COVID-19 Update IV

General Course of the Pandemic

Europe continues its gradual reopening. Greece (that had a relatively small impact) and Italy (that suffered a large one) will welcome tourists in June. Spain will be open in July. Sweden never closed.

Brazil is caught in a depressing downward spire. Africa has not struggled as much, but maybe we just do not hear what is going on.

The US is at various stages of opening. Large unprotected gatherings were everywhere to be seen this past weekend; we will know in two weeks if there will be payback for them.

Testing

Although we have antigen and saliva testing available, there is no national policy on…anything. Who gets tested, what kind of test, where are results reported to, you name it. The results of antigen and RT-PCR testing, which detect active infection, have been mixed with the results of antibody testing, which detects if infection was present at least 2 weeks prior. The CDC, which used to be our sacred temple of accurate information and prevention, reported both of these as being the same. It is inconceivable that scientists at the CDC cannot tell the difference between an antigen and an antibody, so I am left with the conclusion that a layperson was entrusted with this chore. I do not have the words to express how depressing a tragedy this is. It is sure to cost us in the future. To make matters worse, many states have refused to publish information on how many people are infected in prisons, meat packing plants, and nursing homes. These are the places most likely to have an outbreak, yet we have been blinded by our politicians as to how they are faring. In short, we cannot say with any confidence if the pandemic is slowing down or not. We would never dream of going to war if we did not know our enemy and its capabilities. Yet this is what we are doing now.

Treatments

The VA study on hydroxychloroquine showed that those patients treated with it did no better than those who did not receive it. The patients who were given hydroxychloroquine died at a significantly higher rate. When the Z pack was added to the hydroxychloroquine, the death rate spiked even more. And we still have people who want to take this.

There was an interesting comment from infectious disease specialists this past week. They think that we should treat patients as soon as a positive result is confirmed. Until now, the policy has been to treat only people who are in distress, since most infected people have few or no symptoms. If we treat everyone, the cost of this intervention will soar, as will the incidence of medication side effects. On the other hand, if we could prevent an ICU admission because of early treatment, it may be worth it to treat everyone. If we had a regimen that works at least 90% of the time, this choice would be easier to make. As of today, there is no such thing.

I read that we have garnered much experience on how to approach severely ill people. Most hospital regimens now consist of a three-pronged approach. Antiviral medicine, an immunosuppressant, and an anti-inflammatory are frequent standard regimens. This may explain why the mortality rate has decreased despite no apparent change in the infection rate.

Convalescent serum continues to be used with some success. I have not read anything new on treatment with synthetic antibodies.

Vaccines

There are now more than a hundred different vaccine candidates. You read that right. This is not counting China since there has been no cooperation with them. The Oxford adenovirus vaccine will start extensive (tens of thousands) in early September. The Moderna RNA vaccine will probably ramp up at about the same time. I said last week that our defense secretary’s claim of a safe and effective vaccine by the end of the year was hogwash. He doubled down on this claim this past week. Maybe he knows something that I do not, so I will keep my mouth shut. No one will be happier than me if he turns out to be right.

Please continue to wear your masks. Wash your hands a minimum of seven times a day. Be nice to others. Tip generously if you go out, or if you order takeout. Pay it forward.