The Stock of Where we Are
MEDICAL AND MENTAL HEALTH UPDATE
Let’s take a deep breath—or two. And then let’s take a bird’s eye view of the pandemic. Where are we now? What more do we know? Is there reason for hope amidst chaos?
(Short answers: October, a lot, and yes.)
Today I’ll provide a clinical update and some ideas for getting through the fall, mentally and physically.
Updates on the PREVENTION of COVID-19:
Vaccines. There is a lot of positive news here. The vaccines being developed by front-runners Moderna, Pfizer, and Johnson & Johnson are showing great promise. In a few months we’ll have a lot more efficacy and safety data. There is reason to be optimistic that we’ll likely have one or even a few vaccines available for widespread distribution in early 2021. The icing on the cake? The FDA announced that it won’t release a vaccine until it is deemed safe.
Vitamin D and zinc. Mounting scientific evidence suggests that these may indeed help prevent COVID-19. Vitamin D is a fat-soluble vitamin, so don’t take it by the fist-full. Instead, have your vitamin D level checked with your doctor and consider taking a small dose, like 1000-2000 IU daily. Taking a daily zinc supplement (50 mg daily) may also help, but don’t expect miracles! We still need more studies, but in the meantime these two supplements can’t hurt—and may actually help—if taken in moderation.
Masks. They are still the best way to prevent infection with coronavirus. They work! And I’ll say it again: it’s essential to layer risk mitigation elements à la MOSHPIT. When you socially distance, avoid crowded spaces, and practice hand hygiene, you dramatically reduce transmission risk.
Updates on the TREATMENT of COVID-19:
Monoclonal antibodies. This type of treatment has been used for decades in a variety of illnesses. In the case of COVID-19, antibodies have been cloned from patients who have recovered from COVID-19 to target the spike protein on the surface of the coronavirus. They are given intravenously in the first week of illness to help reduce viral load and disease severity. While not yet approved by the FDA for COVID-19, an emergency-use authorization (EUA) may be coming soon given the promising data that is emerging from small studies. What’s exciting to me is the possibility of developing a self-administered shot of monoclonal antibodies that could be more widely used to prevent hospitalization in patients with mild to moderate illness. That would be a game-changer.
Remdesivir. This is the antiviral medication that is given intravenously for 5 days to hospitalized patients in the early phase of illness when the virus is actively replicating. The latest good news here is that the supply of Remdesivir now meets real-time demand for eligible hospitalized patients.
Dexamethasone (steroids). This is the treatment proven to help our sickest, hospitalized patients. Steroids continue to show significant benefits as they tamp down the body’s hyperactive immune response (aka the “cytokine storm”) in response to coronavirus. Dexamethasone is in part responsible for the decline in the COVID-19 death rate.
Blood thinners/anticoagulation. COVID-19 can promote clotting in the blood vessels of almost any organ. New guidelines from the American Society of Hematology were released last week. They suggest using prophylactic (aka preventative) blood thinning medication in all patients with acute illness from COVID-19 who are not at high risk for bleeding. Translation: put everyone sick with COVID-19 on anticoagulation medication. The dosing and choice of medication should depend on disease severity, other comorbidities, and bleeding risk. Should you pop an aspirin if you get COVID-19? You’ll need to check with your doctor, but the answer is probably yes.
UPSHOT:
Consider taking vitamin D and zinc supplements now while you are well.
Consider taking an aspirin daily if you get sick with COVID-19.
Know that wearing a mask, using the MOSHPIT protocol, and taking care of your underlying health are still the best ways to prevent infection. (And will continue to be, even after we have a vaccine.)
Get a flu shot.
Prioritize sleep, exercise, healthy eating, and brain rest.
Limit your media inputs and screen time.
Schedule your check-up, and talk to your doctor about all of the above.
And know that science is on our side, that medical advancements are galloping along, and we are getting smarter and more savvy about preventing and treating this dreadful illness every day.
I will see you next week. Until then, be well.