Once again, I hope this note finds you all safe and well. My thoughts go out to all of you who have been personally affected by Covid-19.
As we continue to follow the course of this pandemic, we see parts of our country (and the world) start the process of reopening while other areas brace for possible increased cases of Covid-19. As of this week, Connecticut has over 30,000 confirmed cases and over 2,000 deaths, but has seen an overall significant decline in hospitalizations over the past two weeks. Governor Lamont is looking at criteria for beginning to re-open the state, including 14 days of decreased hospitalizations; adequate testing, personal protective equipment (PPE), and healthcare capacity; substantial contact tracing; and protection of high-risk populations. If these goals are met, we may see a partial re-opening by May 20.
What is new?
In my last update, I briefly mentioned that the drug Remdesivir was being evaluated in clinical trials. Since last week, the U.S. Food and Drug Administration (FDA) has approved this anti-viral medication to treat Covid-19 following a clinical trial at the National Institutes of Health (NIH) showing efficacy. This study was a randomized, double-blind study (meaning neither the provider nor the patient knew who was receiving Remdesivir or the placebo; this helps eliminate bias in a clinical study) with over a thousand patients enrolled. Efficacy was demonstrated in 50 percent of the patients receiving Remdesivir. The patients who received the medication improved by day 10 and 11 (depending on whether the medication was administered for five or 10 days) compared with the placebo group, which improved at 15 days on average. The death rate was 8 percent for those receiving Remdesivir and 11.6 percent for those receiving placebo. (This, however, did not meet the criteria for being statistically significant).
Remdesivir has a good track record showing safety in humans when trialed a few years back during the Ebola outbreak. It works by mimicking the amino acid adenosine in the virus’s RNA, which causes it not to be able to replicate or infect. (It’s kind of like replacing the fuel injector in your car with the wrong part. Your car is not going to run.) Of course, this is only one study and more research is needed. A prior study conducted in Wuhan with over 200 patients and published in The Lancet was inconclusive. If Remdesivir is ultimately able to decrease hospital stays, it will reduce the chance of hospitals becoming overwhelmed.
Progress is also being made on antibody testing. The FDA has approved a number of tests under the EUA (Emergency Use Authorization Act). At this time, we do not know how sensitive or specific these tests are. Nor do we know if a test showing past exposure to Covid-19 means that a person has protective immunity. Further research and time will tell.
Last week I discussed potential issues with Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for patients with Covid-19. The New England Journal of Medicine published the results of three observational studies that, when taken together, seem to indicate that Covid is not worsened by these medications. Thanks to the parent who shared an article with me that theorizes these medications may actually help with recovery from Covid by increasing the ACE-2 receptor that is free floating in our blood, which traps the virus. If found to be true through further studies, that would be great news.
Researches are also looking for other, less invasive ways to test for active Covid-19. Anyone who has had the nasal swab performed will tell you it is about a millimeter shy of a brain biopsy. Thanks to another parent who shared a paper noting that a saliva test out of Rutgers University’s Human Genetics Institute has been approved by the FDA (under the EUA). There are also some initial studies being done in California looking at swabbing the cheek. At this time though the nasal swab still remains the gold standard.
Please continue to send me questions, comments, and other information you think might be useful to share with the community.
As we move forward, common sense and reason will be our best allies. Be safe. I truly believe our researchers and scientists will get us to where we need to be. Yes, the future is uncertain, but we all have each other and will get through this together.
Tom McLarney, MD