COVID-19: What’s on the Horizon?

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COVID-19: What's on the Horizon?Updated Saturday, December 5, 2020
COVID-19 has put us all into a tailspin. With daily updates of infections and deaths, it’s unnerving to say the least. Currently, and in the foreseeable future, it is absolutely imperative that people follow the rules of social distancing, hand-washing and surface hygiene, and only make minimal and necessary errands out of the house. When you go out in public, please wear a mask.1

Face Masks

If you wear a cloth mask, make sure one of the materials used in the mask is a good filter material, i.e., material from an antimicrobial pillowcase, or car shop towel as suggested by the inventor of the N95 mask.2 Here is a helpful video to make a cloth mask with a pocket: How to sew a reusable facemask with filter pocket 3 Surgical and cloth masks decrease the chance droplets from the wearer will infect others. However, they do little to protect the wearer, so please maintain a social distance of at least six feet. Only N95 masks confer protection to the wearer but they must be properly fit-tested per the manufacturers' recommendations (most manufacturers have online videos on how to do this), or they are useless. At the present time, N95 masks are not recommended for the general public because they are in short supply for healthcare workers on the front lines and our national stockpile is depleted. Healthcare workers are having to reuse N95 masks several times. Some cleaning methods are being tried but there is concern the cleaning methods will degrade the masks' filtration ability.

What’s next? What’s on the horizon?

First and foremost, do not become complacent. Please do not let sunny weather, politics, or rampant social media conspiracy theories allow you to let your guard down. This is indeed a pandemic, the virus is highly transmissible, unpredictable, and people are dying.

Antibody Testing

The FDA has approved an antibody test produced by the Cellex biotech company.4 From all known data, the antibodies do confer at least months of immunity. There are case reports of people in China who had negative second COVID nasopharyngeal swabs and positive IgG and negative IgM antibodies,5 but then had their nasal swabs turn positive; however, none of those patients exhibited any symptoms of the disease and they were eventually negative for shedding 1-2 weeks later. Convalescent serum being used is appearing to be fairly effective in reducing the course and severity of the disease in those receiving it but results are extremely preliminary—pretty much peer reported on chat pages for ICU docs sharing information at this point.

The problems with the approved antibody tests:

1) They can be positive in a person who is still shedding the virus, so they need to be combined with a nasopharyngeal PCR. 2) They do not quantify the amount of antibody—only that you have been exposed, and for instance, no longer make IgM. 3) They are not a viral neutralization test—they do not show how effective the antibodies are. However, they do let you know if you’ve been infected and if you have a negative nasal swab, likely cleared the infection, especially if you have IgG and not IgM antibodies. With IgM (acute) antibodies, you may be somewhere on Day 9 of infection or later. Some complicating factors might be that the nasopharyngeal swabs have about a 30% false-negative rate currently on the most widely used machines at this point. The Abbott machine for nasopharyngeal swabs is better—90% accurate (at least in their FDA approval document) and fast, but it is not widely available yet. I think what is next on the horizon might be a virus-neutralizing antibody test being more widely available.

Recurrences After Testing

51 patients thought to be recovered in South Korea have recently tested positive again.6 Once again, the likely thing is that the cleared samples were false negatives. We are seeing about 30% false negatives on COVID testing in people who have every sign including ground-glass opacities without any other reason to have them. We have people with all the symptoms test negative 1-2 times, and then test positive with all the same symptoms.

The takeaway with regard to current Antibody Testing:

1. There are false positives (10% even on the best tests) and also positive antibodies while you are still shedding virus. 2. Really unless you have had 3 negative nose swabs and a positive IgG and Negative IgM, you could still be infectious. 3. IF two people both have IgG antibodies (long term antibodies forming weeks after virus exposure) and no IgM antibodies (short term antibodies) forming 5-9 days after, then the chance of one infecting the other is low because they have both been exposed to the virus and either cleared the virus, or already have it.

