Category Archives: Medicine

Covid-19: Chloroquine + Azithromycin (Z-Pack) – “First Line” Treatment For Early Symptom Patients

WSJ Coronavirus Patients treated with Chloroquine + Azithromycin Z-Pack March 22 2020

JAMA Clinical Reviews LogoChloroquine was shown in 2004 to be active in vitro against SARS coronavirus but is of unproven efficacy and safety in patients infected with SARS-CoV-2. The drug’s potential benefits and risks for COVID-19 patients, without and with azithromycin, is discussed by Dr. David Juurlink, head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto.

From Wall Street Journal article:

Our experience suggests that hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment. Unfortunately, there is already a shortage of hydroxychloroquine. The federal government should immediately contract with generic manufacturers to ramp up production. Any stockpiles should be released.

As a matter of clinical practice, hydroxychloroquine should be given early to patients who test positive, and perhaps if Covid-19 is presumed—in the case of ill household contacts, for instance. It may be especially useful to treat mild cases and young patients, which would significantly decrease viral transmission and, as they say, “flatten the curve.”

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Coronavirus: “Do Face Masks Work? Do They Protect People?” (BBC)

As coronavirus continues to spread around the world, face masks are in high demand as people look for ways to protect themselves. But do they really protect most people from contracting the virus? Dr Shunmay Yeung from London School of Hygiene and Tropical Medicine explains.

Health Update: Ibuprofen Results In “More Severe Illness” For “Coronavirus / Covid-19” Patients (BMJ)

From a BMJ online release (March 17, 2020):

Acetaminophen Bottle“The finding in two randomised trials that advice to use ibuprofen results in more severe illness or complications helps confirm that the association seen in observational studies is indeed likely to be causal. Advice to use paracetamol (acetaminophen) is also less likely to result in complications.”

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of covid-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.

The BMJIan Jones, a professor of virology at the University of Reading, said that ibuprofen’s anti-inflammatory properties could “dampen down” the immune system, which could slow the recovery process. He added that it was likely, based on similarities between the new virus (SARS-CoV-2) and SARS I, that covid-19 reduces a key enzyme that part regulates the water and salt concentration in the blood and could contribute to the pneumonia seen in extreme cases. “Ibuprofen aggravates this, while paracetamol does not,” he said.

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Health Update: The First Clinical Trial Of A “Coronavirus / Covid-19” Vaccine Begins (NIH)

From the National Institutes of Health (NIH) (March 17, 2020):

NIH Logo“Finding a safe and effective vaccine to prevent infection with SARS-CoV-2 is an urgent public health priority,” said NIAID Director Anthony S. Fauci, M.D. “This Phase 1 study, launched in record speed, is an important first step toward achieving that goal.”

The vaccine is called mRNA-1273 and was developed by NIAID scientists and their collaborators at the biotechnology company Moderna, Inc., based in Cambridge, Massachusetts. The Coalition for Epidemic Preparedness Innovations (CEPI) supported the manufacturing of the vaccine candidate for the Phase 1 clinical trial.

NIH Covid-19 Clinical Trial Vaccine March 17 2020A Phase 1 clinical trial evaluating an investigational vaccine designed to protect against coronavirus disease 2019 (COVID-19) has begun at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is funding the trial. KPWHRI is part of NIAID’s Infectious Diseases Clinical Research Consortium. The open-label trial will enroll 45 healthy adult volunteers ages 18 to 55 years over approximately 6 weeks. The first participant received the investigational vaccine today.

The study is evaluating different doses of the experimental vaccine for safety and its ability to induce an immune response in participants. This is the first of multiple steps in the clinical trial process for evaluating the potential benefit of the vaccine.

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Health: “What It’s Like to Take a Drive-Through Coronavirus Test” (WSJ)

As coronavirus spreads across the world, countries are setting up drive-through clinics to make it easier for their citizens to get tested. WSJ’s Andrew Jeong visited a test site in South Korea to see how it works.

Health Update: “New Coronavirus Test” From Johns Hopkins Medicine

New Coronavirus test developed by Johns Hopkins microbiologists Karen Carroll and Heba Mostafa, look to test as many as 1,000 suspected Covid-19 cases per day in the Johns Hopkins Health System.

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“Telemedicine” Is The Way To Treat “Coronavirus / Covid-19” Pandemic (NEJM)

From a New England Journal of Medicine article (March 11, 2020):

New England Journal of Medicine logoA central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure. 

It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.

Telemedicine for Coronavirus Covid-19 New England Journal of Medicine March 11 2020

More than 50 U.S. health systems already have such programs. Jefferson Health, Mount Sinai, Kaiser Permanente, Cleveland Clinic, and Providence, for example, all leverage telehealth technology to allow clinicians to see patients who are at home. Systems lacking such programs can outsource similar services to physicians and support staff provided by Teladoc Health or American Well. At present, the major barrier to large-scale telemedical screening for SARS-CoV-2, the novel coronavirus causing Covid-19, is coordination of testing. As the availability of testing sites expands, local systems that can test appropriate patients while minimizing exposure — using dedicated office space, tents, or in-car testing — will need to be developed and integrated into telemedicine workflows.

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