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Can Dexamethasone Improve COVID-19 Survival For Critically Ill Patients?

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British researchers have found an inexpensive and readily available steroid that prevented more than a third of the sickest COVID-19 patients from dying. Researchers conducted a new study, including a large group of coronavirus-infected patients who required mechanical ventilation to breathe. A ten-day course of the drug dexamethasone reduced mortality by 35%, according to researchers from the University of Oxford. In patients with less severe symptoms but still required supplemental oxygen, the steroid treatment reduced death rates by 20%. Dexamethasone could become the first drug treatment with lifesaving effects for COVID-19 patients. The only other medication remdesivir the antiviral drug has proven effective in an extensive clinical trial, but its benefit was limited to shortened recovery time.

Administering the medication to patients in the early stages of the infection could be dangerous for those who are experiencing milder symptoms. According to Dr. Steven J. O’Day, director of regional research at Providence St. John’s Health Center in Santa Monica, people who are tempted to misuse the drug will cause much sicker patients.

The drug dexamethasone is a corticosteroid that emulates the effect of cortisol, which is a hormone produced by the adrenal glands. Dexamethasone can effectively bring down inflammation and is prescribed to treat allergic diseases, skin diseases, rheumatoid arthritis, and autoimmune diseases.

Oxford University’s Dr. Peter Horby, an infectious-diseases expert and one of the clinical trial’s chief investigators, stated the corticosteroid “is the first drug to be shown to improve survival in COVID-19,” He further explained that the survival benefit is prevalent in patients who are ill enough to require oxygen treatment. Dexamethasone could become the standard care in these patients, and the drug is inexpensive and can be used immediately to save lives worldwide, he added. 

According to experts, the reported benefits of dexamethasone or any other steroid are exclusive to coronavirus patients with severe symptoms. Corticosteroids inhibit the production of T cells, a type of white blood cell that the immune system uses to fight a coronavirus infection. With fewer T cells at work, O’Day advised that the treatment could backfire by making a person more vulnerable to infection.

 Approximately 40% of COVID-19 patients who rely on mechanical ventilators will die of the disease, and this drug could provide a new alternative for physicians who are treating critically ill patients. Physicians are currently reviewing the data from the study before implementing any new forms of treatment for patients.

Critical care specialist at UC San Diego’s School of Medicine, Dr. Mark Hepokoski, stated in the study’s initial results stand up to review by independent scientists it could offer him comfort knowing there is a treatment to provide their sickest patients. 

COVID-19 resembles two forms of severe illnesses that are commonly treated in intensive care units. Septic shock is one of them, which is a diagnosis that steroid medications can be used for treatment. The second is acute respiratory distress syndrome, a condition for which steroids are often avoided.

The effectiveness of dexamethasone and precise results will make it a “game-changer” if the study’s findings prove accurate. The new results surfaced from a clinical trial in the United Kingdom known as  Randomized Evaluation of COVID-19 Therapy, or RECOVERY. The RECOVERY trial consisted of 2,104 patients who received dexamethasone and 4,321 who acquired care routinely provided in hospitals throughout the United Kingdom.

The British study results suggest a 10-day regimen of dexamethasone would prevent 1 in 8 mechanically ventilated patients from dying. Patients that require supplemental oxygen alone, about 1 in 25 patients, could be saved by the treatment.

The drug’s use does include some risks, such as making extremely ill patients more susceptible to fungal and bacterial infections that can be fatal. It can make patients’ blood sugar challenging to regulate for heavily sedated patients and on a respirator. This can cause an increased risk of profound muscle weakness.

Since dexamethasone is often used in critically ill patients, the new findings indicate prompt critical care specialists to use it sooner than as a last resort, according to Hepokoski. This could prevent the need for mechanical ventilation for patients, he added. Multiple healthcare experts have stated that dexamethasone could be a useful drug with its wide availability, low price tag, and the ability to scale quickly. 

Discovering effective treatments for patients such as dexamethasone can transform the impact of COVID-19 on patients affected worldwide.

Sources:

  1. https://www.latimes.com/world-nation/story/2020-06-16/widely-available-steroid-can-improve-chances-covid-19-survival
  2. https://wordofhealth.com/2020/05/20/woh-series-part-2-current-treatments-for-covid-19/
  3. https://www.saintjohnscancer.org/about-jwci/people/steven-oday/
  4. https://www.healthline.com/health/corticosteroids-what-are-they
  5. https://www.ndm.ox.ac.uk/principal-investigators/researcher/peter-horby
  6. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell
  7. https://profiles.ucsd.edu/mark.hepokoski
  8. https://medlineplus.gov/ency/article/000668.htm
  9. https://www.nhlbi.nih.gov/health-topics/acute-respiratory-distress-syndrome
  10. https://clinicaltrials.gov/ct2/show/NCT04381936

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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