Dr Deepthi Jayasekara, April 05, 2020in essay entitled “COVID 19-What we know now” **
The phase 1 of the COVID-19 pandemic is over and we are in phase 2 now. Phase one dealt with preparedness for the crisis which was defined in terms of health and economic consequences. Phase 2 is the reality check in the midst of actual crisis where COVID 19 is sweeping across the globe. The pandemic is unfortunately crushing dreams, lives and businesses in every country. This is crunch time for most of us except the southern hemisphere which is anxiously waiting for their winter in the months to come. Some countries are more impacted than others based on the level of preparedness to the pandemic and also because of logistic reasons. The testing for the virus is carried out or not carried out due to varying reasons per guidelines set forth by their countries. Unfortunately, the denominator for each country based on number of tests done will determine the real case fatality in the end. The final analysis of these figures will surface only after post-pandemic epidemiological studies.
What lies ahead? The more tests we do, the more we would know about the immunity of the people to combat this virus. This is of paramount importance specially when we collect data from antibody tests (seroprevalence testing). Some labs have already started antibody (IGM and IGG) and others are still waiting for their reagents to arrive. Some antibody tests only require a drop of blood.
The Cellex and Mayo Clinic are launching their first antibody tests in a few days. These tests will shed light on deciding as to who has developed immunity to the virus. If you have developed immunity, we can use your convalescent serum antibodies to treat another patient who has not responded to convention treatment protocols. This way, we could also identify doctors and nurses who are immune to the infection and deploy them to treat active COVID 19 patients.
On the testing front, we continue to test patients for COVID-19 with nasopharyngeal swabs and in some instances, self-collected nasal swabs for RT-PCR. The sensitivity of the test varies based on the lab (from 70% of routine RT-PCR to 90% POC GeneXpert and Abbot quick test).
On the treatment front, we continue to be in dire straits with shortages of antiviral medications and immune modulators like Hydroxychloroquin specially for outside prescriptions. But most hospitals are stocked up with Hydroxychloroquin, Azithromycin and some Tocilizumab (IL 6 inhibitor) for combat cytokine storm. Remdesivir (antiviral used for previous SARS and Ebola patients) is only available on compassionate basis via RDV NIAID study protocols. Some hospitals have added a new IL -1 inhibitor called Anakinra (which is used for severe Rheumatoid arthritis) based on a phase 3 trial from Italy. Corticosteroids are not recommended except for early ARDS (Acute Respiratory Distress Syndrome) which carries very high mortality due to lung damage. Inhaled Nitric oxide and Viagra are been looked into through new ARDS trials in severe COVID-19 infections.
Some hospitals are inundated with patients confirmed with COVID 19 with entire floors open and dedicated to such admissions. ICU’s of some hospitals in mid-city areas are completely overwhelmed by the patients on ventilators. The more the demand for ventilators , the more chaotic It gets. Most of us in the hospitals donn surgical masks on regular basis and N95 masks with face shields/gowns/gloves for actual COVID patients and PUI’s (Patients Under Investigation).
Let’s all try to flatten the curve by observing CDC and local public health guidelines. Do not be a victim of fearmongering. We will overcome this monster in the weeks to come with absolute confidence. Please reach out to those who are in desperate need of your help now and beyond. This is your time to shine as a true leader!
Dr Jayaskera is Clinical Professor and Infectious Diseases Specialist, Claremont, California
** There is a taken-for-granted US-centric view of the world within this good doctor’s well-intentioned essay. The article should be utilized in conjunction with WHO notices and other presentations from accredited personeW