April 29, 2020

hope springs up

As I write this, the count of COVID-19 cases in the US is more than a million with over 60,000 deaths. Despite arguments to the contrary, these numbers could have been much higher. But we are not done yet. These numbers will rise with the re-opening of the country, there is no doubt. Whether the numbers will be enough to convince skeptics, I don’t know. This is a great article about recognizing bullshit and finding more reliable information. Dr. Carl Bergstrom suggest getting information from “professional fact-based media versus hyper-partisan media”. It is well worth the read. Another great source is the New England Journal of Medicine’s Coronavirus page which updates regularly with new information. Lucky for us, they are making it free to read without a subscription.

As, I am sure, many of you have heard, the antiviral remdesivir shows promise in speeding recovery. Data, from a placebo controlled trial in which half the patients got placebo instead of remdesivir, showed that the time for recovery was decreased from 15 days to 11 days. And deaths decreased from 11.6% in the placebo group to 8% in the treated group. It is expected to get expedited FDA approval due to the crisis, bypassing the usually long process. The other good news is that a five day course of treatment was as effective as 10 days, which means there will be twice as many courses available. Gilead is already ramping up manufacturing to be able to have it available, which will be the biggest limitation.

It is nice to know it helps, but it is not a cure or a prevention. Treating viral infections is very different than treating bacterial infections. When you have strep throat, you can take penicillin for 10 days and your sore throat is usually better by the next day or two. Antivirals don’t work in the same way. Even Tamiflu in influenza shortens it by only 1-2 days. Remdesivir works, but will not be available for mild cases. Still best to avoid infection. You do not want to be sick enough to need this drug!

And that will start be more challenging for those of us with risk factors or who live with loved ones who do. Things are opening up, people understandably want to get out and about and be active again, not to mention getting back to work. For many of us, this increases our vulnerability to exposure. I want to remind everyone to stay sensible and take the risks you think you can, but try not to be cavalier.

I braved Costco yesterday because I needed gas and a couple of things. I reasoned that going before the end of the month and before the shut down eases up that it wouldn't be so crowded and there will be less infections in the community to get exposed to. Theoretically a good idea. I felt pretty safe in my old N95 mask and nitrile palmed gloves that Jamie gave me. Until check out, when the young woman that was boxing up all the goods for the woman in line before me, had her mask pulled down and not covering her nose. She kept pulling it and holding it up when she talked. I could imagine the droplets flying, sticking to her hands and everything she touched. Probably my last trip to Costco for a while. Good reminder to me that things are going to be riskier, not safer, for us soon. The mask you wear protects me and vice versa. But only if you wear it correctly and cover your face and don’t touch it.

Wash your hands and cover your nose!

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.theguardian.com/world/2020/apr/28/there-is-no-absolute-truth-an-infectious-disease-expert-on-covid-19-misinformation-and-bullshit

https://www.nejm.org/coronavirus

https://www.nih.gov/news-events/news-releases/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19

https://www.nbcnews.com/health/health-news/coronavirus-drug-remdesivir-shows-promise-large-trial-n1195171