Coronavirus Tidbits #12 3-18-20

Plague doctorFor the past couple of weeks, I’ve been sending out almost daily news “tidbits” to friends and colleagues.

I have been asked to share more broadly, so will post here as well. I will post back issues as I have time.

This will enable you to share more readily with friends or on social media, if you find the news and tips helpful. Basically, I obsess and read about this all day so you don’t have to, and send you information from sources I feel are most reliable.

I am trying to figure out a way to tag individual topics. In the meantime, apparently best to

Enter site: www.drjudystone.com/politics-science-and-other-assorted-musings/ and then your specific search term into the search box.*

Good news:

Smart move: Medicare to cover virtual doctor visits

CMS is urging states to expand telehealth services for low-income people in their Medicaid programs. Problem is that many states, esp in the south, refused to expand Medicaid, so a lot of people—the working poor—still won’t be covered.

Testing:

Ontario’s Public Health Lab at @PublicHealthON has tested more people for Coronavirus than the *entire* US lab system.

Epidemiology:

Bad news:

We are not talking about 2 months and back to normal. We are now talking 18 months, with repeated waves of infection as people lighten restrictions.

Also bad: Contrary to previous reports of illness generally being mild/mod in young-middle age adults: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

new CDC analysis of more than 2,400 cases of COVID19 in the US shows that at least 1 in 7 and perhaps as many as 1 in 5 people between the ages of 20 and 44 who contract the virus require hospitalization

Between 2-4% of those need ICU. The fatality rate is low, only 0.1 percent to 0.2 percent, but is about two times higher than a bad flu season.

20-33% of those 45-65 need hospitalization

>75 yo 30-70%

age > 65 account for 80 percent of the deaths associated with the coronavirus in US

Similar data coming from France and Italy about serious illness in young people

As I’ve written in earlier issues, we have no where near the capacity to hospitalize the number of patients, let alone ICU beds and ventilators—hell, in some places here, there are no masks/gowns/gloves, and we’re just at the beginning of the US’ problem.

Hospital Capacity—NYTimes has great info on this: 

Virus Plan Anticipates 18-Month Pandemic and Widespread Shortage

https://www.nytimes.com/2020/03/17/us/politics/trump-coronavirus-plan.html?

Hospital beds

Cidrap: As of this morning, New York was reporting more than 1,500 positive cases, up from 950 yesterday, and 12 deaths. Cuomo said the number of cases will likely outstrip hospital capacity in 45 days, the New York Times reported.

As many as 37,000 intensive care unit beds may be needed, when the state currently has only 3,000 such beds, 80% of which are already occupied, Cuomo said in the same article.

Pence asked construction companies to donate their respirators to hospitals.

http://www.cidrap.umn.edu/news-perspective/2020/03/us-moves-prop-economy-gird-swell-coronavirus-patients

Supplies:

Memorial Sloan Kettering Cancer Center in New York has at least three patients and five staff members that have been diagnosed with the coronavirus. The hospital has a one-week supply of masks.

https://www.buzzfeednews.com/article/rosalindadams/a-top-cancer-hospital-faces-mask-shortages-as-covid-19

Not a good time for Trump to be pissing off China, who makes many of our masks and drugs.

 Already, some hospitals have reported shortages of personal protective equipment like masks, gloves, and gowns, and some providers have said they have resorted to cleaning and reusing supplies they would have normally discarded. Though the availability of supplies varies around the country, some facilities have said they’re facing a lack of basic materials as well, including nasal swabs that are needed to conduct test for the virus.

https://www.statnews.com/2020/03/17/hospital-in-boston-will-be-converted-into-covid-19-treatment-center/

Children’s infections:

Among infants under 1 year old, 11% of cases are critical, and 7% of cases are critical for kids between ages 1-5. But for kids aged 6-15, only 4% of cases are severe, and only 3% of older teens have severe cases.

https://www.forbes.com/sites/tarahaelle/2020/03/18/severe-coronavirus-risk-higher-in-babies-lower-in-kids-study-finds/#c14ed887f1b8  Tara Haelle writes a lot of good stuff on kids. You should check out her columns.

