Use My Blog as a Filter
MEDICAL AND MENTAL HEALTH UPDATE
Today we’ll go over some hot topics, a sprinkling of good news, and some suggestions. On everyone’s mind these days is COVID antibodies, immunity, the vaccine, and the upshot for schools.
Let’s start with this BURNING question: how will we ever get out of this HOT MESS??
Well, there are three ways (alone or in combination):
Therapeutics: treatments for active illness that target the virus itself, quiet virus-induced inflammation, and bolster the immune system. We have yet to find proven therapies for mild to moderate COVID-19, but scientists around the world are working overtime to develop them. As of now, only our sickest patients benefit from the available therapeutics like Remdesivir (antiviral), Dexamethasone (steroid), and convalescent plasma (antibody infusions from recovered patients). There are so many exciting new drugs in the pipeline that give me hope (for example drugs that are clones of human antibodies), so stay tuned!
A vaccine: a substance designed to trigger the body to mount a robust antibody response against coronavirus. This week we saw promising data on a vaccine made by Moderna in partnership with NIH: this small, non-infectious snippet of a vaccine induced an immune response in all of the 45 healthy volunteers who received it. This is great news, but the big question remains: WILL IT WORK TO NEUTRALIZE CORONAVIRUS? It is way too early to know. A larger phase 3 trial will begin later this month to test thousands of patients. Looking for ways to help? Volunteer for any of NIH’s trials by checking out NIH’s new COVID-19 clinical trials network!
Herd immunity: the phenomenon where most of the population is immune, thereby reducing the risk of NON-immune people from encountering a sick person and becoming ill. There are three ways to achieve herd immunity:
widespread infection with the coronavirus (aka Sweden’s not-so-hot plan that caused thousands of unnecessary deaths),
widespread vaccine administration, or
a combination of the above.
Now: herd immunity can happen ONLY when infected or vaccinated individuals mount a robust AND durable antibody response. Meaning that the immune system generates enough antibodies to fight the virus AND the antibodies hang around long enough to keep you safe. Herd immunity through vaccination also hinges on people actually GETTING the vaccine (a conversation that lends itself well to a future post on separating fact from fiction).
Interestingly, a recent study out of the UK tested proven COVID patients for the presence of antibodies at least 8 days after symptom onset, and nearly ALL tested positive for them. Hooray! That’s good news. But, the study also showed that these antibody levels declined significantly in most patients over time.
While this of course SOUNDS like a huge bummer, the study was small and is STILL NOT PROOF that antibodies aren’t durable. Plus, there are other parts of our immune system that fight infection, for example our super cool memory B-cells. These guys might be the reason that PAST exposure to benign coronaviruses (aka the “common cold”) might help protect us from the novel coronavirus by priming our immune system to make antibodies upon demand. Could this help explain why some people with COVID-19 fare better than others? Ongoing research will most certainly tell us.
What are the upshots here?
At the moment, we still cannot reassure people who develop antibodies—from natural infection or the 45 people who got the above vaccine—that they are safe and immune indefinitely.
Science is on our side, and researchers are working around the clock to figure out how to beat this beast. It’s all hands on deck, and I remain optimistic.
Because information is changing by the minute AND because most COVID news isn’t actionable, I suggest “batching” your medical news. Sort of like I tell patients who are trying to lose or gain weight for medical reasons NOT to weigh themselves every day (or EVER in some cases), look instead at trends. By keeping a bird’s eye view—instead of living in the weeds—you can free up some brain space and OBSESS LESS about the natural day-to-day ups and downs.
USE MY BLOG AS A FILTER. My job is to live in the medical weeds so my patients don’t have to!! I enjoy it here, dirty and hanging out with the worms. But if I DIDN’T have a filter, I, too, might obsess over my blood type, getting COVID twice, the toilet plume in a Sunoco bathroom, or the inevitable attack of aerosols. I’m lucky that a white coat comes with a built-in medical panic de-escalator. (Just don’t put me on a roller coaster.) With so much information coming at you, just turn it off and check in later. It’s okay.
And last: SCHOOLS. As a doctor, mom of three teens, and current consultant to some DC schools, I’ve got a lot to say about this. I really want my kids in school this fall, but I also appreciate the risks, particularly to the adults on campus. I’ll talk a bunch more about this next week, but in the meantime, click here to watch my Monday night conversation about these complex issues with Dr. Clay Ackerly.
I will check in next week. Until then, try to maintain calm vigilance, and be well.