To my Patients and Friends,
Happy Friday! Here’s my latest COVID-19 update. I hope you find it useful.
First, some reassuring news
A recent analysis published in JAMA Cardiology indicates that patients who are hospitalized for COVID-19 are not at increased risk for complications if they are using ACE-inhibitor or angiotensin receptor-blocking (ARB) medications– both of which are commonly used to treat high blood pressure, kidney disease and congestive heart failure. There has been quite a bit of speculation within the medical community as to the potential negative impact of the use of these medications on COVID-19 outcomes as they can increase the quantity of certain receptors which the coronavirus happens to use as a means of gaining entry into its target cells. However, this and other recent studies provide reassurance that those who currently use these medications should feel safe continuing to doing so.
Monitoring the tides
Experts worry that a second wave of COVID-19 during the upcoming fall and winter season is likely if not inevitable, and that we may even see a wave during the summer, especially if individual states decide to ease physical-distancing measures prematurely and/or in opposition to current guidelines (which many believe are already overly ambitious). And a new model from Virginia confirms that, if physical-distancing restrictions are lifted prematurely- as we are already beginning to witness in some states– we could see a summer COVID-19 surge.
So when should we begin to shift to containment strategies?
The highly-respected Institute for Health Metrics and Evaluation (IHME) model (often referenced by many experts, including those in the White House Coronavirus task force) has provided some updated state-by-state COVID-19 projections. Many authorities rely upon this IHME model in order to better understand when US states might safely begin relaxing social distancing policies assuming robust containment measures have been instituted. As of this writing, the model predicts that Connecticut may consider beginning the process on or after June 8th. Unfortunately, IHME has recently adjusted its U.S. mortality projection upward by 10%. Check out their periodic updates for the latest projections.
It should be noted that, on April 22, the CDC reported the second consecutive day of record-high death rates nationally. And another very upsetting statistic: as of today we’ve surpassed 50,000 U.S. deaths. In this doctor’s humble opinion, this is no time for anyone anywhere in the U.S to be relaxing physical-distancing measures. One of our biggest dilemmas is that, without testing and contact tracing on a massive scale, we don’t have any good way of knowing where COVID-19 may be lurking. In fact, recent studies have confirmed that those with the virus are most contagious in the days before symptoms appear.
For ongoing state-specific, national and international updates, check out this useful real-time COVID-19 dashboard from Johns Hopkins University.
Should we worry about prisons?
Yes. All personal feelings on the matter aside, the high rate of COVID-19 in prisons presents a major a problem for us all. Many worry about the health and safety of prisoners, but even for those who feel conflicted in this regard, it’s important to consider that prison guards and other staff can bring the coronavirus home from the prison setting to their families and communities. Additionally, the average prison stay for pretrial detainees is brief and turnover is high, which means that many of these individuals can also bring the virus back from prisons to their communities. Compare this scenario to that related to hospital workers, who are exposed to high numbers of COVID-19 patients and often commute to and from hotels in order to avoid potentially exposing family members to the virus. Many are advocating for non-violent criminals to be moved from prison settings. It’s a controversial but important discussion for us to be having.
Some other forgotten Americans
This interesting perspective recently published in the New England Journal of Medicine (NEJM) discusses the unique ways in which the Navajo Nation has been impacted by COVID-19. It’s worth a few minutes of your time.
As I mentioned in a previous installment, Quest Diagnostics is now offering coronavirus IgG antibody blood testing for asymptomatic patients who are interested in determining if they have previously been exposed. It would be useful to know if we’ve produced these antibodies in response to a prior exposure, because a positive result may indicate that we are- at least to some degree– immune to a repeat COVID-19 infection. Again, some important caveats warrant consideration:
- Although there is good reason to be hopeful, research to date has not clarified if (or for how long) individuals may remain immune to a repeat infection after an initial exposure to this particular coronavirus (SARS-C0V-2)
- We can only speculate at this stage as to whether or not the presence of IgG antibodies is a reliable indicator of robust or sustained (versus mild or transient) immunity; we still don’t know for sure
- The accuracy of these tests will not be 100%; there are concerns about false positives as well as false negatives
- The presence of IgG antibodies does not in and of itself exclude the possibility that someone may still be contagious; current PCR testing and symptom monitoring will still play critical roles
- In theory, there can be cross-reactivity between other coronaviruses that are associated with the common cold and the one associated with COVID-19; accuracy is a concern for this reason as well
- Some individuals who have recovered from COVID-19 may produce antibodies that are below detectable levels, or no antibodies at all.
In time, we will have answers to these questions. However, based on what we know about similar viral infections, most experts agree that, while we await an effective vaccine, we can count on at least a degree of immunity for some period of time after a COVID-19 illness.
I’ve been in contact with one of the Senior Medical Directors at Quest Diagnostics, and after a review of their technology and its accuracy relative to other commercial tests that are currently being marketed, I suspect it’s one of the better options that are available at the moment. The turnaround time is expected to be 3 to 4 days. The company has advised that anyone with a physician’s order to be tested can go to the website to schedule an appointment at a preferred location (although an appointment isn’t necessary). Please note that you may see a popup window indicating that Quest facilities are not collecting specimens for COVID-19 tests. This only refers to nasal and throat swabs- not blood specimens. Also, when you’re asked what testing you need, select “All other tests.” There will be no need to select COVID-19 testing specifically.
As I had mentioned in a recent newsletter, this app is worth downloading, and it has now been officially endorsed by Connecticut Governor Ned Lamont. It represents a valiant early attempt at tracking COVID-19 based on crowdsourcing, or self-reporting of symptoms (or lack thereof) by users of the app. Additionally, the developers of this app will donate a meal to someone in need every time a user logs in and adds their status. I’ve tried it out, and it’s very easy to use. Technologies like this will play crucial roles as we work our way to the other side of the COVID-19 pandemic. Please check out the free app on the Apple store or at Google Play. There’s also an online version for those who are smartphone-averse. Consider logging in on a regular basis whether you’re feeling well or unwell (both matter, and it takes but a minute), and share this!
A smart guy’s perspective
As you’ve probably seen or read, Bill Gates has been chiming in quite a bit lately. Here are some of his latest thoughts on what we need in order to begin reopening. Spoiler alert: he correctly emphasizes that we need more technology and more time.
Not smelling something fishy?
A new report from the Journal of the American Medical Association (JAMA) confirms previous observations that many individuals can present with loss of taste and/or smell as an early symptom of COVID-19. In fact, the Centers for Disease Control (CDC) have added loss of taste or smell to their list of COVID-19-related symptoms. Although these sensory losses can be associated with other conditions including the common cold, experts have suggested that, under the current circumstances, those who notice these symptoms for the first time should initiate isolation precautions and contact their physicians for further guidance.
Still, hold your noses
Check out this amusing (but interesting) podcast which touches upon an Australian doctor’s take on a potential means by which COVID-19 can be contained. The entire 10-minute conversation is informative, but you can fast-forward to minute 5:35 if you want to cut to the cheese… oops, I mean the chase.
That’s all for today. Please continue to stay home, stay calm and stay well! See you soon.