Coronavirus Tidbits # 21 3-28-20

News: 

Best news of the day:

‘Going full-on MacGyver’ – U of MN doctor creates makeshift ventilators to battle COVID-19

Even better, in some ways, he’s also made the plans OPEN Source and will be updating here

Physical Prototype Video: https://youtu.be/3ssVoWEVxw4

CAD Prototype Video: https://youtu.be/RpEqtGa2vTI

Diagnostics:

Rapid diagnostic tests are winning approval,

like this 5-minute coronavirus test by Abbott Laboratories that won emergency FDA approval

The problem is that we don’t yet know enough about the accuracy of the tests, known as sensitivity and specificity? In particular, is a negative test really negative. Until we know more, many ID experts recommend assuming someone who has symptoms is infectious, even if the test is negative.

Drugs:

Trump’s push for risky malaria drugs disrupts coronavirus response

“All this buzz is confusing the American public,” said one senior Health and Human Services official involved in drug policy.

“Using untested medicines without the right evidence will raise false hope and even do more harm than good — and cause a shortage of essential medicines that are needed to treat other diseases,” said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization.

The battle over chloroquine and hydroxychloroquine:

On the one hand: Medical experts and scientists

“We need to make sure the sea of new treatments will get the right drug to the right patients, at the right dosage, at the right time,” FDA Commissioner Dr. Hahn said last week. “That’s why it is important we have our professionals looking at these therapeutic developments.”

Fauci drew a clear line the next day, even as the president pushed back. “You have to be careful when you say ‘fairly effective.’ It was never done in a clinical trial. It was given to individuals who felt that maybe it worked.”

https://www.politico.com/news/2020/03/27/trump-malaria-coronavirus-152498

vs.

“I’m a smart guy. I feel good about it,” Trump said. “Let’s see what happens. We have nothing to lose.”

This statement is absolutely false. We have at least two major things to lose:

a) prescribing drugs like this without gathering data is irresponsible and loses us precious time in finding an effective treatment. In fact, there is a real-time project on “repurposed drugs”–using already approved drugs for new indications. Unfortunately, not enough doctors are aware of this yet and, if they can prescribe it willy-nilly, they will be less inclined to take the <5″ to submit the case to the database.

b) Patients with Lupus, rheumatoid arthritis and many other autoimmune illnesses rely on these medicines for their illnesses. Kaiser Permanente is already telling their patients in California that they will not be able to refill their medicine, reportedly thanking them for their “sacrifice.”

All of this when there is NO evidence that chloroquine works. That’s why we need clinical trials.

I agree wholeheartedly with bioethicist Art Caplan “The real problems are not trying to find a magic bullet” …“I wish the administration would figure out how to get equipment and protective gear to places where the outbreak is the worst. If we had testing, it would do far more than figuring out whether this malaria drug can kill the coronavirus.”

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Trump’s irresponsible promotion of these antimalarials will now hurt a number of patients–mostly young women–who are on the meds for rare diseases or suspected autoimmune disease.

“No pharmacist (in NY) shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.”

Note: The length of time from symptom onset to an accurate diagnosis is around 4.8 years for a rare disease. The longer it takes to diagnose a rare diseases, the more physicians the patient needs to see. Patients see an average of 7.3 physicians before a diagnosis is made.

Similarly, According to the American Autoimmune Related Diseases Association (AARDA), the average time for diagnosis is 4.5 years (down from 7) and during that period the patient typically has seen four doctors. There is a strong gender difference, with these diseases being much more common in women.

This decision, like so many others will disproportionately hurt women.

Epidemiology/Infection control:

Shameful lack of PPE and preparedness:

Expired Respirators. Reused Masks. Nurses in the Nation’s Original Covid-19 Epicenter Offer Sobering Accounts of What Could Come.

https://www.propublica.org/article/expired-respirators-reused-masks-nurses-in-the-nations-original-covid-19-epicenter-offer-sobering-accounts-of-what-could-come? 

This sadly reminds me of draftees being treated like cannon fodder.

Tips, general reading for public:

Community: Mutual aid

AARP has a searchable map called “Community Connections.” There are then links to the local sites when you zoom on the map.

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Durable power of attorney for medical care, Living Wills, etc.

My family spent the morning having very frank discussions of what we would want in various circumstances, should we not be able to make decisions for ourselves. We have long had such documents–I’ve seen too much of what happens in hospitals–but are updating them a bit because of coronavirus.

Please have these discussions NOW, if you haven’t. You don’t have to have a lawyer for these either.

Downloadable forms and guidance are available at AARP (free to all) and state-specifichere

Please also read 5 Wishes, which has some additional considerations not in most legal documents.

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Is it safe to take NSAIDs like Ibuprofen or Naproxen?

There is no published or peer-reviewed data suggesting a potential interaction between NSAID use and SARS-CoV-2.

“There is not enough evidence to recommend that patients who take NSAIDs for medically-indicated reasons should change their behavior in the face of this new pandemic,” Dr. David Aronoff, Director of Infectious Diseases at Vanderbilt added.

https://news.vumc.org/2020/03/18/ibuprofen-and-covid-19%E2%80%88a-doctors-guidance

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Tips for staying safevery practical post and valuable perspective

Politics:

Why is the CDC being sidelined, asks Legendary #Ebola responder Pierre Rollin: https://www.statnews.com/2020/03/26/cdc-veteran-asks-why-is-cdc-sitting-on-the-sidelines-covid-19-fight/

Feel good du jour:

Rotterdam Philharmonic teamed up with a Dutch healthcare provider to film the finale of Beethoven’s 9th with all the musicians playing their parts by video from their homes. It’s pretty amazing. Highly recommend:

Not to be outdone, here is the Toronto Symphony with Aaron Copland’s Appalachian Spring, one of my favorites.

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This woman is writing notes for nursing home residents or other folks on these origami hearts. She provides instructions for those, too. What a kind idea.

Posted by Lauren Sophia Kreider on Wednesday, March 25, 2020

 

Comic relief:

I made the big time! My post on loss of smell and taste as an early symptom of COVID19 infection was such a hit, that @TheSmellPodcast turned it into a podcast! https://podcasts.apple.com/us/podcast/the-smell-podcast/id1429270582?i=1000469311479

While I am happy and amused about that post’s success, I wish my posts on detainees or social justice issues did as well.

Perspective

A.M. Carter writes that she had no immune system for months after her bone marrow transplant. Here’s how I avoided viral illness, and how you can, too. It’s easier than you think. It is both a very practical post and valuable perspective. Highly recommended.

Bits of beauty:

From Scotland, via Italy. I love how this chain of sharing and caring for each other is growing.

Thank you Louisa (photo credit) and Roberta. The Birks of Aberfeldy – Perthshire, Scotland

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