COVID-19 Update VIII

General Course of the Pandemic

The United States Has seen the number of cases rise almost daily. The original “hot spots” on the East Coast have decreasing caseloads. Many southern and western cases have experienced a sharp rise. The governor of Florida says that the numbers are higher because we are testing more people. If this were true, the percentage of positive cases should remain the same or drop. They have been increasing. Hospital admissions and ICU occupancy have also gone up. Arizona and Alabama may face a shortage of ICU beds soon. Several public health officials in the most affected states have had their lives threatened, because they have promoted social distancing and wearing of masks. There have been some resignations. A great way to reward bright people who choose to work for lower government wages because they want to help humanity.

There is much talk about what a “second wave” may look like. Common sense dictates that there will be no second wave if we are not done with the first wave. The way things are going in the US, current levels of infection and medical disasters may continue unabated for another year.

In the rest of the world the situation is just as diverse. Europe has emerged from the most draconian measures, but their fingers remain crossed. Most European countries heavily depend on tourism. There is widespread concern about what might happen when the borders reopen. China had a small hot spot in Beijing. They have taken draconian measures, and no one has protested, as expected. New Zealand had a few cases; so did Korea, but in general, Asia has done much better that the Americas. Africa and South America are doing poorly.

Testing

There is no information on what kind of tests are being done. There are many reports of contradictory results from antibody testing. A logical consequence of having approved all tests without knowing if they were accurate first. Most disturbing: we still do not know if people who have antibodies will be immune when they are re-challenged by the virus.

Treatments

A lot of publicity was given to the British study that showed that severely ill people (Low oxygen; ICU; ventilators) had a lower death rate when they were treated with dexamethasone. This is a form of cortisone. In the US, the trade name is Decadron, although almost everyone uses the generic drug, because it is effective and inexpensive. Cortisone compounds decrease inflammation. They have been used in low doses to treat inflammatory and autoimmune diseases for decades. They suppress the immune system. Most lung specialists feel that an exaggerated surge of the immune system, called a cytokine storm, is responsible for a large percentage of the complications that seriously ill patients with COVID-19 develop. Blunting this response proved useful in the British study.

NOBODY should take it upon themselves to procure their own supply of dexamethasone. I have prescribed this medicine a lot over the last five decades. The side effects are significant and serious. Please do not do anything stupid.

No news on oral drugs. In my opinion, this means that none of the combinations being used are jaw-droppingly effective. When a study is done, safeguards are put in place so that, if a drug is found to be effective, the study is ended, so that no patients remain on placebo. So far, no studies have been stopped.

No new developments on antibody treatments.

Vaccines

Phase III studies are underway in the EU, US, China, and maybe Russia. It will take months for any results to emanate. We have been told that there will be enough vaccine for the whole world if one or more of the candidates being tested pan out. It will probably come to having to use three or four different vaccines. Which will make it more difficult to ascertain which is the most effective one.

On one hand, humanity should be proud of what has been accomplished. This is a new and vexing disease, and we have halted its spread in many places. We are getting better at finding ways to treat its complications. On the other hand, the lack of coordination between sovereign states, the chronic underfunding of the WHO and all national public health entities, and the scandalous neglect of our elderly, our prisoners, and our food processors will earn us points to go to hell immediately; do not pass GO.

One hopes that maybe we will not let this happen again.