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Covid-19

Coronavirus Antibody Testing is Coming to Orange County

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Orange County officials are working with UC Irvine to study how many people have been infected with COVID-19. Researchers will examine blood samples of 5,000 people for antibodies from COVID-19 to understand how many people have contracted the disease throughout the county. 

This month, samples that represent the county population will be examined, and eight to ten drive-through sites will be set up. Pin-prick tests will also be administered to collect blood and sent to UCI for an analysis of the blood samples.

Similar tests have already begun in Los Angeles, and Santa Clara counties, and the number of infections was more significant than the number of confirmed cases. Officials conducting the Orange County examinations expect to have the same result. 

Contrary to the testing administered in Los Angeles and Santa Clara, the UCI study is intended to be more extensive and rigorous by testing more individuals than the other two studies. Researchers will go to the homes of those who cannot go to the drive-through sites and try to reach under-served communities. These efforts will help to have better estimates of disease prevalence by age and race/ethnicity. To observe how subjects’ immune responses change, researchers will follow some subjects over time. 

The director and founding dean for UCI’s Program in Public Health Bernadette Boden-Albala is leading the effort with Tim-Allen Bruckner, an associate professor. The study costs about 1.5 million, the proposal says, and is the largest of three surveillance studies currently in the works at UCI. 

The LRW Group, who led the sample for Los Angeles study, has email, mobile, and land-line information for more than 800,000 adults in Orange County. The LRW Group will be charged with pulling together the sample of 5,000 people that represents the Orange County population. 

Researchers are in the process of finalizing, which finger-prick test to use, and hope to begin testing in the next couple of weeks. After data is collected, the results will be analyzed and aim to be ready for publication by fall. The study will consist of about 200 participants who have tested positive to COVID-19 or for antibodies. The participants will have blood drawn every two weeks over four months

This surveillance study will be sent to the County Board of Supervisors to inform how long to continue restrictive public health measures, identify who is at high risk for the disease, and understand the persistence of the duration of immunological responses

Sources:

  1. https://www.ocregister.com/2020/05/14/rigorous-coronavirus-antibody-testing-coming-to-o-c/
  2. https://wordofhealth.com/2020/05/11/cedars-sinai-expert-weighs-in-on-uncertainty-over-coronavirus-antibodies/

Covid-19

WOH Series Part 2: Current treatments for COVID-19

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Patients diagnosed with the coronavirus are receiving different care depending on the severity of their symptoms. Current healthcare facilities are in clinical trials with possible antiviral drugs that could be used as a treatment, such as remdesivir. Even plasma from recovered patients is being considered for a potential treatment for COVID-19 patients. If respiratory problems caused by the virus persist, healthcare professionals are turning to ventilators to help patients breathe and fight for their lives. Researchers are currently evaluating the effectiveness of these treatments to determine which care is suited for various patients with mild to severe symptoms. 

One drug that is the furthest along in clinical trials for treating COVID-19 is remdesivir. Researchers are also testing older medications that are typically used to treat other conditions to see if they are also useful in treating COVID-19. 

Remdesivir

This antiviral drug is administered by intravenous (IV) infusion in the hospital. Remdesivir is a new drug that has been given an “emergency use authorization.” Previously, the drug showed to have some effect against SARS, MERS, and Ebola in cell and animal models

Based on the positive reports from studies, the FDA issued an emergency use authorization (EUA) for remdesivir on May 1, 2020. The EUA does not mean that the FDA has approved remdesivir for the treatment of COVID-19. Instead, the EUA intends to make it easier for doctors to get remdesivir for hospitalized patients with severe COVID-19 symptoms. These are patients who require mechanical ventilation or extra oxygen

Hydroxychloroquine and chloroquine

Hydroxychloroquine and chloroquine are two medications that have been used to treat malaria and autoimmune conditions like rheumatoid arthritis and lupus. Some studies suggest that both medicines may also help treat hospitalized patients with mild cases of COVID-19. In contrast, other studies showed that hydroxychloroquine did not make a difference. Based on what we now know, the risks of heart problems and other issues appear to outweigh the benefits relative to treating COVID-19. More comprehensive studies are needed to confirm whether these medications work in treating COVID-19.

