COVID-19 Update VI

General Course of the Pandemic

The United States continues to have a fragmented course. There is wide variation between states, even counties, on number of active cases, ICU admissions, and deaths. Reporting is still sketchy. There have been noticeable outbreaks in places where crowds accumulated, yet in other places (like our Lake of the Ozarks) there has not been a huge surge following crowded revelry. We may get a better idea on the effects of gatherings in 2-3 weeks following the large demonstrations.

The rest of the world is a similar mishmash. Brazil’s president decided to ignore the virus; not much data is being collected. People who live there describe hospital crowding and mass graves being dug. Russia is doing poorly, but hard information is hard to come by. Iran may have had a flareup; again no one knows for sure. South America is beginning to descend into mass disease. I do not know much about Africa. Asia has seen minor flares in Korea and Singapore. Vietnam has (still) not reported a single death. It has become a source of national pride; rightfully so. What this tells us is that we are likely to get another round of epidemic when we begin to open the country to foreign travel.

Testing

Another disappointing story. Diagnostic testing continues to ramp up. This week the New England Journal of Medicine reported that nasal patient-collected samples are almost as good as having a trained health care worker slip the long swab up our noses. This would save a lot of PPE and would make expansion of testing more available. Unfortunately, there is still no standard on what constitutes a positive, and which test is more accurate.

This means that you could test negative with Test A and positive with Test B two hours later. It seems like it would be an easy bar to clear, but no.
Two exciting reports: Testing of sewage is at the point where it is accurate and reliable. As an example, if you lived in a large building, as I do, our sewage can be tested to see if there is any virus in it. This way you can test a hundred families at once, cheaply. If virus were found in the sewage, of course everyone would be asked to submit to an individual test. Sewage testing started out as a public health measure (germs), then moved on to looking for illegal drugs, not to arrest people, but to decide where to concentrate public health interventions. I am excited about the potential for this technology.

The next breakthrough comes from China, where they did millions of tests in ten days in one of their cities. They found a way to run ten specimens through one test. If a positive comes out, again, individual testing must be done, but the cost of doing things this way is way lower.

Treatment

Two more studies on hydroxychloroquine, showing no benefit on prevention or treatment. We will have to endure a rash of these studies coming out, because they were started weeks ago, when people thought it may have helped. If you hear that I have died suddenly in the next few weeks, it is probably because a positive study was reported on hydroxychloroquine, and I had a massive heart attack. I am that dead set against it.

No more news on oral antivirals. There are persistent reports that Pepcid (yes, the acid medicine) may help to treat infected people. So many anecdotes came in, that controlled studies were started. The generic name is famotidine; it is cheap; it has minimal side effects; it is sold without a prescription. I am not asking you to take it; just giving information. What you do is up to you.

Vaccines

If there is any light at the end of the tunnel, this may be it. Phase 2 studies are ongoing for the two major candidates, and there are more than a hundred others. My concern is that the process will be rushed by political considerations. In order for us to be sure that a vaccine is effective, we need to give it to tens of thousands of people and sit back and wait a few months.

We calculate how many people who got the vaccine developed the disease, and we compare to how many people who got the placebo got sick. In order for the vaccine to be deemed safe, you need to triple the prior number of vaccine recipients and sit back and wait a year or two. We have an election coming up in November. It would not be beyond some people to interrupt the “normal” flow of events that have to happen before a vaccine is approved, in order to be able to tell the world that we have a vaccine and that it will be great. The best. Proof that we have the best country, with the best doctors, and the best pharma corporations. It would not be beyond some people to not give a damn if it turns out that the vaccine turns out to be ineffective, or dangerous, as long as some people get elected to the office they seek. We need to be careful when we get to October. Please do not believe everything that you hear from any politician or any of the agencies that are under the influence of politicians.

Wear your masks; take a walk every day; laugh a lot.