COVID-19 Immunity Is Questionable

If you've recovered from COVID-19, immunity to another COVID-19 infection is absolutely not a certainty. In a July 7, 2020 inteview with CNBC, Dr. Danny Altmann, professor of immunology at Imperial College London, stated: "Immunity to this thing looks rather fragile. Some people might have antibodies for a few months, and then they might wane, so it's not looking like a safe bet."7

Therapeutic Drug Possibilities

Remdesivir

IV Remdesivir and survivor serum show some early promise. However, clinical trials are not completed, and supply is limited. Remdesivir is from an American company, Gilead Pharmaceuticals,8 the same company that produced the Hepatitis C cure.9 On April, 29, 2020, the National Institutes of Health announced an NIH clinical trial has shown that Remdesivir accelerates recovery from advanced COVID-19.10 On May 1, 2020, the FDA granted emergency authorization for use of Remdesivir as a therapeutic treatment for COVID-19.11 Bear in mind, Remdesivir is not a "cure." It has only been shown to lessen the duration of COVID-19 in some cases. It is early days yet. Remdesivir was originally formulated as a possible therapeutic for ebola, but was not effective.

Convalescent-Plasma Therapy

Trials are currently being launched for convalescent-plasma therapy12 which is showing some promise. The survivor serum called Convalescent Sera is being closely looked at.13,14 Without further study, the true effectiveness of convalescent serum will not be known. For those who have had the disease and are in good shape after recovery, consider donating your own convalescent serum to studies being done in your area.

IV Zinc

There is a world-first, fast-tracked clinical trial at the University of Melbourne in Sydney, Australia, to test the benefits if IV zinc. Their studies have shown that zinc can protect vital organs from damage caused by lack of oxygen. Zinc has also been shown to be beneficial in treating severe pneumonia cases.15

Hydroxychloroquine

A large-scale, multi-hospital study from the Henry Ford Health System has shown treatment with hydroxychloroquine to significantly cut the death rate: "when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality."16

Dexamethasone

A commonly used and inexpensive steroid medication, dexamethasone, may reduce mortality in COVID-19. While the results of 1/3 less mortality in ventilated patients and 1/5 less are encouraging, they must be interpreted with caution. Unfortunately, the results were released in a press release without raw data, and have not undergone peer review as of yet. Anecdotally we have not seen great results with steroid use in patients in my experience, but we normally use SOLU-MEDROL and not dexamethasone.

Vaccine

There are investigational vaccines by Pfizer and Moderna which use a new type of technology (messenger RNA or "mRNA") currently being evaluated in Phase III clinical testing that have shown promise in mouse studies. See: NIH-Moderna investigational COVID-19 vaccine shows promise in mouse studies. However, because mRNA is a new technology, the long-term side effects are unknown. It is a caution for any vaccine not having gone through the usual 18-month Phase III trials and/or using a totally novel approach never before used, i.e., mRNA. I feel a lot better about the vaccine the Israeli government is developing which uses an attenuated harmless virus recombined with COVID antigens; it is a much more tested way of making a vaccine. Also, they are doing all the usual trials and their motive is not profit.17 There is information coming out with regard to the BCG vaccination (Bacillus Calmette–Guérin) primarily used against tuberculosis; countries without a BCG vaccination policy “saw ten times greater incidence and mortality from COVID-19.”18

What to Do Now

Please bear in mind, everything is fluid and quickly evolving right now. By all means, PLEASE continue with the rules put into place by the CDC which are: to wash your hands often (use hand sanitizer when soap and water aren’t available), avoid touching your eyes, nose, or mouth, avoid close contact with others, stay home as much as possible, put distance between you and others, wear a mask when in public, cover coughs and sneezes with the inside of your elbow or sneeze/cough into a tissue, clean and disinfect frequently touched surfaces daily.19