Convalescent plasma

On March 24, 2020, the FDA issued an Emergency Investigational New Drug (eIND) for convalescent plasma to treat people with COVID-19. Plasma is the liquid part of blood that carries blood cells. Currently, antibodies containing plasma from a recovered patient are given by transfusion to a patient suffering from COVID-19. The donor antibodies help the patient fight the illness, possibly reducing the length or lessening the severity of the disease.

In China, ten adults with severe COVID-19 symptoms were given convalescent plasma. The researchers reported that all symptoms (such as fever, cough, shortness of breath, and chest pain) had significantly improved within three days. Still, it is not widely available since healthcare centers have just recently begun collecting it.

Ventilators

Patients with increased respiratory complications, healthcare professionals are turning to ventilators to help patients breathe. Ventilators are used for patients that can no longer breathe and need the machine to help provide oxygenation. In short, a ventilator takes over the body’s breathing process when the disease has caused the lungs to fail. This gives the patient time to fight off the infection and time to recover. There are two types of medical ventilators that can be used to treat patients. 

Graphic showing two common types of medical ventilation

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How is the ventilator used? 

In severe cases, the virus can cause damage to the lungs, prompting the body’s oxygen levels to drop, making it harder to breathe. A ventilator pushes air with increased levels of oxygen into the lungs to alleviate these problems. The ventilator has a humidifier, adding heat and moisture to the air supply matching the patient’s body temperature.

Patients are given medication to stay sedated and help relax the respiratory muscles to tolerate the discomfort from the ventilators. 

Timeline of Ventilators

The average timeline of ventilators is two to three weeks, possibly even longer, when a COVID-19 patient requires mechanical ventilation support. Some individuals could require a tracheostomy, where a tube is inserted in the opening of one’s neck rather than down the windpipe. Doctors must consider whether a ventilator’s complications are worth it in giving the patient enough time to recover from COVID-19, which can take weeks on the machine.

Possible Complications 

The pressure from a ventilator can make a patient’s lungs collapse or increase the risk of pneumonia. Gradually, doctors use reduced volumes of oxygen with lower pressure to limit injury to patients. However, ventilators are still “not completely safe and harm-free,” says Dr. David Hill, a pulmonary and critical care physician and board member of the American Lung Association.

Rehabilitation

Rehabilitation usually involves physical and occupational therapy to help patients get up and to move again. Eventually, a patient will begin transitioning to either home or a rehabilitation facility to start the recovery process after being taken off the ventilator. The recovery process varies for each patient, and older individuals with existing medical conditions could have a longer recovery period

Though COVID-19 is still relatively new, researchers are still conducting studies such as clinical trials, to determine which treatment is effective for patients with mild to severe symptoms. 

Sources: 

  1. https://wordofhealth.com/2020/03/12/can-blood-plasma-be-used-to-treat-coronavirus/
  2. https://wordofhealth.com/2020/05/14/how-does-covid-19-affect-the-lungs/
  3. https://www.goodrx.com/blog/coronavirus-treatments-on-the-way/
  4. https://www.cidrap.umn.edu/news-perspective/2020/04/fda-warns-about-hydroxychloroquine-chloroquine-covid-19
  5. https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19
  6. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19
  7. https://www.fda.gov/media/137565/download
  8. https://www.webmd.com/lung/news/20200415/ventilators-helping-or-harming-covid-19-patients#1
  9. https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma
  10. https://www.pnas.org/content/early/2020/04/02/2004168117
  11. https://www.bbc.com/news/health-52036948
  12. https://www.pbs.org/newshour/health/why-ventilators-are-increasingly-seen-as-a-final-measure-with-covid-19
  13. https://www.healthline.com/health/tracheostomy

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Covid-19

Orange County COVID-19 cases May 18

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Several North Orange Country cities continue to serve as the hotspot as coronavirus cases continue to increase in Orange County. For new cases, Anaheim, Santa Ana, Orange, and Buena Park produced half of all new cases from last week. 

A new update on Monday, May 18, 59 new cases were reported bringing the total in Orange County to 4,434, and 461 are from senior living residents and 350 from jail inmates. There were no new deaths reported Monday and the total number of deaths within the county remains at 88. Of the total deaths, 21 were people living in skilled nursing facilities.

With 24 of 25 hospitals reporting, there were 194 people in Orange County hospitalized due to the virus with 78 patients in intensive care units. On an average 1,595 people were tested each day, a reduction from 2,715 the previous week and 2,199 from the week before. Another 166 tests for the coronavirus were given on the last day, bringing the collective testing total to 80,533 in the county of 3.2 million people. For the county to reopen, the county is expected to report 1.5 tests per 1,000 residents each day.

