I feel like it’s time for another update. I’m sad to report that I’m a bit overwhelmed with the information that is coming out so I’m not sure where to start. Some data: There are currently over half a million confirmed cases of COVID-19 in the world. (These are just the confirmed #s-some places like us have shortages of tests, equipment, etc.) 190/195 countries are now reporting cases.
United States has now topped the global list surpassing China and Italy for the # of confirmed COVID-19 cases at 83,000+. We (the US) have only seen about 1200 deaths from this virus, but it is somewhat early for our timeline.
Some states such as New York, Michigan, and Louisiana are feeling the strain on their healthcare/hospital system and are having to divert cases and pull physicians from out of retirement or other Specialties to help care for the sick. Shipments of PPE (personal protective equipment) and testing kits are coming but are still inadequate for the impact that we would like.
In the surrounding area of Charlotte, NC, and many other hospitals, doctors and staff are allowed one surgical mask per day that they must wear on their entire shift. Since the virus can be aerosolized, they will wear an N95 mask, if available, for intubations. There has been a national effort to help with masks with many sewing groups donating masks for healthcare workers. While these aren’t effective for full protection, they are most likely going to be used on symptomatic patients that are unconfirmed COVID-19 + to add a layer of protection.
Some good data: Physicians are communicating like never before on an international scale to share anything and everything we have learned to fight COVID-19. Because the COVID-19 is a novel (or new) virus strain, a lot of the information is anecdotal, meaning we haven’t tested it properly yet, but it could help nonetheless.
Hydroxychloroquine (Plaquenil) and Azithromycin Combo: There is hope that this combination of medication can both help the severe cases of COVID-19 as well as can be taken as a prophylactic medication for healthcare workers who are exposed daily. Countries like India are already testing it for prophylaxis and they have a good amount of the PAI (pharmaceutical active ingredient) for mass production if it works. The data is mixed on whether this combo is helpful however, with some hospitals reporting that it does not help their patients, and others saying they are seeing great results. Some states such as Texas and Illinois have had to ban prescribing of Plaquenil to 14-day supplies and only for pre-existing conditions such as Rheumatoid Arthritis or Lupus because there was a rush to get the medications when it was announced in a press conference to be a miracle drug. We do know that there is ramped up production, however we do not know when we would have the quantities needed to treat adequately. It is still NOT recommended to take this medication combo without being monitored in the hospital or by a doctor because of the serious cardiac arrythmias (abnormal heart rhythms) that can occur and lead to cardiac arrest.
New Drugs are being studied such as an anti-viral medication, Remdesivir by Gilead Sciences that is showing some promise in treating COVID-19.
Existing Drugs are being studied as possibly reducing the risk of getting COVID-19 such as
- Losartan: a blood pressure medication that blocks the receptor used by the virus to enter cells in our bodies.
- Hydroxychloroquine (see above)
- Estradiol, a form of estrogen that acts on several pathways to improve function of the immune system. Experts speculate that its benefits could be contributing to the observed lower death rate in women vs men with COVID-19.
North Carolina is now doing more testing per capita than most other states. However, the demand is still outpacing the supply and the turn-around time for results varies greatly. There is still news of a rapid test that can be resulted in a few hours, but I’m not aware of this being widely available at this time.
So, once again there is new criteria for testing for COVID-19. To be tested for COVID-19 in NC, you now have to have a fever + negative flu test + cough + shortness of breath (the shortness of breath piece having been added). Some states are even not testing for flu now because we are beginning to think you can be co-infected with the flu and COVID-19 at the same time, and we need the swabs that are used for flu for testing for COVID-19. If this paragraph was confusing to you, you are not alone! CALL AHEAD or CALL/TEXT ME before going to get tested and we can talk through if you need to. I previously recommended that you purchase a thermometer and a pulse oximeter. Even if you won’t have it for a couple of weeks, we may be in this for a long haul and it can become a valuable tool for assessing your health. We know that you may or may not have a fever and be positive for COVID-19. Usually, there are reports of fever at least at some point in the course of the illness. The pulse ox which measures the amount of oxygen you are getting is becoming the unofficial gold standard by which we are assessing the need for hospital/inpatient care verses outpatient care. Some patients are being discharged from the hospital on oxygen with a pulse ox due to the lack of beds. It really is a helpful tool to have.
A lot of you are wondering when and how will this pandemic ever END?? It will probably end when we reach herd immunity or a vaccine is developed. Herd immunity is when there are enough individuals in the population that are immune to getting the disease (COVID-19) from either (1) having it before and their body has produced antibodies against the disease, or (2) the vaccine confers an 84-94% immunity rate in the population. You can think of it like chicken pox. If you had the chicken pox when you were little, then you don’t necessarily need the varicella vaccination because your body has already developed immunity to the disease. However, if you never had it, then you would get the vaccination, i.e. varicella shot so that your body will produce antibodies and your immune system will fight the disease.
There have already been vaccinations developed for COVID-19 in record time and injected in humans to test if it works. However, it takes about 18 months to fully test the safety and efficacy of a new vaccination and even longer to develop and distribute it to everybody. But this can be done! It has been done! And we will do it again!
Until then, we must stay the course, HOLD THE LINE, and practice social distancing so as to flatten the curve and not overwhelm our hospitals and healthcare infrastructure. This virus is tricky in that it can be bad in young and healthy people as well, so we’re not just fighting for our elders or those with other medical problems like heart disease or diabetes. Although, those that are older and with other medical problems may have an increased risk of a bad outcome, we are seeing more and more young and healthy patients wind up on a ventilator. As of now, 1 in 10 positive cases of COVID-19 are healthcare workers, and all positive cases are someone’s loved one.
Lastly, the COVID-19 may be like the flu or influenza virus in that it may never truly go away. Just like we need to get a flu shot every year because the flu can be particularly bad in the winter months, COVID-19 may turn out to be a waxing and waning type of infection as well. This is something else we will have to wait and see and only time will tell.
That’s all the info I have for now. I really can’t wait for the day when I get to hug my family and friends and many of you (you may get a hug coming into the office, not just on leaving)! Until then, I will try my best to keep you informed, be available to you, and stay away from everyone so we can beat this thing.