Shopping:

Many stores are encouraging that the first hour of operations each day be dedicated solely for the shopping needs of seniors or those with higher risk. Really nice to

Drug treatment, studies:

None of these have been shown to work, but some are looking promising:

#Chloroquine Anti-malarial

Several potential mechanisms: change in cell membrane pH, impairs viral fusion, interferes with glycosylation of viral proteins

#chloroquine and #redemsivir are active against SARS-COV2 in experimental models

#Hydroxychloroquine (Plaquenil)

– Analogue of chloroquine – Anti inflammatory effect. Used for autoimmune diseases. Being studied for prophylaxis as well as treatment of COVID19

Hydroxychloroquine was more potent than chloroquine against #SARS-CoV2 in vitro.

#lopinavir-ritonavir 

Not looking so good for COVID19 yet, but needs more study; may have been used too late

Protease inhibitor against HIV
Inhibits viral replication (in combo with ribavirin)

MIRACLE trial for #MERSCoV
Clinical data during the #SARS outbreak

# favipiravir Early good data—IF confirmed

            Used for influenza in Japan and in Ebola

340 Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug, public broadcaster NHK said.

In addition, X-rays confirmed improvements in lung condition in about 91% of the patients who were treated with favipiravir, compared to 62% or those without the drug.

Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people,

https://www.theguardian.com/world/2020/mar/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-says-china

#Remdesevir

A nucleotide-analog inhibitor of RNA-dependent RNA polymerases
Activity against many RNA viruses including #coronavirus in vitro and animamodels (against #MERS Cov)  https://doi.org/10.1073/pnas.1922083117

Clinical: only anecdotal evidence of use Compassionate use – clinical trials beginning.

#Tocilizumab

Anti-human IL6 receptor monoclonal antibody; Used in Castleman’s disease

Inhibits signal transduction by binding to IL6 receptor to reduce severity of lung inflammation

21-patient clinical data from China showed promise in #COVID19 https://www.thepharmaletter.com/article/tiziana-goes-stratospheric-on-plans-to-develop-a-mab-for-lung-damage-in-covid-19-patients

#Sarilumab

IL6 inhibitor
Clinical trials are being planned for selected #SARSCoV infection

#Darunavir

Lack of evidence based on this report https://www.jnj.com/lack-of-evidence-to-support-darunavir-based-hiv-treatments- for-coronavirus

Resources:

https://t.co/Tewaah7X2I The kids should see this series

Tara Haelle writes a number of pediatric oriented columns for Forbes and as a freelancer. Always a trusted source, e.g.

https://www.forbes.com/sites/tarahaelle/2020/03/18/severe-coronavirus-risk-higher-in-babies-lower-in-kids-study-finds/#4bac00977f1b

Melinda Wenner Moyer is another one of my go-to journos for kiddie and general questions https://www.nytimes.com/2020/03/13/parenting/kids-playdates-coronavirus.html

Loneliness

https://www.washingtonpost.com/opinions/2020/03/17/combating-loneliness-an-age-self-quarantine/

History lessons:

South Korea learned the importance of preparedness the hard way: It lived through a traumatizing MERS outbreak in 2015. That’s one reason the country went all out on #COVID19 testing. bit.ly/2TY1WfE

Politics: 

@JoyAnnReid

Trump ends his press conference by saying no offer was made to the U.S. to have the WHO-certified test, says any such news of that is fake, and then adds that the WHO test — the GOLD STANDARD TEST FOR COVID19 is a “bad test.” This is straight-up gaslighting propaganda.

US did reject WHO test: https://t.co/udbK1Qvx0w

We still don’t have adequate testing. Why won’t the US get tests from WHO at this point?

~  ~ ~

On support for business but not people:

@docdre 3/17/20

My brother got laid off yesterday from Marriott. He applied for unemployment; they called to check his employment status. Marriott HR says he’s NOT laid off but on a ZERO hour schedule. So he can’t qualify for unemployment NOR does he have health insurance.

@damron_bn

This just happened to my cousin at Bob Evans, except they are just forcing all staff to take one shift of carry-out duty a week. So she also can’t claim unemployment.

Thoughtful essay:

The World We Once Lived in Has Vanished

https://www.nytimes.com/2020/03/18/opinion/coronavirus-life.html?

 

Comic Relief:

I go back to this joyful dog on occation: pic.twitter.com/FzvtrmC70D

How did you meet your dog?

https://twitter.com/i/status/1240065380900618241

 

Sick humor:

Rufovillosum @rufovillosum

People should subscribe to newspapers — they need the income. And after reading, entertain the out-of-school kids with paper hats, expanding trees, and paper mache. You can clean windows with them, and your butt.

Bits of beauty: (later)

 

 

 

Share this post:

Leave a Reply

Your email address will not be published. Required fields are marked *