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Larry Leibowitz COVID-19 Updates

Larry Leibowitz COVID-19 Updates

To my Patients and Friends,

Here’s a summary of some of the latest COVID-19 news.  I hope you find it helpful.

Internal climate change

You may have heard the term cytokine storm used to describe the severe, life-threatening reaction that afflicts some COVID-19 patients.  For reasons which have yet to be completely understood, some people experience an overwhelming immune response involving inflammatory mediators called cytokines, which can lead to major damage to multiple organs and tissues including blood vessels, liver, lungs and the nervous system and can render the prospect of recovery much less likely.

But there has been some good news on this front.  One of the cytokines that seems to play a major role in this process, called interleukin 6 (IL-6), can be inhibited by a drug called tocilizumab, an immunosuppressive agent used to treat rheumatoid arthritis.  Preliminary studies of this drug for the treatment of severe COVID-19 have been very encouraging, and an FDA-approved phase III trial is now underway to more definitively establish the benefits (and risks) associated with this agent.  We are moving forward.

 

The latest on hydrochloroquine

A relatively large analysis of the potential effects of hydrochloroqione on COVID-19 outcomes among hospitalized patients in the Veterans Health Administration system did not demonstrate benefit and suggested an increased risk for death in those to whom this medication was administered.  The study has been submitted for publication in the New England Journal of Medicine, although it hasn’t yet been peer-reviewed.  Other studies of hydrochloroquine are still underway, and some researchers are still holding out hope that this agent may play a meaningful role in the treatment of COVID-19, so stay tuned… although other (perhaps better) options are on the horizon.

Home testing kits approved

The first home-based COVID-19 test has won emergency-use approval by the FDA.  The home collection kits for the Laboratory Corporation of America (LabCorp) COVID-19 RT-PCR Test will be available to consumers (who have obtained a physician’s order) in the coming weeks, and it will reportedly retail for approximately $120.  This certainly represents the addition of a potentially important tool to our armamentarium.  However, pressing questions remain as to the accuracy of PCR-based test results, particularly as related to high false-negative rates.  Therefore, it remains important that we not rely upon these tests to make a diagnosis to the exclusion of other important factors, such as the presence or absence of symptoms consistent with COVID-19, an individual’s exposure risk and community prevalence.

Meanwhile, another simple home test?

This New York Times opinion piece written by a New Hampshire emergency room physician has garnered a lot of attention, so I thought I’d address it here.  The article summarizes some of the details as related to a particular type of pneumonia caused by the coronavirus.  It goes on to explain that one of the first signs of COVID-19 pneumonia may not be cough or shortness of breath, but rather low oxygen levels in the bloodstream.  From there, the disease course can proceed precipitously in some patients.

The author proposes that one means by which individuals may be able to monitor themselves for COVID-19 at home maybe by periodically checking their oxygen levels using small handheld pulse oximeters, which you’ve likely seen in medical practices and are affordable and readily available.  Time will tell if this turns out to be a viable strategy: we’ll need to better understand to what degree true abnormal findings at home are reliable indicators of COVID-19 (versus some other process involving the lungs or the circulatory system), the ability of consumers to perform the test correctly in order to minimize the risks for false positives or negatives, and what sensible actions should be taken if a result is found to be abnormal.  Either way, it’s good to know that doctors are thinking outside the box.

An updated Connecticut mask law

Governor Ned Lamont issued a new executive order effective April 20 regarding the universal use of face masks in settings in which safe social distancing measures cannot be ensured.  The language is copied here for your reference:
Cloth Face Coverings or Higher Level of Protection Required in Public Wherever Close Contact is Unavoidable 

Effective at 8:00 p.m. on Monday, April 20, 2020, any person in a public place in Connecticut who is unable to or does not maintain a safe social distance of approximately six feet from every other person shall cover their mouth and nose with a mask or cloth face-covering.  In addition, individuals shall use a mask or cloth face covering when using the services of any taxi, car, livery, ride-sharing or similar service or means of mass public transit, or while within any semi-enclosed transit stop or waiting area.  The Commissioner of Economic and Community Development shall issue updated versions to the Safe Workplace rules issued pursuant to Executive Order No. 7V, Section 1 and the Safe Stores rules issued pursuant to Executive Order No. 7S, Section 1, which updated versions shall set forth additional requirements for face coverings within those settings.  Nothing in this order shall require the use of a mask or cloth face covering by anyone for whom doing so would be contrary to his or her health or safety because of a medical condition, a child in a child care setting, anyone under the age of 2 years, or an older child if the parent, guardian or person responsible for the child is unable to place the mask safely on the child’s face.  If a person declines to wear a mask or face covering because of a medical condition as described above, such person shall not be required to produce medical documentation verifying the stated condition.  This order shall supersede and preempt any current or future municipal order.

LOL of the day: losing track of time?

If you’re like most people, you’re struggling to keep track of the days.  This news station’s approach may help.

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