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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 Promising COVID-19 Vaccine Selects Hoag Hospital for Trial

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UCI graduate Chen Cao became the first of 35 individuals to be vaccinated in NantKwest Inc. and ImmunityBio’s phase 1 clinical trial for COVID-19. This trial is only happening at Hoag Memorial Hospital Presbyterian in Newport Beach, CA.

According to the WHO, there are 44 vaccine candidates in clinical evaluation worldwide and another 154 in preclinical evaluation. Most are targetting the coronavirus’ signature spike protein, which leads to its name “corona,” meaning “crown” in Latin

NantKwest/ImmunityBio’s vaccine also does the same, but it also targets structures within the virus’ cytoplasm called nucleocapsids that have been shown to stimulate T-cell responses.

Philip Robinson, Hoag’s medical director of infection prevention and principal investigator for the vaccine trial, states, “This vaccine is novel because it stimulates the second arm of the immune system, the cell-mediated immunity, the T-cell response.” 

Based on SARS-CoV 1, he added that patients who developed that T-cell and cellular immune response have long-lasting immunity that can be measured 17 years after they got infected. T-cell responses are more durable than antibody responses activated by the spike protein alone and develop a much longer-term immunity, the company states. 

This vaccine’s dual-edged approach is a “key advantage” that could also prevail in mutations in the spike proteins, which might reduce the efficacy of “S-only” vaccines moving forward. There are several other features that the NantKwest/ImmunityBio vaccine has that is generating enthusiasm.

While several vaccine candidates are using adenoviruses — which cause the common cold — to transfer the coronavirus’ genetic material into the human body to hopefully induce an immune response, however, there’s a potential risk that the body’s immune systems could recognize the cold virus and attack before it can complete its task. This vaccine overcomes this challenge by making deletions to the adenovirus that render it invisible, Robinson said.

Similar to other vaccine candidates, this one will consist of two shots, three weeks apart. But apart from many others, it won’t need to be stored in frigid temperatures, which can pose significant logistical challenges. 

Instead, it just requires standard refrigeration and can remain viable at room temperature “for quite a long time,” Robinson said. Down the line might also be delivered by mouth or by nasal spray, rather than just by injection, making administration even easier.

Last Wednesday, five volunteers received their first injections at Hoag, and five more will get their first injections this week, according to Deborah Fridman, Hoag’s director of clinical research. There will be a pause after each set of 10 to review the safety, side effects, and immune system reactions. 

This phase 1 trial’s primary goal is to confirm the vaccine’s safety and induces immunity, Fridman said. If proven successful, it will expand into phases 2 and 3 next year, recruiting hundreds, and then thousands, of participants.

Hoag Hospital has participated in more than 20 COVID-19 clinical trials since caring for the state’s first known COVID-19 patient in January. Hoag has given patients access to advanced therapies and innovative treatments, officials said. Though, this vaccine is its first COVID-related vaccine trial.

The hospital has expanded its research department in recent years. Hoag has a relationship with Los Angeles County-based NantKwest, Inc., and ImmunityBio is the only Orange County hospital. It is the only nonacademic institution to offer the companies’ phase 2 immunotherapy clinical trial for solid tumors.

Patient No. 1 Chen Cao must report any side effects to Hoag immediately. She has a diary to record how she’s feeling and will return regularly for evaluation and blood draws. 

Anyone interested in participating should email clincialresearch@hoag.org. 

Sources:

  1. https://www.ocregister.com/2020/10/21/hoag-memorial-selected-as-trial-site-for-promising-covid-19-vaccine/
  2. https://www.who.int/docs/default-source/coronaviruse/novel-coronavirus-landscape-covid-19cc0232c16129498983a6a0e30ca94000.pdf?sfvrsn=87aa8dc9_1&download=true
  3. https://nantkwest.com/immunitybio-study-shows-positive-t-cell-and-antibody-immune-responses-to-its-covid-19-vaccine-candidate-that-targets-both-spike-and-nucleocapsid-virus-proteins/
  4. https://www.hoag.org/news/clinical-trial-for-pancreatic-cancer-patients2/

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Covid-19

Health Officials in Orange County Warn Residents of Flu and Coronavirus ‘twindemic’

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Fall has officially begun with another flu season in store, but this year, public health officials and politicians are warning the flu could increase the demand on Orange County’s health care grid, which has been stressed due to the coronavirus pandemic.

A second outbreak is a primary concern with cooling temperatures approaching, and relaxing pandemic rules could lead to more people gathering in tighter quarters.

County leaders are urging residents to maintain their pandemic habits, to help prevent a so-called “twindemic” of influenza and the coronavirus, and advise residents to get a flu shot.

Andrew Noymer, an epidemiologist and professor of public health at UCI, states that the driving factor is COVID, a new virus, and the flu shot is not. 

Both are respiratory diseases with similar transmission modes such as coughs and sneezes spouting infectious droplets around – the flu has been around for centuries, and health systems know how to manage it, Noymer stated.

The COVID-19 countermeasures like wearing face masks, social distancing, and frequent hand washing will also work against the flu. 

One concern is that both diseases share symptoms that could cause the lesser-studied COVID-19 to spread undetected if a sick person believes they have the flu, Noymer said. That will be a challenge for an already stressed healthcare system, he said. 

Annual flu hospitalizations could cause hospitals to maintain pandemic surge plans that added beds and staff. Healthcare providers are spreading the message to their patients ahead of the expected strain. 

