COVID-19 Update I

General Course of the Pandemic

European countries, for the most part, have seen a consistent drop in new cases, ICU admissions, and deaths for the past 2 weeks. There are occasional spikes here and there, which may be due to inconsistent reporting instead of a change in the pattern of infections. Sweden has not been as strict with social distancing as other European countries, and it has seen increased levels of infections and death, but nowhere near what Spain and Italy have experienced (both of these countries are heavily dependent on tourism; both had delayed responses).

In the US, the virus continues to invade us. Despite the decreased intensity of the devastation in the NYC metro area, infections in the rest of the country persist in their inexorable rise. Prisons, meat packing plants, and nursing homes continue to feed this fire. Many of these places have not tested their inmates, employees, and patients. In cases where tests have been done, results have often been delayed, or are not reported at all. It is extremely likely that actual deaths and infections are much higher than what we see in the news media. Some media outlets fear that there is a concerted (national) effort to hide the extent of the damage, because of political consequences. We should remain alert, and we should demand that complete information is made available as soon as it is acquired.

Testing

The RT-PCR test remains the only accurate way to diagnose active infection. As you recall, this is the test that requires a swab that goes deep into your nose. LabCorp has developed a swab test that can be done at home, thus eliminating the need for trained employees that wear PPE to collect the specimen, because the swab is much shorter. This test can be ordered by your doctor. It must be mailed or delivered to a lab that has RT-PCR capability. The accuracy of all RT-PCR tests depends on how many viruses are present in the subject’s nose or throat at the time. If you only have a few copies of the virus in these areas, you may get a false negative result.
The search for an antigen test continues at a feverish pace. You may have had a rapid Strep test done at your doctor’s office, where results were available within ten minutes. This is an antigen test. An accurate Covid-19 antigen test would fix a lot of our problems.

Antibody tests are a major headache. These tests measure whether you have been infected. They will not turn positive until 2-3 weeks after infection occurs. Nobody knows how long after infection they will remain positive. We have no idea if having a positive antibody test makes you immune to another COVID-19 infection.

As I told you, the FDA allowed dozens of antigen tests to be sold in this country without checking if they were accurate. Most were not. Spain bought thousands of these tests through a Danish company that claimed to have made them in Denmark. It turns out that they were made in China, with poor quality control. Now come the lawsuits.

Roche (a Swiss company) has developed an antibody test that they claim is 100% specific, meaning that it gives no false negatives. They promise an ample supply, but I do not know when it will be available. I assume it will involve a blood draw instead of a fingerstick, because the specimen must be run by a machine that is made by Roche. Ask your doctor as to availability. I do not know if the test will measure IgG, IgM, or both. I do not know if it will tell us how much antibody is present, or whether it will be a binary proposition (positive or negative).

As mentioned above, not everyone who needs a test is able to get one. We have been told by Dr. Fauci that by the end of May the situation will vastly improve.

Treatment

No one talks about hydroxychloroquine anymore. There has been one study report that showed no benefit and an increased likelihood of death. Other studies are pending. I figure that if this were to be our miracle cure, we would have far fewer deaths. Do not count on this drug.

One remdesivir study showed marginal benefit, decreasing length of ICU stay. Other studies are pending. Remdesivir must be given IV, which would rule it out as a treatment for millions of people. We should keep looking at it, but I am sticking my neck out there to say that it’s not our silver bullet.
A recent study in the New England Journal of Medicine showed no efficacy for a combination of lotinavir and ritonavir. This is a shame because this is an oral regimen. A number of letters to the editor followed, taking the study authors to task because they felt that they had given up on these drugs too soon. They may have a point. This drug combination will continue to be studied.

Antibody therapy shows promise. This involves infusing antibody to Covid-19 into sick people. Two major forms of immunotherapy are being considered. Convalescent serum, meaning blood components from someone who has recovered from COVID-19, is being used. Many companies, the most prominent one being Regeneron, have taken to making their own version of convalescent serum. They can teach mice to make an antibody protein that has anti-COVID-19 properties. These mice have been taught to make human antibodies, so there would not be an allergic reaction to them. If this works, it would have the advantage of making people immune for a few weeks or months after treatment.

The latest rage on antibody therapy is nanoantibodies. These molecules are much smaller than traditional antibodies. For reasons that I do not understand our bodies take a lot longer to break these down. The idea is that we could get an injection (not necessarily IV) of an anti-COVID-19 nanoantibody that would protect us for months. Stay tuned.

Vaccines

There are dozens of vaccines being tested. Our government has begun to ramp up manufacturing capability; in other words, we are building factories that can make millions of vaccines before we have one that works. Just in case the research comes through. A group at Oxford University was able to piggyback Covid-19 material into an inactivated adenovirus (one of the causes of common colds). It worked to protect rhesus monkeys. Human tests are to follow. No adenovirus vaccine has ever worked, but we remain hopeful.

An RNA vaccine is also close to Phase II testing in humans. No RNA vaccine has ever been tested extensively.

We are in the middle of a terrifying invasion, but I am optimistic that we can find an answer. It is unlikely that it will be one thing. It will probably involve a combination of social distancing, testing, and tailored treatments and vaccines.

Please feel free to forward this post to friends. I hope to be able to transfer all this information on a video format. I would love to start out with a big audience. More than ever, we need a source of information that we can trust.