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

I spoke recently with D2, who is a nurse. She said that her hospital had 9 or so Covid-only ICUs at one point. One especially for patients whose kidneys were being attacked, or heart, etc. I knew they had moved Labor and Delivery out of the hospital, but she said they had moved out almost everything. Even organ transplants were being done at an outpatient surgical center a few miles away.

This all happened very fast and now they are back down to only one Covid-only ICU. I’m wanting to heap praise on the hospital staff who facilitated all these logistics. They’ve done a great job.

Not to rain on the ivermectin parade, but as a medicinal chemist, the potency of ivermectin against the coronavirus worries me. In order to have enough ivermectin in your bloodstream to kill the virus, you’d need a does that is 35 times higher than the dose approved for humans. Maybe it will work in combination with something else?

From the abstract:

From: The Approved Dose of Ivermectin Alone Is Not the Ideal Dose for the Treatment of COVID-19 https://pubmed.ncbi.nlm.nih.gov/32378737/

Wow @greenwitch, your Daughter must be at a really large hospital to have 9 ICU units. Glad that they are down to one now. Even off sited organ transplants, which I hear are way down with this pandemic. Glad to hear that things are starting to get back to normal.

My rough understanding is that, while the in vitro study shows that a high dose kills the virus, it does not demonstrate that there would be no possible benefit at lower doses (the in vitro study from Australia, https://www.sciencedirect.com/science/article/pii/S0166354220302011) Another possible angle is that perhaps the in vivo mechanism of action isn't present in the in vitro study, such as some interaction with the immune system.

(For anyone interested who missed it earlier, here is the study from University of Utah, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3580524 )

Anecdotes from a doc in Florida: https://www.nbcmiami.com/news/local/local-doctor-tries-new-coronavirus-drug-treatment/2219465/

I guess we’ll see what happens with the current studies, nine as of now, though I don’t think that includes the one(s) in Japan. Hopefully some of them report something one way or the other in a few months, at least a couple of the international ones that have sooner end dates. While we are impatient for results, it’s amazing that so many studies in so many different directions seem to have gotten off the ground relatively quickly, which doesn’t happen in ordinary times.

Thanks, @evergreen5. I had read that paper from Patel et al earlier, and it made me even more skeptical. That does of ivermectin they use in the study is tiny! You’re right, we’ll just have to wait until we get the results from randomized trials. Fingers crossed.

@scout59 The in vitro study’s authors responded to the above dosing issue in the bottom letter here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172803/:

^^ Thanks, @evergreen5 - I saw that, too. Still not completely convinced by that explanation, but that’s okay. The more rigorous studies already in the pipeline will give us an answer!

Told you I was a skeptic.

For anyone that’s interested in drug discovery from a chemistry perspective, there’s a blog from Derek Lowe called “In the Pipeline” that’s pretty good. He’s been talking about coronavirus therapeutics for a while.

The head of Montefiore did his (now weekly, was daily) talk today. No one who worked for them died this week. That’s progress.

Good info from former FDA director on state of testing -

https://time.com/5836206/scott-gottlieb-covid-19-testing-systems/

“Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19” http://www.onlinejacc.org/content/early/2020/05/05/j.jacc.2020.05.001

The state of Indiana randomly selected people listed on state tax returns (including dependents) to test for coronavirus. A total of 4600 Indianans were tested. Of those, 1.7% were currently infected and an additional 1.1% were found to have antibodies against the disease. The researchers calculated an infection fatality rate of 0.58%, in line with other estimates from elsewhere.

Slightly less than half of the people in the study were asymptomatic.

It’s great to see such careful science.

https://news.iu.edu/stories/2020/05/iupui/releases/13-preliminary-findings-impact-covid-19-indiana-coronavirus.html

That seems to be a better sample than many other samples, although the very poor may be excluded (Indiana requires filing state income tax returns if income > exemptions).

A study from France…estimating a 4.4% infection rate for the population as of May 11, and infection fatality ratio (IFR) of .7%, in line with studies from other countries/states.

Over 9,000 of their 16,386 deaths have been in retirement homes.

https://science.sciencemag.org/content/early/2020/05/12/science.abc3517

The very young may also have been excluded.

Indiana requires tax returns for many of its citizens: a single person with income >$1,000 is required to file an Indiana return. Many elderly also file to obtain an elderly, refundable credit which is based on adjusted gross income.

“This number includes more than 3,600 people who were randomly selected and an additional 900 volunteers recruited through outreach to the African American and Hispanic communities to more accurately represent state demographics.” Dr. Box and the governor have been very clear this sample is representative of the state population.

One of the regions (mine) had 300 samples, of which 0 were positive.

https://news.iu.edu/stories/2020/05/iupui/releases/13-preliminary-findings-impact-covid-19-indiana-coronavirus.html

Indiana did a great job, giving policymakers and the public a look at what is happening in their state. The good news is, Hoosiers did a good job suppressing covid-19 in their state. It wasn’t allowed to spread to some areas.

The bad news is, the virus hasn’t forgotten how to infect people. There was no silent epidemic, where people had the disease in great numbers, didn’t know it, and are now immune. Most people who were infected got sick. Virtually the entire population of Indiana is still vulnerable to catching covid, and more than 1 in 200 would die of it, not to mention the other complications.

Theory: “Hydroxychloroquine as an aerosol might markedly reduce and even prevent severe clinical symptoms after SARS-CoV-2 infection.” https://www.sciencedirect.com/science/article/pii/S0306987720307076?via%3Dihub

They nebulized HQ and found it well tolerated. Recommending trials - I don’t see any yet. (I think they’re hoping someone will come up with an inhaler product.)

“Endogenous deficiency of glutathione as the most likely cause of serious manifestations and death in patients with the novel coronavirus infection (COVID-19): a hypothesis based on literature data and own observations”

https://www.researchgate.net/publication/340917045_Endogenous_deficiency_of_glutathione_as_the_most_likely_cause_of_serious_manifestations_and_death_in_patients_with_the_novel_coronavirus_infection_COVID-19_a_hypothesis_based_on_literature_data_and_ow

Progress with the candidate vaccine, Chimpanzee Adenovirus Oxford

“ChAdOx1 nCoV-19 vaccination prevents SARS-CoV-2 pneumonia in rhesus macaques”

https://www.biorxiv.org/content/10.1101/2020.05.13.093195v1?fbclid=IwAR1Xb79A0cGjORE2nwKTEvBb7y4-NBuD5oRf2wKWZfAhoCJ8_T73QSQfskw

https://covid19vaccinetrial.web.ox.ac.uk/press-updates

Maybe. But glutathione is one of those wonder antioxidant supplements that was being pushed well before covid-19, by the people who push wonder supplements.