COVID-19 Update: Retracted Studies, Hospitalizations Declining, Vaccines, and More

Dr. Steven Bishop returned to Facebook Live to provide another update on COVID-19. He discussed the retraction of some recent Hydroxychloroquine studies, the latest COVID-19 numbers, the definition of asymptomatic vs. pre-symptomatic, vaccines under development, and more.

He also answered questions about social distancing, schools reopening, antibody tests, and more. Watch the full video below and read on for a recap. 

Note: We experienced some audio issues at the very beginning. The sound begins working at the 0:37 mark.

Retracted Studies for Hydroxychloroquine 

As we discussed last week, there were concerns surrounding studies published in the New England Journal of Medicine and The Lancet. Those studies have now been pulled completely, because the data was unverifiable.

This doesn't mean anything definitive for Hydroxychloroquine; it is just a good reminder that it's important to be cautious about studies and what they mean until we are absolutely sure of their accuracy. Read more about the retracted studies here. 

COVID-19 Numbers in Virginia and the U.S.

The total number of cases continues to increase, and that is going to be the case as we continue to test people. However, the 7-day moving average of hospitalizations and deaths is declining, which is great news. The positive test rate itself is down to 9% today, which is much lower than it has been. 

Nationally, the number of new cases is up and down based on the day. Some states are seeing upticks in cases or hospitalizations, which is to be expected as the country opens back up in various stages. 

Asymptomatic v. Pre-symptomatic 

The WHO earlier this week released confusing statements related to asymptomatic spread of the virus. They essentially said it is rare that it is transmitted asymptotically, but that claim was quickly questioned by the CDC and other public health authorities. 

A lot of the confusion is related to the definition of an asymptomatic individual. Pretty much all viruses have a period of time when they spread asymptomatically, meaning the person is well and does not appear sick, but they are spreading the virus even though they feel fine. This is commonly known as the incubation period. 

What the studies haven't determined is if you can get the infection from someone in the pre-symptomatic phase, meaning they have the virus AND show symptoms later. This is highly, highly likely. And can you get the infection from someone who is asymptomatic, meaning they have the virus but never show any symptoms.

That's the key distinction, but the data the WHO used did not do a good job of parsing out whether someone was truly asymptomatic (if they never showed symptoms). 

COVID-19 Vaccines Under Development

The New York Times has put together a very helpful tool tracking all the COVID-19 vaccines under development. Check it out here. There are currently more than 125 vaccines under development throughout the world. Most of them are in the pre-clinical phase, meaning scientists are purely working with them in the lab trying to figure them out. 

7 are in Phase I, which means they are being tasted for safety, usually on animals and some humans. 7 are also in Phase II, which feature expanded safety trials. And 1 is in Phase III, a large-scale efficacy test, which is the collaboration between AstraZeneca and the University of Oxford.

You Asked. He Answered.  

• What's your take on the vaccine being developed by Oxford? 

That vaccine is in Phase III. It's a viral vector vaccine. I haven't researched this one in-depth, but I believe the way it works is they are attaching a viral gene into a DNA molecule of adnovirus, and then they infect the person via the vaccine. Then, the human cell machinery produces the viral protein and creates antibodies against it because it recognizes it as foreign. 

Because it's beyond Phase I, that means the initial testing likely showed good safety and at least a little bit of efficacy in terms of creating antibodies. But now we wait for more data from the Phase III trial. 

• What data are you and other physicians looking at to ensure that a potential vaccine is safe?

Like everyone else, we're going to wait for the published studies. We are going to want to see that people are open and transparent about their data. It's not always common practice to completely open up your data, but I hope that is the case here, particularly if the U.S. Government is doing the funding. They should be publishing a summary of their findings, but also release the full set of their data so everyone can vet appropriately.

• We are going into "Phase 2" but a lot of states that opened early are now seeing spikes. As you mentioned, rates are at 9%. Are we feeling safe for Phase 2?

I do. My perception is that the rates of the virus are going down. Some is probably from social distancing. Some is seasonal as the weather warms up. That's been our hope from the beginning. 

Some states are seeing spikes, but spikes are always expected as we open up more and more and more people interact closer than they have been doing. 

The thing I keep looking at is the trends for hospitalizations and deaths. That's the most important indicators. If a lot of people get the infection, but don't get very sick with it, that's kind of ok in a way. What we worry about is people getting sick enough to get hospitalized. The ideal situation would be people get mildly ill from the virus, but nowhere near sick enough to  get hospitalized, and then they get better and we move on. 

• I know all of you doctors protect yourselves with masks, shields, gloves, and probably more while with patients. But when you go home to your families, are they still quarantined “enough” so that you and your families stay safe, and your patients stay safe from the external influences from your own families?

I can't speak for all physicians, but personally, we are being as reasonably cautious as possible with our families. Yes, we are interacting with more people. But when we go out in public, especially if we're indoors and around people we don't know, we are wearing masks and keeping our distance.

At PartnerMD, all our physicians are being tested periodically for asymptomatic infection, so we are monitoring that to a large degree out of an abundance of caution. 

• What types of social interaction do you think are reasonable for teens at this stage of the pandemic? 

I think that is going to have to be a case-by-case basis. What my family is doing with our kids is making sure they are reasonably safe by being with friends that we know and that we know the parents, and are confident that if their kid or someone in their family had been sick, that they would let us know. 

• What are your thoughts on the opening of school in the fall?

I think it's good, and they have tied the different phases of school opening to the larger phases. If all goes well, I would expect we'd be in Phase III or Phase IV by the fall in terms of the state, which means we'd be in Phase III or Phase IV for schools as well. 

By the fall, we will have more information about asymptomatic spread, which will be helpful. If it turns out that what the WHO said is true, that asymptomatic spread is uncommon, then that would be even more reason to reopen. And then we could just quarantine those showing actual symptoms. 

• I was sick back in early March and did have an antibody test but came back negative. Could I possibly have had COVID-19 and tested negative due to being immunocompromised?

Certainly possible. And we know there are some people who have gotten sick with COVID-19, but never make antibodies or make antibodies that don't last. And it's probably more likely in someone who is immunocompromised because your immune system doesn't operate like normal.

• What do you think are the most important unanswered questions about Coronavirus and COVID?

I think we need to know more about its origin and where it came from, and it's mechanisms and how it infects people. 

It's origin is going to be important, not to lay blame, but to help us when the next thing like this happens and so we can develop a vaccine faster. 

• Are you hearing about or observing any shifts to the virus?

We've heard some whispers about it becoming less virulent or less lethal, but we haven't seen any good data yet. Most viruses, as they evolve over time and mutate, they tend to become less virulent. That's the more common pathway, but that's not always. I'm hopeful that's still going to be the case, but I haven't seen any clear data.

We could be seeing that since the fatality and hospitalization rates are dropping while lots of new cases are going on, but we don't know for sure. 

• What's the latest about the reliability of the antibody tests?

Nothing has changed lately. The IgGs are sensitive and specific. Very reliable. Those are tests you get after you've been sick a few weeks to determine if you have at least some presumed immunity. Those tests are very accurate.

The IgMs are not as accurate. There are false positives, meaning you could test positive but not actually have the virus. That's a limitation of the way IgM tests work. That's true of all IgM tests; it is not unique to COVID-19 tests.