COVID-19 | science, damage limitation, NO POLITICS

[armand]

Be happy. They'll be bigger next year.

Not if everybody goes fishing this summer.

[Chris Kern]

The World Health Organization warned governments yesterday against issuing "immunity passports" to survivors of COVID-19 infections, pointing out that "[t]here is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection."

Many countries are now testing for SARS-CoV-2 antibodies at the population level or in specific groups, such as health workers, close contacts of known cases, or within households.  WHO supports these studies, as they are critical for understanding the extent of―and risk factors associated with―infection.  These studies will provide data on the percentage of people with detectable COVID-19 antibodies, but most are not designed to determine whether those people are immune to secondary infections. . . .

At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.”  People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice.  The use of such certificates may therefore increase the risks of continued transmission.

[Alan Goldhammer]

Breaking Radio Silence to Correct a Misperception

While these drugs have not been shown to be effective in controlled studies, apparently there is some anecdotal clinical evidence of their utility and physicians may still use them in the United States hospitals under a federal Emergency Use Authorization.

The Emergency Use Authorization has nothing to do with this.  Once a drug has been approved for use by the FDA, a physician may prescribe it if he/she deems it beneficial for the patient.  Hydroxychloroquine was being prescribed 'off label' by community physicians for both their own and patients use in the absence of any clinical data.  Lupus and Rheumatoid Arthritis patients for whom the drug does in fact work are facing shortages and may have to go off treatment.  The FDA Emergency Use Authorization was nothing more than a political document that had little or no regulatory meaning.  'Off label' use prescribing happens all the time and there have been big fines for companies who were found to be promoting such use (that is forbidden under the FDA laws and regulations)

Back to lurking.

[Alan Klein]

The World Health Organization warned governments yesterday against issuing "immunity passports" to survivors of COVID-19 infections, pointing out that "[t]here is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection."

Dr. Birx advising the administration commented on this issue the other day when she was questioned about it.  She said while there are no studies yet, her experience with viruses are that once you get it, the body does produce antibodies that protects against re-infection.  I believe she said that's true in about 90% of the cases.  So we probably will find that people are protected if they caught it once. Of course, viruses also mutate like seasonal influenza.  So you're not protected against mutated strains. 

I also recall reading an article the other day where plasma from a previously infected patient of Covid 19 containing the antibodies had already save a patient with Covid 19.  The story I heard was that it reversed the dire condition within hours. 

[Robert Roaldi]

Dr. Birx advising the administration commented on this issue the other day when she was questioned about it.  She said while there are no studies yet, her experience with viruses are that once you get it, the body does produce antibodies that protects against re-infection.  I believe she said that's true in about 90% of the cases.  So we probably will find that people are protected if they caught it once. Of course, viruses also mutate like seasonal influenza.  So you're not protected against mutated strains. 

I also recall reading an article the other day where plasma from a previously infected patient of Covid 19 containing the antibodies had already save a patient with Covid 19.  The story I heard was that it reversed the dire condition within hours.

There is another case that is hardly ever mentioned. According to epidemiologist Seth Berkley (head of Gavi, the Vaccine Alliance) in his TED interview, it sometimes happens that even for a virus that does NOT mutate, the human immune system can lose its effectiveness against that virus and infection can re-occur. During that discussion they did not speak about this much, it was an aside in the middle of another point. I've mentioned it before but TED's series of interviews about Covid-19 are worth listening to, https://www.ted.com/podcasts/ted-interview.

[Chris Kern]

The FDA Emergency Use Authorization was nothing more than a political document that had little or no regulatory meaning.

Thanks for explaining this.  The FDA alert was worded in a way that led me to conclude the Emergency Use Authorization was a requirement imposed pursuant to the agency's regulatory authority.

[Bart_van_der_Wolf]

Stop reading between the lines. Ventilators generally don't kill people (unless mismanaged). There is no clear data besides the fact that if a patient ends up on ventilators his chances of survival are not that good. But they die because they were too sick, not because of the ventilator.

Today, I've heard some anecdotal evidence from a doctor in a hospital in my country that 90% of the COVID-19 patients in their ICU die, despite the ventilator. These patients are really really ill when they are admitted to the ICU. Only those in very good condition before falling ill stand a chance.

[Bart_van_der_Wolf]

There are multiple ongoing trials but the current in hospital experience is not good so in many places they are only used in trials.
This a retrospective study, not vetted yet, which shows harm: https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2

Indeed:

CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

Not sure if these initial results will inspire more tests ...

[armand]

Today, I've heard some anecdotal evidence from a doctor in a hospital in my country that 90% of the COVID-19 patients in their ICU die, despite the ventilator. These patients are really really ill when they are admitted to the ICU. Only those in very good condition before falling ill stand a chance.

That was probably true in the beginning but I think the numbers look better now, at least from what I heard elsewhere and what we have in my hospital. Still worse than average for ARDS though which can be ~ 40%. Where the ICUs got hit hard the patients did even worse, for example NYC was close to 90% but others places did better, Seattle which had fewer numbers had some initial reports of 50%. The studies from China hover around the 70-80%.

The therapeutic approach changes also, trying to get away from earlier intubation if possible now that many places can contain well enough the aerosolization with high flow rate on HFNC (high flow nasal cannula) or BiPAP/CPAP. So some of this intubations were performed sooner than later to avoid infecting the others. There are also various vent strategies being attempted, the consensus remains to go for the standard care and adjust from there.

