COVID-19 Update XI

General Course of the Pandemic

The US has reached daily highs of new cases during the past week. Hospitalizations and ICU stays are taking off; close to a vertical asymptote (I was a math major; I could not resist using this word). For a long time, the number of deaths did not spike, but the upward trend is beginning. Experts say that deaths usually lag behind new cases by three weeks or more, which makes sense if we consider that people who die in ICU, for the most part, have been there for a while. Although the virus by itself can and will kill you, the complications of prolonged ICU stays, particularly in people who have preexisting issues with diabetes, heart failure, etc., take a few days to appear and are a major reason that these patients die.

Much attention is being paid to autopsy findings on those who die of Covid-19, and to the myriad manifestations of the disease outside its respiratory complications. Blood clotting has emerged as a common and potentially crippling complication, even in younger patients. Many, if not most of the patients who recover report significant symptoms that last weeks, even months. Even if we accept that the death rate for all infected people is a bit less than 1%, think about this: The US has a population of 330 million. If we propose to infect 70% of all US citizens in order to obtain the maybe mythical “herd immunity,” that means that 231 million people will get infected, and 2.3 million will die. Are we ready to accept this horrible burden?

South America, Africa, and India seem headed into disaster. It is not just medical: poverty, hunger, and crime are likely to claim as many victims as the virus. We should not trust the number of cases that are reported by most governments in these areas. Even if they mean well, and many of these countries do not, they do not have the medical infrastructure to fully account for all of the affected population. There have been scattered outbreaks in China, and Europe, but for the most part they are controlled, and their economies are reopening carefully. I find it bitterly ironic that an American citizen who wants to lower her chances of getting infected is better off moving to China. Of course, she would not be allowed in.

Testing

Despite the five months that we have had to make sure that everyone who needs a test gets one, we are not close to that goal. Many cities in the southern US report a delay of 5 days to 3 weeks in getting results back. This nullifies any value that identifying and tracing contacts may have. It is not just one issue with testing. Lack of swabs, reagents, tubes, machines to read the tests, PPE for personnel to use… All of these have been identified; not all in the same places. One state could have enough tests but not enough swabs; another may have the opposite problem. A national strategy that directs supplies and personnel where needed would be helpful. But no…

Treatment

I hear through the grapevine that the Regeneron monoclonal antibody studies are progressing. Final results are expected mid- to late September.

There was another study on remdesivir published. This is larger, better put together, and more definitive than the initial one. There was significant evidence that it helps. Because this is an IV treatment, because it is expensive, and because we do not have enough remdesivir for the whole world, you should only receive this drug if you are seriously ill.

A study that showed a beneficial effect of hydroxychloroquine on mild cases was published. A number of people have found fault with the study design. The WHO has stopped all hydroxychloroquine studies. Further information is not likely to be generated.

No further news on the protease and kinase inhibitors being tested.

Vaccines

The Chinese government has developed its own vaccine; the Western world has three major candidates going through studies. Many nations are sponsoring their own versions. It seems to me that the smaller countries are afraid that the wealthier nations will hoard all of the supply if a vaccine is found to be effective. I read in the Spanish newspaper that they have their own vaccine candidate. It would make much more sense for everyone to work together and pool funds and testing sites. The US, as a renowned world leader in research and humanitarian assistance, is uniquely positioned to lead this charge. Do not, I repeat, do not hold your breath.

Please wear your masks. Be nice to every stranger. Tip generously.