In general, there are 4 or 5 main ways to "treat" Covid-19:
1. Vaccine.
This would be the best. However, it's also the one that takes the longest time to develop, involves the most extensive research, costs the most money, and so on. It's at least a year away. And that would be extremely fast. By comparison, consider that a vaccine was eventually developed against Ebola, but it took approximately 5 years. If I recall, I think it only arrived last year in 2019. Yet 5 years is more typical of the timeframe in vaccine development.
2. A new drug.
This would take slightly less research effort and time than a vaccine. Even if we accelerate it.
3. An old drug.
By this I mean a drug that has been used in other diseases or conditions but is re-purposed for the use in Covid-19. This is where most of the drugs we hear about in the news would be categorized. Such as chloroquine and hydroxychloroquine. These drugs were anti-malarial drugs and also used in rheumatoid diseases like lupus. Today medical experts are trying to re-purpose them for use in Covid-19. However, contrary to what most the media is reporting, there isn't much good evidence that these drugs will work - at least not yet. There is promise and hope, but only time will tell. By the way, in case anyone is interested, here is a summary of all the clinical trials we are working on to date. It's not comprehensive, but it's close.
4. Covalescent plasma therapy.
This is a treatment that's been around for years. In a general sense, it's been around even as far back as the Spanish flu in 1918. It was used to some degree in the first SARS pandemic or SARS-1; our pandemic is SARS-2. Many medical experts working in infectious disease and vaccine development have been pushing convalescent plasma therapy (e.g. Peter Hotez at Baylor, Arturo Casadevall at Johns Hopkins, Ian Lipkin at Columbia University). Basically it's just transferring the antibodies (in blood plasma) from someone who has recovered from Covid-19 to someone who has been infected with Covid-19 (as treatment) or to someone who is at high risk of infection (as prophylaxis). So the elderly, the immunocompromised, health care providers. There wouldn't likely be enough for the general population, but we can target at-risk groups and perhaps even areas that are seriously affected (e.g. NYC, Seattle). This could help diminish the virus' spread so that we can get a better handle on things. Clinical trials are already under way. It should move much faster than vaccine development. The medical technology is available today and as such comparatively easy to implement. The major issue is rolling it out. I'm referring to logistics like setting up blood banks, asking for blood donors (though the donation would require much less effort on the donor than, say, donating blood at the Red Cross), and so on.
5. Supportive care.
This is primarily what we're doing now. For the sickest patients, i.e. patients in the ICU with acute respiratory distress syndrome (ARDS) which is the leading cause of death in Covid-19 patients, it's basically just trying to give them oxygen, help them breathe better via mechanical ventilation, make sure they stay well-hydrated with fluids, maintain their nutritional status, put them in a prone position (i.e. lying face down) which has been shown to significantly help reduce mortality from ARDS, etc. All this is far better than we had, say, in 1918 with the Spanish influenza, but it falls short of an effective treatment against the SARS-2 virus itself.
References
Ian Lipkin on convalescent plasma therapy
Peter Hotez on convalescent plasma therapy
"A Seattle Intensivist’s One-pager on COVID-19"
"Should we use #hydroxychloroquine (HCQ) +/- azithromycin to treat #COVID19?"
Hawk, have you been under a rock? No evidence? "However, contrary to what most the media is reporting, there isn't much good evidence that these drugs will work - at least not yet."
ReplyDeleteWhy don't you hear it from the doctors themselves who are using it:
https://www.youtube.com/watch?v=zer6omW0vnU
How many of the vulnerable elderly in nursing homes are ever likely to receive mechanical ventilation, the best hope in this circumstance? In my experience, many of these people have end-of-life directives including DNR (do not resuscitate) and DNI orders which prohibit hooking the patient up to a ventilator. If they are serious about saving lives from COVID-19, and not shy about taking coercive measures, why shouldn't their first move be to invalidate all advanced directives which preclude mechanical ventilation, for the duration?
ReplyDeleteI'm no lawyer, but wouldn't the elderly be able to change their advance directives at any point they wish (DNI, DNR)? Presumably they would have regularly reevaluated their advance directives with family and physicians to ensure they are current with their wishes.
DeleteGranted, many in nursing homes are no longer mentally capable of making decisions. However presumably they would have appointed power of attorney to someone they trust to make those decisions for them should they have become incapable of doing so. If not a power of attorney, then a guardian.
Otherwise, you may well have a point. In any case I definitely agree we should do our utmost to protect the elderly who can't protect themselves.
Personally I can't escape the suspicion these end-of-life directives do not reflect the spontaneously expressed wishes of the elderly so much as a societal preference pushed on them by social workers. The prior administration wondered why American health care was so expensive. They discovered a lot of money is spent in the last year of life. They realized this could be economized. If the social workers stopped pushing these directives, few would spontaneously demand them.
ReplyDeleteWhen it comes to ventilators, people are always thinking they'll end up like Terry Schiavo or Karen Ann Quinlan, with useless breath forced wheezing into a near-lifeless shell. They do not think of a transient,fast-moving infection like the coronavirus, where ventilators can save lives. Especially realizing that the states have put most of the U.S. population under virtual house arrest to protect the vulnerable elderly, I would like to see a public discussion of just what it is the elderly are vulnerable to: coronavirus, or DNIs? If the answer turns out to be the latter, that can be fixed: stop pushing them.
Thanks, Fredericka. I certainly agree with you about the need to protect the elderly.
DeleteDavid Chan is a Stanford-trained oncologist who discusses why health care in the US is so expensive. You might be interested in his posts (e.g. here).
When it comes to the vent, you might be interested in this infographic.
You might also be interested in this video from a pulmonary and critical care physician:
Delete"Do Ventilators Save COVID-19 Patients?"
Wow, that's scary. Thanks!
DeleteJust saw this:
Delete"Seems like it's been an age since I gave that congressional testimony warning about the risk of #COVID19 in US nursing homes and assisted living facilities, but tragically it still rings true"