April 15, 2020
Lesson From Singapore: Why We May Need to Think Bigger
This article is worth a careful read. Basically, Singapore, a small city-state capable of tight monitoring (testing and contacts and cell phones), has had a “relapse” and have now had to shut things down tightly. They have gone from the most envied to just another country struggling and trying to figure out what to do and how to do it while remembering:
“All this sounds expensive. But consider that the cost of a shutdown is trillions of dollars. We clearly don’t want to do this again… if it costs a couple of hundred billion to avoid it, that may still be a relatively low price to pay.”
The letters to the editor are also interesting, some helpful. The bottom line is that we are not well enough to leave home yet.
Fort Worth: FWISD board votes to buy thousands of computers, hot spots for students learning at home
The purchase of 3,000 Chromebooks and 6,000 hot spots will cost nearly $2.5 million. Other school districts are making similar purchases.
Longview: There were no new cases of COVID-19 reported in Gregg County on Tuesday, according to Gregg County Health Administrator A.J. Harris. The case count remains 47.
New England Journal of Medicine.ICELAND STUDY:
Spread of SARS-CoV-2 in the Icelandic Population
Part of the study involved screening the population: “Although we asked participants who had respiratory symptoms that they described as more than mild not to participate in population screening, close to half the participants reported symptoms, most commonly rhinorrhea and coughing.….. Notably, 43% of the participants who tested positive reported having no symptoms, although symptoms almost certainly developed later in some of them….. Young children and females were less likely to test positive for SARS-CoV-2 than adolescents or adults and males. Whether the lower incidence of positive results in these two groups resulted from less exposure to the virus or from biologic resistance is not known. In other studies, investigators have found that infected children and females were less likely to have severe disease than adults and males, respectively.”
My Comment: The Iceland studies will be exceedingly important as they progress. The population is contained and can be controlled. Travel can be limited. Their physicians and researchers are doing some elegant genetic studies of their population which may reveal genetic variations in susceptibility to this virus. Perhaps more importantly, they can rapidly and seemingly accurately detect genetic differences in the infecting viruses. The virus’ genetic patterns differ depending on the area a patient visited and became infected. Multiple mutations in the viruses are noted frequently.
The virus’s genetic sequences and mutations might have significant importance in the development of functional vaccines. I do not pretend to understand modern virology or genetics, but I will attempt to” translate” what I can. JH
Drug Evaluation during the Covid-19 Pandemic
A readable explanation of how to scientifically perform and evaluate drug studies and medication treatments for our current epidemic and for the future:
Excerpts: During a pandemic that is causing morbidity and mortality to grow exponentially, there is an understandable temptation to make unproven therapies widely available and not wait for rigorous clinical trial data. However, well-conducted randomized, controlled trials in these acutely ill patients can actually be carried out quite rapidly. Thousands of new patients with Covid-19 present for care each day and many can be (and are) quickly enrolled in pragmatic clinical trials. The most relevant clinical outcomes for evaluating these drugs — including death, hospitalization, number of days spent in intensive care, and need for a ventilator — are readily assessed and available within days or weeks…… Rigorous premarketing evaluation of drugs’ safety and effectiveness in randomized, controlled trials remains our primary tool for protecting the public from drugs that are ineffective, unsafe, or both. It is a false dichotomy to suggest that we must choose between rapid deployment of treatments and adequate scientific scrutiny. For the Covid-19 pandemic and other pressing medical challenges, the health of individual patients and the public at large will be best served by remaining true to our time-tested approach to clinical trial evidence and drug evaluation, rather than cutting corners and resorting to appealing yet risky quick fixes. The pandemic will inevitably leave considerable morbidity, mortality, and loss in its wake. Damage to the country’s medication-assessment process — and the public’s respect for it — should not be part of its legacy….At least 25 drugs are under investigation for use in Covid-19, with 10 in active clinical trials. The first published major randomized, controlled trial of an antiviral drug combination (lopinavir–ritonavir) began enrolling patients in China just a week after the virus had been identified.5 Contrary to expectations, its results were negative, providing important clinical guidance…. From the Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston.
MASKS FOR NY GROCERY SHOPPERS ???
WHY ROLLING CORONAVIRUS PATIENTS ONTO THEIR STOMACHS IS SAVING LIVES
A good summary article sent by Dr. J. Vassar.
We actually did this in back in the dark ages at Parkland Memorial Hosp. and tried other positions if needed (postural drainage) along with physical therapy (chest clapping) if indicated. JHarris
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