Covid-19 Update
Another week, more important news…
1. Why the big shifts upward and downward in infection rates? We see big national shifts and trend. Covid-19 cases were initially very high in the Northeast, especially in New York, New Jersey, Connecticut and Massachusetts. These states are now clearly way past their peak and trending downward. Massachusetts had its first day today with zero Covid-19 deaths. On the other hand, states that were initially slower to see cases such as Texas, Florida and Arizona are now experiencing major rises in new cases that will certainly result in more hospitalizations and deaths. The cause and effect between states insisting on social distancing and wearing of masks is very clear. California is kind of in the middle of this dynamic as they shut down early and forcefully reduced their numbers but are now seeing major increases in Los Angeles as they let up restrictions too early. Increasing data about the wearing of masks shows that they are an important tool in the prevention of viral transmission. The graphic below shows the effectiveness of masks when worn by both the infected person and the healthy person.
2. Cost of Remdesivir Gilead, the drug maker, just came out with a cost estimate for the use of Remdesivir intravenously per patient -- $3,120. As stated in an earlier post, Remdesivir is one of only two drugs to date proven in clinical trials to reduce mortality for patients in hospitals. The other drug is the steroid dexamethasone that costs about $1.25 per dose. Hydroxychloroquine was found to be less than useful and there is still no evidence that the commonly used antibiotic Azithromycin (Zithromax) has any utility.
3. Why can Covid-19 symptoms go on for months? A new phenomenon has emerged – patients who stay sick for months! These patients appear to have cleared the virus from their bodies, but still experience daily fever and severe fatigue. This reminds me of patients I used to see with the Chronic Fatigue Syndrome now called the Chronic Fatigue Immunodeficiency Syndrome. This is felt to be caused by a virus that sets up an ongoing maladaptive immune response. This syndrome is also well known to occur sometimes after a typical influenza infection, sometimes called Myalgic Encephalomyelitis. The take home message for me is to understand that our immune system evolved to protect us from infections and cancers, but sometimes it backfires and causes a lot of miserable symptoms. In most patients, these symptoms resolve over months to years, but in a very few they last indefinitely.
4. What’s the latest with a vaccine? We know that the government has blessed five companies to proceed with vaccine research and development – Moderna, AstraZeneca-Oxford, Merck, Pfizer and Johnson and Johnson. The Moderna and AstraZeneca vaccines are already being tested in human volunteers. A Chinese company, SinoPharm, has started testing its vaccine in over 1000 people with reports of strong antibody responses. There are many other companies around the world working on a vaccine. The holy grail of a good vaccine is safety, effectiveness and low price.
Yesterday, Dr. Fauci suggested that the best we may see is a vaccine that is 65-75% effective in preventing infection. A recent CNN poll shows that up to a third of the population may decline getting the Covid-19 vaccine even if it is shown to be safe, effective and inexpensive. If one third of the population declines to get vaccinated, that will make attaining widespread herd immunity more difficult. Herd immunity exists when enough people have either had the infection or have antibodies from a vaccine to stop the transmission.
Big picture. The U.S. has 4.25% of the world’s population but 25% of total cases worldwide – 2.5 million out of 10 million and 25% of all deaths worldwide – 126K out of 503K. And, tomorrow the European Union will bar visitors from the United States.