This week, Kaiser Permanente emailed Orange County members with a video explaining the differences between a seasonal cold, the flu, and COVID-19.

The differences between all three can be hard to distinguish, which is why mild coronavirus cases might go undetected, the video explains. The main symptoms of COVID-19 include fever, cough, shortness of breath, with onset up to two weeks after exposure. As with influenza or the flu, it starts suddenly with fever, cough, sore throat, nasal congestion, and body aches. 

Meanwhile, common colds slowly take hold with symptoms, including a runny nose, sore throat, sneezing, headaches, and high fevers are rare.

The flu kills 60,000 people per year nationwide, Noymer said, but “COVID-19 has killed 200,000, and the year is not even over yet,” 

According to public health data, since 2017, influenza and pneumonia have killed an average of 576 people per year in Orange County. Since March, the COVID-19 death toll among residents has climbed to more than 1,100 people.

For health experts, the coronavirus still is the wildcard as winter approaches. Noymer further added that the county’s population is more susceptible to COVID than the flu because they have flu shots and currently don’t have a COVID shot. 

The ongoing coronavirus spread could create a second wave of cases caused by business and school reopenings as well as changes in temperature and humidity.

Recently, Dr. Robert Redfield, the director of the US Centers for Disease Control and Prevention, told a Senate subcommittee he suspects a COVID-19 vaccine will be available in the U.S. by December in limited supply.

For more information on disinfecting and sanitization measures click here

Sources: 

  1. https://www.ocregister.com/2020/09/17/orange-county-health-officials-warn-of-coronavirus-and-flu-twindemic/
  2. https://www.ocregister.com/2020/09/08/orange-county-gains-ground-against-coronavirus-advances-from-purple-tier-to-less-restrictive-red-tier/
  3. https://healthy.kaiserpermanente.org/health-wellness/videos/covid-19/symptoms-cold-flu
  4. https://wordofhealth.com/2020/09/18/coronavirus-sanitize-or-disinfect/
  5. https://wordofhealth.com/2020/07/13/disinfecting-medical-masks-and-n95-respirator-masks/

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Covid-19

Coronavirus: Sanitize or Disinfect?

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During the COVID-19 pandemic, it is imperative that you wash your hands frequently or sanitizing them when soap and water are not available and cleaning commonly-touched-surfaces to keep yourself protected.

While sanitizers and disinfectants are commonly referred to as interchangeably, both products are different and should be used in separate circumstances.  

According to the CDC, cleaning, sanitizing, and disinfecting all have different definitions:

  • Cleaning eliminates germs, dirt, and other impurities from surfaces, but does not necessarily kill them.
  • Sanitizing decreases the number of germs on surfaces or objects by killing them or removing them—to a safe level, according to public health standards or requirements.
  • Disinfecting kills germs on objects or surfaces.

Diane Calello, MD, executive and medical director of New Jersey Poison Center and associate professor of emergency medicine at Rutgers New Jersey Medical School, states sanitizing does not kill everything. 

The Environmental Protection Agency (EPA) defines sanitizers as chemical products that can kill 99.9% of germs on hard surfaces. Again, disinfectants are more potent, killing 99.999% of germs on hard, non-porous surfaces or objects.

The difference comes down to that sanitizing solutions aren’t as potent as disinfecting solutions. Some products can be both sanitizers and disinfectants. Dr. Calello says concentrated bleach can be a disinfectant, but if it’s very diluted, it might be a sanitizer meaning it kills fewer bacteria and viruses.

Sanitize or Disinfect?

There are specific procedures for cleaning groceries, surfaces in your home like doorknobs, and your hands, and it’s crucial to get them right. When it comes to groceries, you don’t need to wipe them down with disinfectant wipes (or any other disinfectants) or a sanitizer. You can clean them using water, but no soap when you bring them to your home.

For highly-touched areas of your home like doorknobs, toilet handles, and even sinks, you want to save disinfectants for these areas. However, for countertops where surfaces are exposed to food preparation, its best to sanitize those so any chemical residue isn’t as powerful and potentially harmful.

As for your own hands, you should not use disinfecting wipes as it can be hazardous for your skin, according to Dr. Calello. She further adds that at the poison center, she works for has seen people’s adverse effects using disinfectants on their own bodies. She said there was a man who acquired powerful, industrial-use disinfectant wipes and developed a blistering rash.

Donald Ford, MD, family medicine doctor at Cleveland Clinic, states that you can wipe off surfaces but wash your hands. Due to the “good” bacteria that live on your skin, when you apply something that kills all the bacteria on your hands, you’re killing off some helpful and natural bacteria. 

Dr. Calello says there is a reason why we do not apply something that does not kill every organism like a hand sanitizer, which should contain 60% alcohol. However, it’s essential to remember that hand sanitizer is adequate if you’re out in public, but washing hands with soap and water for at least 20 seconds is preferred.

Since the COVID-19 pandemic, there has been an increase in people purchasing disinfectants and sanitizing products and knowing when to sanitize and disinfect surfaces or objects can help in practicing proper sanitation. 

Sources: 

  1. https://www.health.com/condition/infectious-diseases/coronavirus/sanitize-vs-disinfect
  2. https://www.cdc.gov/flu/school/cleaning.htm
  3. https://www.epa.gov/sites/production/files/documents/ece_curriculumfinal.pdf
  4. https://www.njpies.org/administrative-staff/
  5. https://rutgershealth.org/provider/diane-calello
  6. https://www.health.com/condition/infectious-diseases/coronavirus/how-to-use-cleaning-chemicals-safely

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