Keep Hope Alive
MEDICAL UPDATE
Today is about HOPE. We can all use a little these days. Let’s acknowledge this difficult moment in history and recognize that no part of our society is untouched by racism—including this disease. There is clear evidence that COVID-19 disproportionately affects people of color.
It’s my job as a doctor (and as a human being) to know and understand this data as it applies to my patients, regardless of color. Indeed my job is not simply about treating coughs, fevers, and sore throats; it’s about understanding patients’ social and emotional determinants of health. Not just because they affect people generally, but because they are relevant to medical outcomes.
My job is also to present hope when it’s possible. And indeed hope is alive when it comes to coronavirus. The past few months have helped shed essential new light on its behavior and how to prevent and treat it.
Yellow is the color of hope, optimism, and enlightenment. And yesterday I stumbled upon this aptly named peony called “Sequestered Sunshine.”
Here I’ll shine some light on (and un-sequester) ten pieces of good news on the fight against COVID-19.
There is mounting evidence that kids do not get seriously ill from COVID-19 (though of course some do, it’s just very few). Some of the earliest and best data came out of China. In fact, kids with COVID-19 tend to have (very) mild cases. This fact is generally accepted but of course is a subject of ongoing study.
The more complicated question of whether kids can spread the virus is being studied extensively, too. And we still are not sure. But mounting evidence suggests that kids are unlikely to be infected and therefore unlikely to spread disease (though indeed kids can be infected, can carry the same viral load as adults, can infect others; it’s that kids don’t seem to get infected very often.) For references, see studies from Iceland, Italy, the Netherlands, and Australia.
The antiviral medication called Remdesivir continues to show promise in hospitalized patients with COVID-19. The next phase of the NIH Remdesivir trial has begun.
A preliminary analysis in a randomized trial of IV Remdesivir showed a statistically significant improved recovery time for COVID-19 patients in one group when compared to a placebo. Remdesivir also showed a reduced mortality rate that was not statistically significant when compared to the placebo but still warrants further study.
We continue to learn more about coronavirus’ behavior. Sophisticated lab and animal models of COVID-19 consistently show a unique and significant inflammatory response to the virus. This knowledge drives what types of medications and treatments to study—and helps us better care for our sickest patients.
Specifically, coronavirus infection causes a reduction in a chemical made by our own bodies called interferon which is normally protective in viral infections. The virus also promotes an increase in cytokines which are proteins made by our immune system that seem to define and drive much of the inflammatory disease state associated with COVID-19 in some patients.
We now know even more about the medication Hydroxychloroquine. WHO has implemented a temporary pause of the Hydroxychloroquine arm of the ongoing world-wide Solidarity Trial because overwhelming data indicates adverse outcomes and increased mortality due to this medication in COVID-19 patients. (It is still used safely for malaria and certain autoimmune conditions.)
Convalescent plasma has been used to treat more than 16,000 patients in the US so far. Preliminary anecdotal reporting suggests improved mortality that is not yet considered significant. These studies are ongoing as more people who have recovered from COVID-19 donate their plasma.
Vaccine trials continue all over the world. As you have probably read, the biotech company Moderna recently announced its exciting preliminary results demonstrating that 8 recipients of their experimental vaccine produced neutralizing antibodies to coronavirus in the lab. So far it looks good, but there’s a long road ahead.
The FDA has helped clean up the mess of antibody testing. It has deemed all RAPID antibody tests of poor quality. As a result, 28 foreign manufacturers have been ordered to remove their products from the market. But there are still a number of accurate and reliable antibody tests available, and testing is becoming more widespread. In my office, we use the very reliable test made by Abbott, and anecdotally, all of my patients who had documented COVID-19 have tested positive for antibodies. This is good news and reflects the larger pooled data showing that most people with COVID are mounting an appropriate immune response—which likely confers some immunity.
In closing, I’ll share with you an uplifting thought that my patient wanted to share. She was quite sick from COVID in April and is now fully recovered. She likely contracted the virus from her mother who was at the end of her life in hospice. Despite being frail and infected with coronavirus herself, my patient’s mother expressed guilt for having given the virus to her otherwise healthy daughter. And now, a month later, even as my patient mourns the loss of her mother, she has found a silver lining. When I told her the good news that she tested positive for high levels of COVID antibodies, she said to me, “My mom gave me everything. She gave me the virus, but she also gave me the gift of immunity.”
Let’s hope for more hope. I will see you tomorrow. Until then, be well.
P.S. Be sure to join me and my colleague Dr. Clay Ackerly on Facebook LIVE at 8 pm TONIGHT. We will answer your COVID-19 questions and hope to see you soon.