The important thing for medical knowledge to advance here is to find ways to reduce the chance that someone with COVID-19 will progress to more serious problems and need hospitalization with a high risk of dying or longer term problems.
No guarantees that this will happen. But if it does not happen, then it will be hard for anything short of a vaccine will convince a lot of fearful people to return to normal economic activity even if everything is reopened fully. If risk levels were better defined, then some people in the lower risk groups may return to normal economic activity, but given that so many American adults are in higher risk groups, that is still a very large percentage who will remain fearful without either a vaccine or a way to significantly reduce the risk.
I read another trial is underway with remdesivir testing its use in more moderate cases to see if it stop them from becoming severe ā presumably decreasing hospitalizations.
Right now itās an IV drug, right? If successful, not sure if itās feasible to switch to oral delivery. Something like Tamiflu would be ideal.
I donāt think current technology will allow remdesivir to be given orally.
IV formulation could be a limitation, but in reality there are home health care providers who currently administer IV drugs, and also non-hospital based infusion centers (or other outpatient type settings) that administer IV drugs. So, those treatment settings could be options for those who are infected prior to becoming very sick and needing hospitalization.
My dermatologist is open now for in person visits on Thursdays only. I just got back from there and she agreed my issue would not have worked for a telehealth visit.
I had a small thing on my nose that I thought was an insect biteā¦but it never went away. She looked at itā¦not concerned about basal cell or anything like that, but agreed it should go. So she used liquid nitrogen to āburnā it off. Painless procedure and recovery should be easy. All I have to do is put Vaseline on a couple of times a day and before bedtime.
Office was well set up for patients. One at a time in the place. No one else was even in the waiting room. Everyone gloved and masked. Disinfected touch pad before and after I used it. The doctor needed to be closer to me, but her nurse did not and she stayed a good distance away while getting my info.
As it stand now, remdesivir canāt be formulated orally - itās unstable in the liver. Itās going to be an IV drug for the foreseeable future.
While Iām happy to see that remdesiver shortens hospitals stays (and may decrease mortality), itās not a game-changer. Yesterday, Anthony Fauci compared it to the development of anti-HIV drugs. The discovery that AZT had some activity against HIV was exciting, too. AZT didnāt cure HIV, and it was a failure as a mono-therapy; however, its combination with other HIV drugs in a multi-drug regimen WAS a game-changer.
Fauci said that the exciting thing about remdesivir is that it could be PART of a multi-pronged approach. Remdesivirās activity is also an indication that this search for anti-viral drugs may work. We just need more drugs that target other parts of the coronavirus structure.
The whole purpose of the shutdown, initially, was to let hospitals prepare for the cases and not be inundated with more cases than they could handle. Now hospitals have many vacant beds and some are even closing their doors due to lack of patients. Salaries of doctors, nurses and other staff are being cut or they are being furloughed.
I saw my dermatologist today. I have fair skin and grew up in Southern California, so I go twice a year. My appointment was scheduled for last month and was rescheduled, I was surprised this one was not rescheduled. She froze about 6 spots off which is about normal. I figure it is a good time since I have to wear a mask and stay 6 feet away no one can see.
This article says Gilead has 50,000 doses, so on the 5 day regimen that would be enough for 10,000 patients. Not sure how that will be distributed, if they will take orders from any country, etc.
The issue with treating moderate patients (of which the definition isnāt clear right now) is that remdesivir is IV only, so treatment setting could be an issue, assuming most moderate patients arenāt hospitalized.
I have seen some stuff that purports to confirm this. I read so much about this subject (COVID) that I donāt remember where I read about it.
Vit D is known to be tied to healthy immune systems. If you are deficient, not a bad idea (whether or not we are talking about COVID) to ask your doctor about how best to supplement or otherwise increase your levels.
On that note, Iām going to go for a walk on this sunny day. Might help, canāt hurt.
If it ends up being true, that could also explain why places like NY and NJ are more deadlier than places further south. Humans canāt make enough Vit D in the northern latitudes in the winter. The sun is too low on the horizon and the UVB rays needed get filtered out.
As people get older, their bodies are less efficient at processing vitamin D received from the sun, which is why both H and I are taking supplemental oral vitamin D and have been for years. Calcium pills also often come with vitamin D, for better absorption.
They talked about this in the LA Times today:
As part of an ambitious project to identify drugs that could be repurposed to treat COVID-19, an international team of scientists reported Thursday they had happened upon a surprising finding: A common active ingredient in dozens of over-the-counter cough syrups, capsules and lozenges appeared to boost replication of the SARS-CoV-2 virus when tested under laboratory conditions.
A lot more study needs to be done, but I think if you have Covid you should avoid Dextromethorphan.
Good to know, @tx5athome. The only two cough medicines I take are a Chinese honey herbal concoction that is delicious but who knows what the ingredients are (I canāt read them) and phenegren with codeine by prescription when coughing is interfering with my sleeping. Will have to ask my MDs if I feel the need to suppress any coughs and in the meantime avoid cough syrups.
Re Vitamin D: the problem is that there are a bunch of studies unrelated to Covid that show adverse effects from too much vitamin D ā and no evidence that Vitamin D would help anyone who was NOT deficient with Covid. So supplementing with large doses of Vit. D is NOT a good idea for people who are not deficient. Apparently itās best if serum levels for Vit. D are in the 25 - 35 ng/ml range. (I used to take a lot more vitamin D based on the belief that āmore is betterā but cut back when I read these studies. I do take calcium supplements that include Vit. D because of my osteoporosis.)
There is so much anecdotal evidence about what works and what doesnāt to help the seriously ill Covid19 patient. I have heard everything from trying a minimalistic approach to the throwing the proverbial kitchen sink at themā¦honestly I have seen very little actually make a difference. All we can really seem to do is buy time so they can make a turn around on their ownā¦or not. I have had patients who seemed to be getting better one minute and crash the next, and some who I thought would be gone in the morning when I came back be extubated and on room air a few days later.
This virus is WEIRD! I have been doing this for over 20 years and have never seen anything even close. It seems to effect all the major life systems (lungs, heart, clotting system, and kidneys.) Itās scary how much we DONāT know about how it behaves.
I thing any effective treatment will have to be multi focal and complexā¦therefore a long time coming. Itās not going to be as easy as finding a fungus growing on an orange.