But from that to get to, as some press my suggest, that ventilators kill it's still a long road. It's like you say more people who go to the hospital die than those who stay at home, therefore the hospital will kill you.

[Alan Klein]

Just a followup from our discussion on ACE inhibitors for high blood pressure.   Well, maybe it was on the other thread. I forget.  In any case, it's suppose to be worse if you're taking them and get the virus. Anyway, I checked with my cardiologist.  He told me I have to stay on them.  If I get the virus and go to the hospital, then they'll decide there if they take me off them. 

[Alan Goldhammer]

Breaking Radio Silence

Indeed:
Not sure if these initial results will inspire more tests ...

unfortunately, hydroxychloroquine trials are still be scheduled and some large efforts in health care workers are underway.  Duke University has a $50M grant to set up a registry and trial.  I'm tracking this stuff in my daily newsletter.  There are about 50 trials on this world wide but I don't have an idea about the number of patients enrolled.  there has also been a high use of hydroxychloroquine in community settings judged by Rx prescriptions written.  Patients suffering from lups and rheumatoid arthritis are having trouble getting their drugs (and they need them for treatment). 

Back to radio silence.

[Jeremy Roussak]

Breaking Radio Silence

unfortunately, hydroxychloroquine trials are still be scheduled and some large efforts in health care workers are underway.  Duke University has a $50M grant to set up a registry and trial.  I'm tracking this stuff in my daily newsletter.  There are about 50 trials on this world wide but I don't have an idea about the number of patients enrolled.  there has also been a high use of hydroxychloroquine in community settings judged by Rx prescriptions written.  Patients suffering from lups and rheumatoid arthritis are having trouble getting their drugs (and they need them for treatment). 

Back to radio silence.

Alan, for God's sake stop this ridiculous, pretentious "radio silence" nonsense. Like everyone else here, you post when you feel like it and don't post in between.

Jeremy

[Alan Klein]

Alan, for God's sake stop this ridiculous, pretentious "radio silence" nonsense. Like everyone else here, you post when you feel like it and don't post in between.

Jeremy

I agree.  Now I'm out of here until I'm not.

[Alan Klein]

Roger. Wilco. Over and out.

[John Camp]

Alan, for God's sake stop this ridiculous, pretentious "radio silence" nonsense. Like everyone else here, you post when you feel like it and don't post in between.

Jeremy

I know what he means, and I don't think it's ridiculous at all.

[Alan Klein]

I know what he means, and I don't think it's ridiculous at all.

What is that?

[Alan Goldhammer]

Alan, for God's sake stop this ridiculous, pretentious "radio silence" nonsense. Like everyone else here, you post when you feel like it and don't post in between.

Jeremy

You must really want me to go away.  I have a right to post or not to post and if you don't like it don't read it.  The pretentious crap that you post in response to me is just too wearying.  I've tried to bring my expertise in drug development and safety as a service to the readers of this forum.  Apparently this is just too damn much for you.  You can suspend me if you want but this is just BS.  Why don't you make a positive contribution rather than being a thought police person.

[Chris Kern]

Deborah Birx, M.D., the coordinator of the Trump Administration's Coronavirus Task Force, said today in an interview with NBC News (a U.S. television network) that "social distancing" in the United States will need to continue "through the summer to really ensure that we protect one another."

Dr. Birx reportedly is one of the few career experts who has developed a relationship of trust with President Trump, and while her syntax was somewhat labored―not unusual for people close to Trump who may be offering opinions that clash with his preferences―her comment seems consistent with what most other medical consultants at both the state and federal levels have been predicting.

CHUCK TODD [interviewer]:

The vice president on Friday said that by Memorial Day, in fact, I want to read the quote exactly here, that, by Memorial Day the epidemic, “I think honestly, if you look at the trends today, that I think by Memorial Day Weekend will largely have this coronavirus epidemic behind us." This Memorial Day, 2020? Is that realistic that it is behind us? Can you explain what he means by that?

DR. DEBORAH BIRX:

I think he means that in the models and in tracking our actual data because previously, we were using models based on data from around the world. And now, we are very much tracking every single outbreak in the United States separately. And if you look at those outbreaks over time and you look at places like Louisiana, if you look at Houston, if you look at Detroit, and you look at how they have reached their peak and come down. And what those cases look like as they come down, it gives us great hope when you project out Boston and Chicago and certainly, the New York Metro which we are all very still focused on. I mean, they still have 45% or so of the entire cases in the United States. And the majority, about 40 to 50% of the mortalities. So we continue to watch this very closely. But that is where the projections take us. And it is very much based on Detroit, Louisiana and other groups. And then looking at Seattle, that never really reached a peak and has never really had a large outbreak. And trying to understand what we can do as a people to ensure -- social distancing will be with us through the summer to really ensure that we protect one another as we move through these phases.

[Robert Roaldi]

Here's a 42 min video interview with a vaccine developer. He explains how vaccines work, how different viruses behave, how humans respond to them, etc., https://www.youtube.com/watch?v=5cYWd0N8nO4. Not dumbed down but not overly technical either. I post this because it's pretty obvious that people say things about viruses that are clearly not based in scientific knowledge, good to have common understanding about basic things. This is no criticism of the public, no way that people could be expected to understand these things when the last biology course they took was 30 years ago in high school. Hope it's useful.

[Chris Kern]

And now for something completely different . . .
The place to stay in New York City when you're treating COVID-19 patients.