The German Way; Antigen Tests; HCQ Disappointments; Promise of Anti-Inflammatory Drugs

The second study, by researchers at the Harvard T. H. Chan School of Public Health, also project a wavy future with peaks and valleys. Social distancing is turned “on” when the number of COVID-19 cases reaches a certain percentage in the population in order not to overwhelm the health care system, and turned “off” when the number of cases drops to a lower threshold, perhaps 5 cases per 10,000.

What is clear overall is that a one-time social distancing effort will not be sufficient to control the epidemic in the long term, and that it will take a long time to reach herd immunity. Lacking a vaccine, our pandemic state of mind may persist well into 2021 or 2022 — which surprised even the experts.

3. Mysterious young-children syndrome. Three young children have died in New York of a mysterious syndrome with links to the coronavirus. More than 73have been sickened. European hospitals report more than 50 cases of the rare illness, as did several states in the United States. The condition, which doctors are calling “pediatric multisystem inflammatory syndrome,”  creates a kind of toxic shock, accompanied by an extremely low blood pressure and an inability of the blood to effectively circulate oxygen and nutrients. So far, the syndrome has afflicted only young children

“One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response,” says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children’s Hospital. “This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn’t happen in everybody. It’s still a really uncommon event in children.”

4. FDA approves antigen test. In a significant move which holds the promise of greatly expanded testing capacity in the United States, the Food and Drug Administration has approved the first antigen test which can rapidly detect whether a person has been infected by the coronavirus.The test is produced by the Quidel Corporation of San Diego, and the FDA posted a notice of the emergency use authorization late Friday.

Medical experts said the approval of an antigen test would enhance testing efforts by giving medical workers and health authorities an inexpensive tool for large-scale rapid testing. If developed further developed, antigen tests also hold potential for use at home, in the manner of a home pregnancy kit.

Some symptoms can resemble features of Kawasaki Disease Shock Syndrome. 

5. Effectiveness of antiviral drugs cocktail. A new study published in The Lancet, researchers in Hong Kong reported that patients with mild to moderate COVID-19 appear to improve more rapidly if they were treated with a cocktail of antiviral drugs, compared with a group receiving a mix containing fewer drugs.

The more successful combination used lopinavir-ritonavir (two drugs marketed in one medication under the brand name Kaletra); ribavirin, which is used to treat hepatitis C; and interferon beta-1b, which regulates inflammation and suppresses viral growth and helps treat multiple sclerosis.

The comparison group was treated only with lopinavir-ritonavir, which some physicians stopped using after a recent clinical trial found it did not significantly improve outcomes in severely ill COVID-19 patients.

Patients given the broader cocktail tested negative within seven days, on average, compared with an average twelve days among those treated only with lopinavir-ritonavir. The cocktail also cut the duration of COVID-19 symptoms in half, to four days from eight days.

6. Hydroxychloroquine continues to disappoint. President Trump has aggressively promoted hydroxychloroquine and azithromycin as “very effective” in the treatment of COVOD-19, and as possibly “the biggest game changer in the history of medicine.” Trouble is, clinical trials so far show that hydroxychloroquine and azithromycin are ineffective in treating COVID-19, and they have serious side-effects, even leading to death.

The most recent large study on the use of the antimalaria drug hydroxychloroquine in hospitalized COVID-19 patients found that the drug had no impact on the risk of the most severe outcomes from the disease.

The observational study, published Thursday in the New England Journal of Medicine, looked at data on nearly 1,400 patients treated for COVID-19 at a large hospital in New York City, more than half of whom received hydroxychloroquine. Analysis of patient outcomes showed that the risk of intubation or death was not significantly higher or lower among patients who received the drug than among those who did not.

The authors of the study say the results should not be taken to rule out either benefit or harm from hydroxychloroquine, which is currently being used to treat thousands of COVID-19 patients. But, they add, the findings don’t support continued use of the drug in COVID-19 patients outside of clinical trials.

“Clinical guidance at our medical center has been updated to remove the suggestion that patients with COVID-19 be treated with hydroxychloroquine,” they wrote

7. Promising COVID-19 treatments. Clinical trials show remdesivir as a promising drug to treat COVID-19, even if it is not the knock-out, silver bullet drug it was initially thought to be. Its eventual value is likely to be as one ingredient in a combination therapy. Other drugs which may be part of such a therapy include further antivirals, and also anti-inflammatory medicines.

One possible anti-inflammatory treatment is tocilizumab, sold by Roche as Actemra and currently prescribed people suffering from arthritis. Many of those most seriously affected by COVID-19 die because of an overreaction of their immune system, called a cytokine storm, which leads to massive inflammation of the lungs and consequent respiratory failure. Cytokines are signaling molecules. Several varieties of these molecules are secreted by the immune system in order to regulate itself. A storm occurs when uncontrolled levels of cytokines are released. Actemra blocks the cellular receptors for a cytokine called interleukin-6.

A recent trial of Actemra on 129 covid-19 patients who had developed pneumonia showed that it reduced deaths in the worst-affected. The big challenge with anti-inflammatory treatments is knowing when to give them. Applied too soon, they will reduce the immune response which is needed to tame the virus. For that, doctors will need to look carefully at the data from the Actemra trial. These, though, have not yet been published either.