Mar 30 2020
Friend: Below are a couple of recent developments that make me optimistic. # 1 is increased testing – This past weekend was approved. Estimated 50k new tests per day - Abbot labs 5 minute testing
Dr. Why: I think this is a good news:
To demonstrate how few people are actually sick while the number of infected will obviously grow because of testing and, I hope, people will calm down
Triage people who are sick faster and more accurately
Allow people to go to work immediately, if everyone in the office tests negative
The downsides are:
Sensitivity and specificity of these tests will produce false positive and false-negative. Initial RT-PCR pharyngeal swab sensitivity ranged from 66%-80% depending on assumptions made about patients with conflicting diagnostic data. The Abbott express test approved today reports 95% sensitivity. Therefore, physical distancing is still important because false-negative people will walk around and spread the infection
Some people carry infection after they had the diseases (see published today: SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19). This is true for every other infection. Testing those will create lots of confusion, because one cannot be in perpetual isolation
Enormous cost of testing for the government, states, insurers, etc.
Friend: Cocktail improving treatment. There was a French study combining hydroxycloroquine and azithromycine (study attached), the original study was only 80 people but it is growing. This is a very cheap drug, readily available and there are continuing trials ongoing globally with similar positive results (attached summary study)
The results were as follows
90% of patients who did not take still sick after 6 days
Hydroxychloroquine only - 45% still sick after 6 days (big improvement)
100% of people with Z pac + Hydroxychloroquine not sick after 5
days.
The hospital in France continue to treat people and you can see the results on this website in French, they are now at nearly 1300. Look on the bottom right at the 1291 number. That is the number of people treated with this cocktail, and the number of deaths below (still at only 1, and 86 year old). This website is updated one per day
Dr. Why: I am sick hearing about Hydroxychloroquine. I am confident this is pushed just to show there is something without regard of the truth. Refer to my blog What might work? . Would you, as an investor, put your faith and money into somebody/something who failed 53 times?
Also, take a look at this for Potential COVID-19 Treatments (transcript is attached) 'Thinnest Threads of Evidence'
Friend: The FDA approved hydroxyclorquine for Covid 19 treatment in the US last night.
Dr. Why: This is not true! Here is from UpToDate.com: Hydroxychloroquine is currently under investigation for use in the treatment and post-exposure prophylaxis of coronavirus disease 2019 (COVID-19) (see ClinicalTrials.gov). At this time, safety and efficacy have not been established. However, we provide preliminary dosing information based on the available published evidence (CDC 2020; Gautret 2020; Yao 2020).
What FDA actually did is to issue Emergency Use Authorization (EUA) to allow hydroxychloroquine sulfate and chloroquine phosphate products donated to the Strategic National Stockpile (SNS) to be distributed and used for certain hospitalized patients with COVID-19. These drugs will be distributed from the SNS to states for doctors to prescribe to adolescent and adult patients hospitalized with COVID-19, as appropriate, when a clinical trial is not available or feasible. The EUA requires that fact sheets that provide important information about using chloroquine phosphate and hydroxychloroquine sulfate in treating COVID-19 be made available to health care providers and patients, including the known risks and drug interactions. The SNS, managed by ASPR, will work with the Federal Emergency Management Agency (FEMA) to ship donated doses to states.
I am confident that it was done under political pressure.
Also, refer to
CDC information on the subject
Friend: Johnson and Johnson announced a “lead candidate” for a vaccine
Dr. Why: There are about 100 vaccines in development. The bad news is that coronaviruses (similar to influenza viruses) mutate and vaccine is not going to work for mutated viral strains. There are at least 8 major strains in circulation now https://nextstrain.org/ncov Therefore, vaccine is unlikely to be more effective than influenza vaccine which has 48% efficacy (50/50)
Friend: Getting back to work thoughtfully. Here is a blogger I enjoy reading “the grumpy economist”. He is a formal Chicago professor, now at Stanford (Hoover). He brings some sensible approaches to the discussion. Scott Gottlieb from AIE also putting out sensible approaches to reopening
Dr. Why: The reopening will occur sooner rather than later. It will be a political and an economic decision rather than medical/public health based on any facts. The only gage we have a the number of new symptomatic cases. The rest is very subjective. What was done yesterday is the act of hedging of bets by the POTUS and public health officials/consultants around him.