Cinco de Mayo (Plus One)

Larry Leibowitz COVID-19 Updates

Larry Leibowitz COVID-19 Updates

To my Patients and Friends,

I hope this finds you well… here are some of the latest updates on COVID-19.

Strange, but (probably) true

You may have seen news reports about COVID toes, and it seems that it’s real.  Patients have been reporting the appearance of small, tender, dark red bumps on their toes, and an association with COVID-19 has been drawn.  These lesions resemble those seen in a syndrome known as chillblains (a.k.a. pernio), which typically appears as a response to exposure to extremely cold temperatures.  They’re common in the winter, but not during warmer seasons.  I’ve actually heard from four patients who have noted these findings to me in the last couple of weeks.  We don’t know for sure when in the course of a COVID-19 illness these lesions will typically appear, and the underlying mechanism remains unclear.  Nonetheless, it does represent a newly-uncovered probable symptom of COVID-19, and those who notice these symptoms- particularly during warmer weather– should contact their physicians for further guidance.

And there’s this

Case reports of children having developed symptoms of inflammation in association with COVID-19 have recently arisen.  Rest assured that the cases are rare and none of these children have died, but this is nonetheless a notable finding.  These children have developed a severe inflammatory condition involving multiple organ systems, including the arteries in and around the heart.  Reminiscent of a known condition called Kawasaki Disease, this syndrome may turn out to be yet another recognized manifestation of COVID-19.

New projections

You may have noticed that the highly-regarded Institute for Health Metrics and Evaluation (IHME) has nearly doubled its projected number of COVID-related deaths by August 4. According to IHME, “these projections are considerably higher than previous estimates, representing the combined effects of death model updates and formally incorporating the effect of changes in mobility and social distancing policies into transmission dynamics.”  In other words, these effects are at least in part due to overzealous relaxation of social distancing measures that we have been witnessing around the country.  For example, health officials in Utah County, Utah have identified COVID-19 outbreaks associated with two local business that refused to adhere to recommended physical distancing practices.  Although New York and adjacent states have reported their lowest daily incidence of COVID-19 cases since mid-March, the rates of COVID-19 in the majority of states in the country have either remained stable or have increased.  A number of states- including Indiana, Iowa, Kansas, Minnesota and Nebraska- have reported increases in COVID-19 cases over the last two weeks, and 35 states (plus Guam) continue to report widespread community transmission of the virus.  The model specifies that a number of states– including Indiana, Georgia, Illinois, Texas, Alabama, Florida and California- “are currently experiencing or have yet to experience their epidemic peaks – all of which appear to be lasting longer and declining more slowly after their peaks. Further, for a subset of states, the easing of social distancing policies has begun and mobility patterns are on the rise (or even started increasing before easing actions occurred).  Additionally, 31 states (plus the District of Columbia) remain well below recommended testing rates for reopening.

Although projections like this aren’t gospel, it is safe to assume that, as states continue to open businesses and prematurely relax social-distancing measures, statistics like this will likely be realized.  That said, there is good news: cases in Fairfield County continue to decline, so keep up the good work!

On testing

Many people understandably remain interested in having their blood checked for antibodies to determine if they may have been exposed to COVID-19.  Questions remain as to the accuracy of these tests and whether or not the presence of the antibody confers immunity and, if so, for how long.  As a result of high consumer interest, over 250 tests have thus far been developed.  Uncertainty abounds regarding the reliability of these tests, the majority of which have not been adequately evaluated for accuracy.  Currently, only 12  of these tests have received emergency-use authorization (EUA) from the FDA.  More recently, the FDA has revised its policy such that manufacturers must rapidly submit EUA applications along with data proving that their tests work, or face possible removal from the market.  Previously, the FDA had allowed companies selling COVID-19 antibody tests to validate their own data.

On another front, studies have demonstrated that saliva testing may be more reliable than the nasal and throat testing that is currently being employed.  Once it’s readily available, this testing modality could make life easier for many of us.

Is an immunization on the way?

Researchers have moved at record speed to develop immunizations against COVID-19.  Although they have made significant progress in a relatively short period of time and a vaccine is on the horizon, experts warn that reports of their progress may lead to unrealistic expectations about the timing of the availability of vaccines for the general public.  They further worry that these expectations can lead to a false sense of security, which in turn may fuel a more significant COVID-19 spike in the fall.  Stay tuned.

Another reason to llove llamas

Researchers have been working with antibodies from llamas as a means of devising ways to prevent COVID-19 in those who are at high risk for exposure (like healthcare workers).  It’s not mandatory reading, but it’s kind of interesting if you have time.

A silver lining for asthmatics?

Early reports from China indicated that, contrary to common wisdom with respect to respiratory infections, having asthma or seasonal allergies did not seem to put patients at increased risk for a more complicated case of COVID-19.  More recently, researchers at the University of Wisconsin School of Medicine in Public Health have confirmed this finding, indicating that levels of a receptor that the coronavirus requires in order to attach itself to the linings of our airways (known as ACE2) is reduced in these patients.  Although this should not be perceived as a get-out-of-jail-free card for patients with asthma and allergies, and these individuals must remain careful with respect to physical distancing measure, these preliminary data should provide some reassurance for those with these underlying conditions.

What about summer camps?

Connecticut’s Office of Early Childhood has provided an updated set of guidelines indicating that summer camps can consider reopening on June 29.  Their guidelines include the following modifications:

  • Enhanced health screening measures must be in place
  • Camp groups will be limited to no more than 10 children
  • Camps will need extra permission to serve more than 30 children at a time
  • Employees will be required to wear cloth face masks and to implement hand and respiratory hygiene measures
  • Protocols for intensified cleaning and disinfection will need to be in place
  • Social distancing strategies will be required

I have been made aware that camp directors are currently considering these measures and will make final decisions in the coming weeks, while appropriately prioritizing the health and welfare of children and our communities.

Important updates from the CDC

For the purposes of containing the spread of COVID-19, the CDC now recommends that a temperature over 100°F should be considered to be a fever.  Previously, the threshold for fever was 100.4°F.

Additionally, the CDC now advises that, for persons recovered from COVID-19 illness, isolation should be maintained for at least 10 days after illness onset and at least 3 days (72 hours) after recovery.  Prior to May 3, the recommendation had been to isolate for only 7 days after illness onset.

In spite of it all

Humans are strong and resilient, and we will ultimately be OK!

That’s all for today.  I hope you all had a nice Cinco de Mayo.  Please continue to stay home, stay calm and stay healthy… and rest assured that spring weather will return!

That’s all for today.  Please continue to stay home, stay calm and stay well!  See you soon.