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

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1481

More quotes on testing capacity.

US commercial labs won’t be able to cope with a testing surge during flu season, Quest executive warns
From CNN’s Health Gisela Crespo

US labs won’t be able to cope with a surge in demand for Covid-19 tests in the fall during flu season, and time lags to process the tests will likely worsen, James Davis, an executive vice president at Quest Diagnostics, told the Financial Times.

In an interview published Tuesday, Davis said, “There is no way that PCR capacity is going to double in the next three months,” referring to the polymerase chain reaction (PCR) tests – the most common and most accurate tests for determining whether someone is currently infected with coronavirus.
Where testing stands now: Quest said in a Monday news release Covid-19 test results are lagging by up to two weeks in some cases, as the company works to handle the increased load from surging cases. The average turnaround time for test results in priority patients is now more than two days compared to one day a week ago, the lab said.
The shortage of chemical reagents and testing machines is what is keeping Quest from being able to expand its testing capacities, Davis told FT. The Quest executive called for academic institutions and the industry to find other solutions to resolve testing problems. He added that pool testing and a blood test that detects a type of antibody early in the infection could help.

The US Food and Drug Administration on Saturday granted an Emergency Use Authorization (EUA) for Quest to conduct pool testing for Covid-19.
Meanwhile, LabCorp, another prominent diagnostic company, said in a news release Sunday that it is processing 165,000 coronavirus tests per day and is delivering results between 3-5 days from specimen pickup.

Speaking on CNBC’s Closing Bell Tuesday, LabCorp CEO Adam Schechter said he is also concerned about the fall, when students go back to school, and called on states to do everything they can to control the spread of the virus.

“We’re continuing to increase capacity every single week over week,” Schechter told CNBC. “The problem is that the number of tests being asked to be performed each week is growing faster than the capacity that we can build.”

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Commercial scale vaccines for Covid-19 are already being made, HHS secretary says
From CNN Health’s Naomi Thomas

The commercial scale vaccine for Covid-19 is already being made and the supply chain is not a concern, according to US Health and Human Services Secretary Alex Azar.

“This is what’s really unprecedented with President Trump’s Operation Warp Speed. We are literally making the commercial scale vaccine now, as we’re going through the clinical trials,” Azar said Wednesday on CNBC. “We’re doing that at-risk using the full power of the US government and our financial resources to do that. No one’s ever done this before.”
Azar said he is not concerned with the supply chain when it comes to manufacturing vaccines for Covid-19.

“We’re not concerned about the supply chain and it’s domestic manufacturing across the portfolio that we’re investing in,” he said.

Azar also said that they have sufficient supplies for the vaccines once they are approved.

“We – right at the beginning of Operation Warp Speed – worked to lock down fill-finish capacity, as well as syringes, needles and glassware, so we’ve secured that to be able to ensure that we’ll be able to vaccinate the American people once we get vaccines that are demonstrated safe and effective to the FDA’s gold standard of approval or authorization,” he said.

The partnership with the US Department of Defense is critical, Azar said, because “they bring just incredible logistics and procurement capabilities to the table for this historic effort.”

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All we are missing is the, you know, vaccine. This kind of hype is really dangerous to the public IMO. A lot of public think this is all over bar the shouting.

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US government and Pfizer reach deal to produce millions of Covid-19 vaccine doses
From CNN Health’s Naomi Thomas

The US Department of Health and Human Services and the Department of Defense announced an agreement with Pfizer Inc. on Wednesday for “large-scale production and nationwide delivery of 100 million doses of a Covid-19 vaccine in the United States following the vaccine’s successful manufacture and approval,” according to a press release. It also allows the US government to acquire an additional 500 million doses.

The initially produced vaccines will belong to the federal government, and Pfizer will deliver the doses in the United States if the vaccine receives emergency use authorization or licensure from the US Food and Drug Administration.

Remember: Pfizer still needs to complete a large Phase 3 clinical trial.

“Through Operation Warp Speed, we are assembling a portfolio of vaccines to increase the odds that the American people will have at least one safe, effective vaccine as soon as the end of this year,” Health Secretary Alex Azar said in the release. “Depending on success in clinical trials, today’s agreement will enable the delivery of approximately 100 million doses of vaccine being developed by Pfizer and BioNTech.”
The Biomedical Advanced Research and Development Authority collaborated with the DoD Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense and Army Contracting Command to provide $1.95 million for the production and nationwide delivery of the first 100 million doses after an OK for the FDA.

How this could play out: If the vaccine is successful and receives EUA or licensure, nationwide delivery would begin in the fourth quarter of 2020.

The doses would be delivered to locations at the US government’s direction and it would be available to Americans at no cost, the release says. Health care professionals could charge insurers for vaccine administration.

