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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

Covid-19

New Study Finds Children Can Spread COVID-19 as Much as Adults

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A new study from South Korea has discovered that children between the ages of 10 and 19 can spread COVID-19 just as much as adults. The extensive study, published by the Centers For Disease Control and Prevention, states that household transmission of the virus “was high” for those between 10 and 19 years old

Household transmission rates were lower for patients aged 0 to 9. Researchers examined reports for 59,073 contacts of 5,706 coronavirus patients in South Korea between January 20 and March 27. Dr. Ashish Jha, director of the Harvard Global Health Institute, told The New York Times that this study is one of the best to date concerning the coronavirus and transmission of the disease.

The results arrive as school officials across the nation determine whether or not to reopen schools for the upcoming year. The South Korean study said that the researchers’ findings of coronavirus transmission during school reopenings emphasize the need for a time-sensitive epidemiologic study to safeguard public health policy.

The study also indicated the effectiveness of contact tracing, especially in light of future waves of SARS-CoV-2, that will rely heavily upon social distancing and personal hygiene as primary factors for preventative measures. Awareness of the role hygiene and infection control measure plays is vital to reducing the household spread, and using masks in the home for family members who are at high risk for contracting the coronavirus needs further research.

Michael Osterholm, an infectious disease expert at the University of Minnesota, told The New York Times, that there will be transmission rates of the virus if schools reopen and include that in plans for preventing and limiting the contraction of the virus. 

Sources: 

  1. https://www.health.com/syndication/children-aged-10-19-spread-coronavirus-just-as-much-as-adults-new-study-finds
  2. https://wordofhealth.com/2020/06/27/young-californians-attribute-in-coronavirus-spike/
  3. https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article
  4. https://www.hsph.harvard.edu/ashish-jha/
  5. https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html
  6. https://wordofhealth.com/2020/04/02/is-social-distancing-helping-californians/
  7. https://wordofhealth.com/2020/06/17/how-to-fix-this-type-of-n95-mask-to-limit-the-spread-of-the-coronavirus/
  8. https://www.cidrap.umn.edu/about-us/cidrap-staff/michael-t-osterholm-phd-mph

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Covid-19

Video Laryngoscope Released in the U.S. for Faster Intubation During COVID-19

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Healthcare facilities worldwide are on the front lines during the ongoing COVID-19 pandemic by providing treatment for patients. Those who are in critical condition in intensive care units need intubation, but this process can be complicated by obtaining an airway precisely. Each patient varies; some can take a minute or more during intubation, potentially leading to fatal consequences. 

Nihon Kohden is launching its NK AWS-S200 video laryngoscope in the United States under the Pentax brand outside the United States. This device is designed to achieve intubation faster and on the first try. Furthermore, the company claims the product “can help protect clinicians while intubating patients suffering from COVID-19 or other respiratory infections”.

Link to Source

The NK AWS-S20 features a high-definition color display targeting cross-hairs that help deliver the working end into the airway. A functioning channel allows for the endotracheal tube to be pushed while viewing the airway properly. 

There is a built-in-channel to guide the endotracheal tube and continuously observe the intubation process. The video laryngoscope can decrease the risk of oral and pharyngeal injury, such as mild mucosal bleeding and sore throat.

Link to Source

Nihon Kohden mentioned that the NK AWS-S200  allows healthcare professionals to intubate challenging patients quicker than other competitor’s devices. The company expressed the device can help clinicians intubate patients with even difficult airways in  22.9 seconds, well below the 30-second threshold suggested for intubations and up to 33 seconds faster than other devices. 

Genoveffa Devers, DNP, MSHA, RN, CPHQ, VP of clinical and strategic alliances at Nihon Kohden stated the importance of tools to establish an airway quickly and efficiently as possible for healthcare providers. She added that the NK AWS-S200 video laryngoscope is designed to attain this while maintaining clinicians’ safety by limiting contact trying to visualize the vocal cords and larynx. 

Using the firm’s disposable NK PBLADE blades, which are available in four different sizes, help clinicians reduce cross-contamination between patients and those providing treatment.

In addition, when administering CPR, the video laryngoscope can be used to intubate patients without delaying life-saving treatment. 

Sources: 

  1. https://www.medgadget.com/2020/07/nihon-kohden-releases-video-laryngoscope-in-u-s-for-faster-intubation-during-covid.html
  2. https://www.webmd.com/lung/intubation-explained
  3. https://www.nihonkohden.com/

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Covid-19

‘COVID Symptom Study’ App Tracks Various COVID-19 Symptoms

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A new smartphone COVID-19 app that tracks symptoms has gathered information from more than 4 million people worldwide and gives doctors the ability to examine the different symptoms patients are experiencing with the virus. The mixture of various symptoms people are exhibiting with COVID-19 is unexpected.

According to Dr. Troy Pennington of Arrowhead Regional Medical Center in Colton, there are various forms of COVID-19 symptoms in patients. The application is called the COVID Symptom Study, was designed by healthcare professionals and scientists at Massachusetts General Hospital, The Harvard T.H. Chan School of Public Health, King’s College London and Stanford University School of Medicine, working beside ZOE, a health science company. Users can input their health information and get statistics on those participating around their region. 

Researchers grouped patients into six different clusters. The first cluster of patients are those experiencing mild symptoms who had flu-like symptoms, according to Pennington. The symptoms included body aches, possibly a sore throat, mild shortness of breath, and mostly mild symptoms, but no fever.

The second cluster of patients displayed similar symptoms, but with a fever. The third group of patients included gastrointestinal issues. Pennington added that there was a GI component with mild diarrhea or even an upset stomach. 

The fourth cluster of patients added severe fatigue, while the fifth added confusion as part of their symptoms. The sixth cluster consisted of patients experiencing the most severe symptoms, including abdominal and respiratory problems. This group had all of the common attributes of flu-like illness, but it had a very significant GI component with persistent abdominal pain and diarrhea. 

Pennington stated some of his patients at Arrowhead Regional Medical Center had exhibited even more peculiar symptoms such as unusual rashes and rashes that also looked like hives or chickenpox. Another patient was complaining of number fingers and toes. 

According to the study, the only common symptoms in all six clusters were headaches and loss of smell.

The COVID Symptom Study app has allowed physicians to get a closer look at COVID-19 symptoms patients experience to help healthcare professionals identify and treat patients accordingly. 

Sources: 

  1. https://abc7.com/covid-19-covid-symptoms-coronavirus-is-upset-stomach-and-diarrhea-a-symptom-of/6345955/
  2. https://wordofhealth.com/2020/07/11/pink-eye-symptom-of-covid-19/
  3. https://covid.joinzoe.com/us
  4. https://wordofhealth.com/2020/05/14/how-does-covid-19-affect-the-lungs/

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