Inside Medicine. What Are You Seeing? [COVID-19 medical news]

^ I thought the bad response to dengue was due to the vaccination, not getting the disease 2x.

I’ll Google! Don’t knock yourself out looking for a link or anything! :slight_smile:

As new as this virus is, I really don’t know how he could make that assertion.

@Nrdsb4, we might have a misunderstanding. For me, “there’s reason to believe X might be true,” is a weak statement, roughly equivalent to “we don’t have much evidence about X; don’t discount the chance that X is not true; include not X in your set of hypotheses.”

One of the 2 largest hospital systems in NJ will now be testing all admitted patients whether they display symptoms of Covid-19 or not. This is new as only seriously ill patients were tested before. NJ is also ramping up the testing of folks who have mild symptoms or are asymptomatic. The ratio of positive to negative test results is slowly falling, from a peak of about 50% in mid-April.

Our state randomly checks flu samples for COVID-19. Still only 2.5% positive, over 36,000 tests total in our state.

Has there been more study about the risk of transmission of SARS-CoV-2 outdoors versus indoors (or in an enclosed space)?

This preprint (not yet peer reviewed) study from China https://www.medrxiv.org/content/10.1101/2020.04.04.20053058v1 suggests that outdoor transmission is rare compared to indoor transmission. This preprint study from Japan https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v2 also suggests that the risk is much higher indoors.

https://www.vox.com/future-perfect/2020/4/24/21233226/coronavirus-runners-cyclists-airborne-infectious-dose has a longer discussion about the matter and references both of the above, among other things.

This does not surprise me and falls in line with why numbers in Florida are so low in proportion to the population and demographics. Weather and outdoor lifestyle.

Good news/mixed bag news. The good: an antigen test has been authorized by the FDA. This test detects viral envelope proteins and is an alternative to PCR (that detects viral genetic material, RNA). The not so good news - not CLIA-waived, so it must be performed in a special facility authorized by the FDA. Also, not yet sensitive enough, so false negative rate could be on the higher end. But it is a good start. It will take some pressure off the PCR test manufacturing supply chain.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-antigen-test-help-rapid-detection-virus-causes

The antigen test is fast, too.

I wonder if it could be used at airports? It wouldn’t keep all infected people off planes, but it would keep some off planes.

Not in the current format, CF. This is a high to moderate complexity test, meaning it requires a trained technician and a properly licensed lab to run it (I am not going to go into boring and highly technical details of how this is done). Also, you would not want your tech to run this test on demand. You would want to accumulate samples and run them in a batch, as it can take almost the same amount of time to do so. So this is not going to be super fast from sample to results, at least for now.

However, a CLIA-waived antigen test, if someone comes up with one, would work for surveillance purposes.

Looks like it can be done in a facility with a waived certificate. Sofia has a waived flu test also.

I mean truly simplified. Like “antigen test for dummies,” on the same level of complexity that it takes to run one of those mass spectrometry devices at the airports.

Another potential treatment in the works: peginterferon lambda-1a https://www.mercurynews.com/2020/05/10/coronavirus-treatment-hit-hard-and-early/

https://www.biorxiv.org/content/10.1101/2020.05.06.081497v1

I quite agree that an antigen test suitable for airports would have to be something you could train to me, a clumsy scatterbrained person, in an hour. Hopefully we can develop something like that.

I am sure you can run the Alere or Cepheid PCR tests… both companies have CLIA-waived flu tests, and their Covid tests have similar steps. :slight_smile: I am hopeful that investors will wake up from their post-Theranos shock and start putting money into development of diagnostics and monitoring devices.

Fascinating!!

https://www.theatlantic.com/science/archive/2020/05/remdesivir-cats/611341/

Wow, that’s fascinating. Incentives for drug companies like Gilead are truly perverse.

If we got to a stage where infections were at a low level and we could detect them early with testing, IV remdesivir at an early stage of the disease could be a game-changer. Sounds like remdesivir’s cat-drug cousin actually cures the coronavirus cat disease FIP.

Yes, that reporting of adverse effects really de-incentivized development of “human” drugs for animal use. The kittyvir and Remdesivir have the same active intermediate (triphosphate), so all adverse effects in cats (like Sphinx kittens born with furry tails - I am making this one up) have to be reported to the FDA and reviewed in Remdesivir file.

Has anyone heard of any testing of prophylactic use of remdesivir in nursing home residents who have tested positive in the sweeps some states are using? Seems like it could potentially make a huge difference, if remdesivir works in early-stage covid-19, which is where theory says remdesivir ought to be most effective.

I haven’t heard of this,…of course docs may have tried it, although not sure how they would have accessed the product outside of a clinical study, before FDA EUA.

Here is the list of registered remdesivir trials, none are for prophylaxis: https://www.clinicaltrials.gov/ct2/results?cond=&term=remdesivir&cntry=&state=&city=&dist=

Right now, there are only two ways to get the drug:

1)From the government, to whom Gilead gave all of their 1.5M existing doses (and it’s not clear how that is getting distributed)

2)If you are a participant in one of the remdesivir studies.

We are likely a long way off from remdesivir as prophylaxis…there isn’t data in those patients, and the product is in short supply.