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Sources: 

  1. https://www.ocbj.com/news/2020/may/18/covid-19-hotspots-oc/
  2. https://www.ocregister.com/2020/05/18/coronavirus-orange-county-reported-no-new-deaths-for-may-18/

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WOH Series Part 1: COVID-19 and Lungs

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The new coronavirus pandemic can cause infected lung complications such as pneumonia and, in more severe cases, acute respiratory distress syndrome (ARDS), and/or an hyperinflammatory state that can cause life-threatening effects to the lungs and other organs. This article will explore how COVID-19 first makes its way into the lungs and the possible lung complications it can cause in patients.

The virus that causes COVID-19 is SARS-CoV-2, which is part of the coronavirus family. The virus travels down your airways and can infect the upper or lower part of your respiratory tract, and the lining can become irritated and inflamed. In some cases, the infection can reach down into your tiny air sacs called alveoli, where oxygen and carbon dioxide are exchanged in your blood.

The advancement of the virus can restrict a person’s ability to take in oxygen. According to the World Health Organization (WHO), the most common diagnosis in severe cases of COVID-19 can cause patients to develop pneumonia. 

Pneumonia

Pneumonia is a lung infection in which the alveoli are inflamed. In pneumonia, the lungs become filled with fluid and inflamed, which leads to breathing difficulties. For some individuals, breathing problems can become severe enough to require treatment at the hospital with oxygen or even a ventilator.

Pneumonia caused by COVID-19 tends to affect both lungs, making air sacs in the lungs fill with fluid, limiting the lungs ability to take in oxygen and causing shortness of breath, cough, and other symptoms.

Most people can recover from pneumonia without any permanent lung damage, but pneumonia associated with COVID-19 may have lasting effects. It could take months to recover from breathing problems from lung injury even after the infection has passed.

Acute Respiratory Distress Syndrome (ARDS)

As COVID-19 pneumonia advances, more of the air sacs become filled with fluid leaking from the tiny blood vessels in the lungs. Eventually, shortness of breath begins and can lead to acute respiratory distress syndrome (ARDS), a form of lung failure. Patients with ARDS are often unable to breathe on their own and may require ventilator support to help circulate oxygen in the body. Whether it occurs at home or the hospital, ARDS can be fatal. People who survive ARDS and recover from COVID-19 may have lasting pulmonary scarring.

Hyperinflammation

Another complication of COVID-19 can lead tohyperinflammation. Hyperinflammation occurs when an infection enters and spreads through the bloodstream, causing tissue damage anywhere it reaches. The lungs, heart, and other body systems work together, and in hyperinflammation, the interoperability between the organs collapses. Entire organ systems may start to break down due to internal bleeding, in bacterial-induced sepsis, cardiovascular shock and death may ensue. A relatively rare condition in children referred to as Pediatric Multisystem Inflammatory Syndrome has recently emerged. The condition appears to be associated with COVID-19 infection but presenting with different symptoms and delayed by a week or more. Hyperinflammation represents an exaggerated immune response and thus occurs in young children, teenagers, and otherwise healthy adults. 

Superinfection

When someone is diagnosed with COVID-19, the immune system is working tirelessly to fight off the intruder. This can leave the body more susceptible to infection with another bacterium or virus on top of the COVID-19 — a superinfection. More infection can result in additional lung damage. Epidemiologists are concerned this is a distinct possibility during the Northern Hemisphere fall-winter flu season in late 2020.

The recovery process after a serious case of COVID-19 takes time for the lungs to heal properly. The injury to the lungs leaves scarring and takes three months to a year or more for the lungs to function pre-COVID-19 levels, according to Panagis Galiatsatos, M.D., M.H.S., an expert on lung disease at Johns Hopkins Bayview Medical Center.

Sources:

  1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs
  2. https://www.webmd.com/lung/what-does-covid-do-to-your-lungs#1
  3. https://www.webmd.com/lung/coronavirus-strains#1
  4. https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf
  5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/sepsis
  6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30691-7/fulltext
  7. https://www.hopkinsmedicine.org/profiles/results/directory/profile/4626291/panagis-galiatsatos
  8. https://www.hopkinsmedicine.org/johns_hopkins_bayview/

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