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

[greenwitch]

Here’s an article about the study:

https://www.washingtonpost.com/nation/2020/06/16/coronavirus-update-us/#link-CXDQECTL2ZDOTNZQDOSVDNINXM

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” he said in a statement. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

A total of 2,104 patients were randomly selected to receive six milligrams of dexamethasone once a day for 10 days. That group was compared with 4,321 randomized patients who were receiving only “usual care” for covid-19.

Patients who received only “usual care” and required ventilation care had a high 28-day mortality risk, and those who needed oxygen had an “intermediate” mortality risk.

Dexamethasone lowered death rates by one-third in ventilated patients and one-fifth in other patients receiving oxygen, scientists found.

[maya54]

Dexamethasone is also apparently inexpensive which is another great thing plus it’s been widely used as a steroid so they have some safety data.

[BunsenBurner]

A BBC News article:

https://www.bbc.com/news/health-53061281

Wonder if a combo of the two drugs that have proven to have a benefit is now being studied. Appears it is:

Researchers in France are testing dexamethasone with standard oxygen to support patients with severe COVID-19. Patients that are included in the trial are also being treated with remdesivir.

https://www.centerwatch.com/articles/24721-remdesivir-being-evaluated-with-other-treatments-for-covid-19

[BunsenBurner]

Anyone have a link to the original dexamethazone paper?

https://www.statnews.com/2020/06/16/major-study-finds-common-steroid-reduces-deaths-among-patients-with-severe-covid-19/

This site says it has not yet been published.

[maya54]

Definitely think caution is warranted until the study is actually published.

[BunsenBurner]

This is the original press release:

https://www.nihr.ac.uk/news/first-drug-to-reduce-mortality-in-hospitalised-patients-with-respiratory-complications-of-covid-19-found/25061

Study was terminated on June 8, so the results should be published any day now.

[Mwfan1921]

Will be interesting to see the paper and data. Docs have been using steroids to treat patients all along, evidently the key is the timing of when to administer the steroids.

[fretfulmother]

@Mwfan1921

Will be interesting to see the paper and data. Docs have been using steroids to treat patients all along, evidently the key is the timing of when to administer the steroids.

Yes - didn’t @3SailAway talk about exciting results along these lines while it was being discovered?

[BunsenBurner]

The prof is speaking to CNBC now. As expected, he confirmed that this immunosuppressive drug can only be used at a certain stage in the course of the infection because unsuppressed immune response is needed at the earlier stages.

[ucbalumnus]

https://www.ucsf.edu/magazine/frontliner-fattahi describes some research with findings about possible reasons why men are more likely to get severe cases of COVID-19.

@Faranak Fattahi in interview

Yes. The fewer ACE2 receptors, the less risk of infection – that’s the idea. The most effective drug that we found is called dutasteride. And there’s a similar drug called finasteride. These drugs are typically prescribed to treat an enlarged prostate; they inhibit androgens, or male sex hormones.

That really caught our attention, because we knew that men are more susceptible to severe cases of COVID-19. We also knew that kids are more protected. It’s possible that people who have higher levels of androgens like testosterone – namely, adult men – are more likely to get severely sick from a coronavirus infection because their cells have more ACE2 receptors to let the virus in.

Preprint article: https://www.biorxiv.org/content/10.1101/2020.05.12.091082v2

[CMB625]

Any new vaccine updates?

[Cardinal_Fang]

Worthwhile paper from Italy, about the chance of being symptomatic, and the chance of being critically ill, if infected, by age.

They took people who tested positive, then tested their contacts to find other positives, and those contacts who tested positive were the sample group. That way, they could find asymptomatic as well as symptomatic cases.

For 20-39 year olds, about 26% of the infected people were symptomatic, and about 0.47% were critically ill (ICU or death).

For 40-59, 38% were symptomatic, and about 0.88% were critical.

For 60-79, 41% and 4.55%.

For 80+, 67% and 18.62%

In all the ages, males were much more likely than females to be critically ill. For the 20-39 year old group, the graph makes it look like the critically ill people were all male.

This was in Italy, with whatever the comorbidity population is in Italy. The American population is probably different.

https://arxiv.org/pdf/2006.08471.pdf

[Cardinal_Fang]

A good rundown on the status of vaccines:
https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

[suzyQ7]

@Cardinal_Fang

A good rundown on the status of vaccines:
https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

Thanks! I continue to be impressed by NYT’s investment in data presentation/graphs/charts on their website. Very clear and concise… well done.

As to the content - I’m especially wowwed and impressed by this:

A vaccine in development by the British-Swedish company AstraZeneca and the University of Oxford is based on a chimpanzee adenovirus called ChAdOx1. The vaccine is beginning Phase II/III testing in England and Brazil. Supported by Operation Warp Speed, ** the project may deliver emergency vaccines by October **. In June, AstraZeneca said their total manufacturing capacity stands at two billion doses.

[HImom]

As a patient, I’d have to say, AstraZeneca has been pretty responsive about working with patients in their clinical trials, which I find encouraging (non-COVID related). That’s a lot of capacity!

[Mwfan1921]

A new study (modeling similar to how CDC tracks influenza) concluding 80% of covid-19 cases in March went undetected.

Need seroprevalence studies/data to confirm, which could be difficult if antibodies don’t stay around in body 3+ months. Hopefully there are more seroprevalence students going on.

https://stm.sciencemag.org/content/early/2020/06/22/scitranslmed.abc1126

[suzyQ7]

@Mwfan1921

A new study (modeling similar to how CDC tracks influenza) concluding 80% of covid-19 cases in March went undetected.

Need seroprevalence studies/data to confirm, **which could be difficult if antibodies don’t stay around in body 3+ months. ** Hopefully there are more seroprevalence students going on.

https://stm.sciencemag.org/content/early/2020/06/22/scitranslmed.abc1126

Do we know how long the antibodies stay around? I was sick in February and am having the antibody test on Wednesday… is it possible that even if I had Covid in February, the antibodies are gone by now?

[emilybee]

My friend’s daughter, in NYC, tested positive for antibodies (negative for CV19.) She thinks she had it in February and her whole (small ) office got sick at the same time. She was just tested last week.

[Nrdsb4]

As to vaccines produced out of the US, what are the chances that our isolationist posture will result in a reluctance to sell us vaccine?

[Mwfan1921]

@Nrdsb4

As to vaccines produced out of the US, what are the chances that our isolationist posture will result in a reluctance to sell us vaccine?

Certainly for the Chinese vaccine there are nearly 2 billion people in line in front of us. Whether Sinovac and/or the Chinese government chooses to sell to us will come down to money.