“We’ve been committed to making the impossible possible by working tirelessly to develop and produce in record time a safe and effective vaccine to help bring an end to this global health crisis,” Dr. Albert Bourla, Pfizer chair and CEO said in a separate release. “We made the early decision to begin clinical work and large-scale manufacturing at our own risk to ensure that product would be available immediately if our clinical trials prove successful and an Emergency Use Authorization is granted.”

Preliminary data released in a pre-print paper this week by Pfizer and BioNTech said its Covid-19 vaccine appeared safe and elicited antibody and T cell immune responses in a Phase 1/2 trial. More research is needed. The company has said it could start a Phase 3 trial of the vaccine in late July if it receives regulatory approval.

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What kind of hype?

1486

So if you test positive, from what I understand your isolation period, for many is 10 days and then you are likely able to return to your activities (with mask). If you are exposed to someone positive, you have the quarantine for two weeks because you may not test positive for up to 14 days? What if you test 5 days and 10 days after you were exposed? Would that not cover it? so the person who finds out they are sick (mostly talking about college kids) spends less time by themselves than the person who is exposed to them.

This is why we have issues with spreading and the younger set. Telling someone to stay in place for 14 days, while the person who gave it to them is free and clear after likely 10 days, is non intuitive.

Do I have my math right?

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However, wouldn’t motivation to participate in contact tracing be different for STDs versus COVID-19? And wouldn’t the contacts react differently when informed of an exposure to an STD versus COVID-19?

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Why would someone with COVID not want to warn their contacts? When the contacts are called, they aren’t told who exposed them, correct?

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These are kids who were having COVID infection party. Are you asking them why’s?

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@igloo folks have different strokes. Kids rather have fun and not worry about their action.

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@Sybylla , no idea. It states in the article that it hasn’t been peer-reviewed, so take it for what it’s worth. The BBC is credible though, so I am guessing they aren’t publishing just for the sake of it.

We all know a vaccine is key, but until sufficient numbers can be vaccinated, it’s very good to know that medicine is on its way to finding effective treatments. And I suspect the disease is going to evolve and change, so vaccines might only provide temporary protection.

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There are 328.2M people in the U.S. (as of 2019). Who decides who gets left out, if there are only 100M doses? Will states be competing against each other again?

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@CTTC, I have no clue, though perhaps it will be population based initially? I am thinking that initial vaccine doses are going to be prioritized by importance: essential health workers, medically vulnerable, elderly, etc…

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I read somewhere that members of the armed forces and medical workers will be first in line.

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100M doses is sufficient to vaccinate 50M people. Given that 1/2 of the IS population will not want to be vaccinated, we only need to about triple that amount… seems doable.

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A dear friend, 80, female, has been hospitalized in Las Vegas, and is awaiting test results, but it is believed that she has lessor discussed covid symptoms: sepsis, renal failure and stroke-like symptoms (terribly slurred speech and muscle weakness). No cough, no fever, no chest pains. But it turns out sepsis and renal failure are very real in the covid world.

She became ill on July 14th - 10 days after she ventured out to a casino to play machines (4th of July) “they were very clean, even coming around and cleaning machines mid-play” - she did say she’d worn a mask, but I have my doubts. Her 4 adult family members had to carry her to the car to go to urgent care, where they called an ambulance to transport her to hospital. The adult 4 say “no, we can’t quarantine” - I want to scream! For many reasons.

This is not “just a flu bug”

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Someone may not want the contacts to have to go into general quarantine or isolation (as some colleges have been considering for their students).

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I’m not sure the science is clear on this. There is reason to believe the virus is infecting other organs directly: the heart, the kidneys, the brain. And that there is serious illness from infections causing serious clotting issues, as well as a potential cytokine storm.

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No. If you’re symptomatic and test positive, we know that you’ve already incubated the disease and are now in the infectious phase, and you will soon move to the non-infectious phase. If you were exposed, but don’t have any symptoms, you could be incubating the disease and about to be infectious on day 11, with or without symptoms.

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I didn’t mean that the virus itself isn’t causing damage. But the life threatening effects in week two and beyond seem to result from host/virus interaction. For example (greatly simplified because I’m not an immunologist):
The virus invades the epithelial cells which line the blood vessels. The immune system targets those infected cells and swallows them up, but this causes tiny holes in the vessel walls. The body recognizes the holes not only as ways blood could leak out, but as openings for invaders to get in. The immune system goes overboard triggering inflammation and activating platelets to plug all the holes. Now, the patient’s body is full of clots which can break off, travel, and cut off blood supply to organs.

My reason for stressing that it’s the human immune system causing most of the problems at this point is in light of potential therapeutics. It’s too late for anti-viral drugs. Too many cells are hijacked, and you can’t kill the hijacker without without harming the cell. The best option we currently have is to try to calm the immune system so it doesn’t overreact and cause life threatening issues. Thus, the steroids, IL-6 inhibitors and anti-coagulants.