to reduce at least 70% of spread if not more. 70% is far better than 0%! Even more importantly, wearing masks when you are outside of the home can help to keep everyone in the community aware that we all have to do our part to prevent the spread of this disease.
Preventing outbreaks is a local, national and global issue:
Map data is rapidly showing us that the outbreak issue is a global issue, a national issue and most importantly a local issue. What happened in Lombardy, Italy is dramatically different than what happened in Rome, Italy. Queens and Brooklyn are the epicenter of the global outbreak, but data in New Orleans, as well as South Florida, are also concerning. In other parts of the country, the data is quite different.
The rapid increases and doubling in cases every 2-3 days shows that we have not leveled the curve yet. In some areas there are hints that social distancing is working but we still premature.
What is clear is that prevention strategies will have to dramatically vary by region of the country – at the state and county level.
Multiple companies are showing ingenuity and innovation on increasing the supply of ventilators and the supply chain is being ramped up. Specific individual regions are taking steps to create additional hospital ICU beds capacity is being created quickly.
THE CRITICAL TWO ISSUES: There are two issues that are critical for us to solve to effectively manage Covid-19 before we can get a vaccine which likely won’t happen for another 12 to 18 months.
Treating the Virus and reducing its complications
We need to effectively treat the complications from the virus – rate of hospitalization, rate of ICU admissions, and fatality rates. There are some early signs that certain countries have lower complication rates, e.g., German. If this rate can drop significantly in the next 3 months, it can save thousands of lives AND help the economy. The way this can happen is for the medical community to collectively work on helping patients recover once they are effective.
In this week, we have seen significant and rapid progress on this front.
1. Integrative treatments:
There is a good article that was published this week discussing how integrative treatments can support the immune system. As the authors point out “Unfortunately, no integrative measures have been validated in human trials as effective specifically for COVID-19. Notwithstanding, this is an opportune time to be proactive. Using available in-vitro evidence, an understanding of the virulence of COVID-19, as well as data from similar, but different, viruses, we offer the following strategies to consider. Again, we stress that these are supplemental considerations to the current recommendations that emphasize regular hand washing, physical distancing, stopping non-essential travel, and obtaining testing in the presence of symptoms”.
2. Chloroquine and Azithromycin.
There was updated data on the French nonrandomized observational trial of chloroquine and azithromycin. The author, Dr. Didier Raoult reports that in 80 in-patients receiving a combination of hydroxychloroquine and azithromycin, the team found a clinical improvement in all but one 86 year-old patient who died, and one 74-year old patient still in intensive care unit. Most of those patients were treated early in their course. The team also found that, by administering hydroxychloroquine combined with azithromycin, they were able to observe an improvement in all cases, except one. The team went on to say: “Thus, in addition to its direct therapeutic role, this association can play a role in controlling the disease epidemic by limiting the duration of virus shedding, which can last for several weeks in the absence of specific treatment. In our Institute, which contains 75 individual rooms for treating highly contagious patients, we currently have a turnover rate of 1/3 which allows us to receive a large number of these contagious patients with early discharge. Chloroquine and hydroxychloroquine are extremely well-known drugs which have already been prescribed to billions of people.” “In conclusion, we confirm the efficacy of hydroxychloroquine associated with azithromycin in the treatment of COVID-19 and its potential effectiveness in the early impairment of contagiousness. Given the urgent therapeutic need to manage this disease with effective and safe drugs and given the negligible cost of both hydroxychloroquine and azithromycin, we believe that other teams should urgently evaluate this therapeutic strategy both to avoid the spread of the disease and to treat patients before severe irreversible respiratory complications take hold.”
We await good randomized trials on this treatment which are critical to advancing the science. They must happen.
In a future post, we will discuss the ethics of treating patients without a randomized double bind clinical trial. Needless to say there was been huge variability in state leadership around hydroxychloroquine which has ranged from the governor of Michigan threatening doctors licenses if they prescribed hydroxychloroquine compared to the governor of Florida who made a deal with Teva Pharmaceuticals to provide compassionate use of the drug to local hospitals in South Florida.
3. Remdesivir. The next Remdesivir data should be due in mid-April from China. It is pharmaceutically designed to inhibit Ebola RNA-Dependent RNA polymerase, which is 96% identical to SARs-COV-1. The article below shows the biological data on how Remdesivir works against SARS-CoV-2 in cells.
The most important data we can watch over the next few weeks is whether the combination of all of these therapies can reduce the complication rate.
We will keep you posted. Keeping Healthcare Workers Healthy Our healthcare workers are doing heroic work in this pandemic. Doctors, nurses and staff are all working around the clock to help people. They are also incredibly vulnerable at this time. The shortage of Personal Protective Equipment (PPE) for medical personal has to be addressed more effectively in the weeks to come.
Convalescent serum could help people remain in the workforce as a form of prophylaxis. This is a treatment that has been around since the Spanish Flu pandemic in 1918. Antibodies that a patient has just created are gathered from the patient in “convalescent serum” which is then given to a patient who is fighting the disease. A study from China a few weeks ago that showed some preliminary results in five critically ill patients. In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, the administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. This strategy was tested in the US at Houston Methodist in Texas over the weekend for the first time.
Clinical References 1. Alschuler, Weil et al. Integrative considerations during the COVID-19 pandemic https://doi.org/10.1016/j.explore.2020.03.007 2. Shen, Wang et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma PMID: 32219428 DOI: 10.1001/jama.2020.4783
3. Wang, Chao et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro PMID: 32020029 DOI: 10.1038/s41422-020-0282-0
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