Dietary Supplements

The two most important immune-boosting dietary supplements on the forefront of the fight against COVID-19 are zinc and Vitamin D. There are recent studies from the Irish Medical journal suggesting that "Vitamin D supplementation in the wider adult population, particularly in frontline healthcare workers, may further limit infection and flatten the Covid-19 curve."20 A recent article from Northwestern University, entitled, "Vitamin D Appears to Play Role In COVID-19 Mortality," states that Vitamin D cannot actually prevent you from getting the virus, but that their "analysis shows that it might be as high as cutting the mortality rate in half."21 Read more about immune boosting dietary supplements. The Doctor Emi Team
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Updated: Saturday, December 5, 2020

References

1. Cohen J. Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says. March 27, 2020. ScienceMag.Org.
2. Bhanoo S. Which DIY mask pattern should you use? Even experts can’t pick one to recommend. April 1, 2020. Seattle Times.
3. How to sew a reusable facemask with filter pocket. HomemadeOnOurHomestead. YouTube.
4. Saplakoglu Y. FDA approves first antibody test in the US to detect the coronavirus. April 3, 2020. LiveScience.com
5. Rachna C. Difference Between IgM and IgG. BioDifferences.com.
6. Brown L. 51 recovered coronavirus patients test positive again in South Korea. April 7, 2020. NyPost.com.
7. Taylor C. Immunity to the coronavirus is 'fragile' and 'short-lived,' immunologist warns. CNBC's Squawk Box Europe interview with Danny Altmann, Professor of Immunology at Imperial College London. July 7, 2020. https://www.cnbc.com/2020/07/06/immunity-to-coronavirus-is-fragile-and-short-lived-expert-warns.html
8. Gilead.com. https://www.gilead.com/
9. Gilead. Viral Hepatitis.
10. NIH clinical trial shows Remdesivir accelerates recovery from advanced COVID-19. NIH https://www.nih.gov/news-events/news-releases/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19
11. FDA Remdesivir EUA Letter of Authorization https://www.fda.gov/media/137564/download
12. Sheehy A. Antibodies in the blood of COVID-19 survivors know how to beat coronavirus – and researchers are already testing new treatments that harness them. April 1, 2020. TheConversation.com https://theconversation.com/antibodies-in-the-blood-of-covid-19-survivors-know-how-to-beat-coronavirus-and-researchers-are-already-testing-new-treatments-that-harness-them-134619?
13. Spencer G. A PROMISING COVID-19 TREATMENT GETS FAST-TRACKED. April 8, 2020. https://hub.jhu.edu/2020/04/08/arturo-casadevall-blood-sera-profile/
14. Casadevall A, Pirofi. The convalescent sera option for containing COVID-19. The Journal of Clinical Investigation. https://www.jci.org/articles/view/138003
15. Phebra Pharmaceuticals. World-First Trial to Test Benefit of Intravenous Zinc in COVID-19 Fight. April 9, 2020. prnewswire.co.uk.
16. Arshad S, Kilgore P, Chaudhry ZS, O'Neill W. Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19. Published: July 01, 2020. DOI:https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
17. Jaffee-Hoffman M. Israel completes Phase I trial of its coronavirus vaccine candidate, Brilife. The Jerusalem Post. November 27, 2020. https://www.jpost.com/health-science/israel-completes-phase-i-trial-of-its-coronavirus-vaccine-candidate-brilife-650382
18. Sruthijith K. BCG vaccination policies make a ten times difference in COVID-19 incidence, mortality: New study. April 3, 2020. The Economic Times. https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/nations-without-bcg-vaccination-saw-higher-cases/articleshow/74956201.cms?
19. How to Protect Yourself & Others. Coronavirus Disease 2019 (COVID-19). CDC.gov https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
20. Ring E. Irish Studies find Vitamin D can Build Covid-19 resistance. April 3, 2020. IrishExaminer.com
21. Backman V. Vitamin D appears to play role in COVID-19 mortality rates. May 07, 2020. News.Northwestern.Edu

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