COVID-19 Update: Treatment Studies, Vaccine Development, and More
On Wednesday, June 17, Dr. Steven Bishop provided another weekly update on COVID-19. He covered new treatment data related to the steriod dexamethasone and hydroxcholorquine, vaccines under development in Phase III, blood donations with the American Red Cross, and answered questions about blood clots in COVID-19 patients, underlying health risks, and where he gets trusted information. Watch the full video below and read on for a recap.
New Treatment Data: Recovery Trial
A recent study at the University of Oxford's indicates using the steroid dexamethasone as a treatment improved mortality rates for COVID-19 patients that are either on a ventilator or on oxygen. It's believed this steroid may be just enough to limit the potential of a cytokine storm, which could lead to death. Read more about this study's results here.
Recovery also released a new hydroxychloroquine study that indicated there is no clinical benefit from the use of hydroxychloroquine in hospitalized patients with COVID-19. However, as we discussed in recent weeks, we need to be careful about results from any study. In particular with this one, they used hydroxycholorquine alone, with no other treatment such as zinc, so we need to get more information on the protocols behind this study.
Vaccine Updates: Two Vaccines in Phase III
We now have two vaccines in Phase III of their trials — one being the AstraZeneca/Oxford study that has been in Phase III for the past few weeks and another, a new one, being a tuberculosis vaccine called the BCG vaccine. This is being re-purposed to see if it has any efficacy against COVID-19. It will probably be another few weeks, at least, before we get any reliable data from these trials. The New York Times is tracking the progress of various vaccines under development here.
You Asked. He Answered.
- Have you reviewed the recent Lancet study on COVID-19 comorbidity, and if so what are the main insights you take away from it? I have not seen that particular study, but I have seen many of the other studies related to underlying health conditions and COVID-19. If that study indicates 20% of the world's population is vulnerable to worse COVID-19 outcomes due to underlying health conditions, that number is probably much higher in the U.S. because more than 80% of the adult population in the U.S. are metabolically unhealthy, meaning they are overweight or their have an abnormal blood sugar level.
When it comes down to it, the older you are and the more metabolic problems you have ( weight, blood sugar, cholesterol, cardiac), the higher risk you are. For higher risk people, especially high-risk elderly people in their 70s and beyond, it's very reasonable to continue social distancing and wait for positivity rates to fall more. When those rates fall below 5%, I am going to feel a lot more comfortable.
- What is the latest in terms of how people respond? Early on it was shared that 80% had mild cases, where does that stand? I think this is still true. Most people are doing well with mild cases, mostly people who are younger and healthier. The people 50 and under make up a large number of overall cases, and they are doing well, with very few deaths in those age groups. Many people are probably having asymptomatic cases. Over 90% of people who don't do well with the virus are either older or have at least one of the chronic conditions.
- Do you think patients should be put on blood thinners when diagnosed? This is in reference to coronavirus being associated with an increased risk of blood cuts and strokes, regardless of the patient's age. I don't fully understand the mechanism yet; I don't anyone does.
The two main thoughts are that the virus itself is a form of vaculitis, which means it attacks your blood vessels and creates abnormalities and inflammation there, which leads to clots. Or sometimes people who are septic and critically ill are generally more susceptible to clots from inflammation and immobility.
There was a study a few weeks ago showing some evidence that the virus attacks the lining cells of blood vessels, so it is possible that is why blood clots are more likely with COVID-19. If people are in the hospital with COVID-19 and fairly sick, requiring oxygen and relatively immobilized, I think it's very reasonable to put the patient on blood thinners. That's what most hospitals that I've seen their treatment protocols are doing.
Outpatients that get diagnosed but are doing well, for the most part, I would not put people on blood thinners. They are dangerous drugs, and I wouldn't put someone on them unless they were being monitored or had a really, really good reason to get one other than COVID-19.
- Any comments on the latest science that much of COVID-19 turns out to be vascular related vs. respiratory? Implications? This was alluded to in the blood clot question. I saw a study a few weeks ago showing that the virus can infect and destroy the lining cells of our arteries and veins, primarily arteries. That can cause a lot of inflammation both in the vessels and everywhere else.
I haven't seen any updates, but if that is true, and it is plausible, it would explain a lot of what goes on with the virus in terms of the blood clots, the massive amount of inflammation we see in very sick, hospitalized patients, and the development of the cytokine storms and bilateral pneumonias.
It's not that the whole lung is filled with virus. It's that the body attacks the lung trying to kill off the virus, and in the process damages the tissue. This is why a lot of people are getting intubated after developing low oxygen levels.
- Blood type is a possible indicator of who is also more at risk. Your thoughts? I haven't seen any follow-up studies on this, but there was an initial association study that came out of China showing certain blood types were higher risk than others. I haven't any confirmations of this.
What they did in that study was they looked at the charts of people who didn't do well and looked at their blood types, but that kind of study leads to a lot of inaccuracies. That study also came out of China, and their blood type distribution is different than other parts of the world, so that might be accurate in China but inaccurate elsewhere in the world. So we just need more info on that.
- Outside of the CDC in general, are there specific people out there that you follow to gain the best, most balanced intelligence? This is an interesting and slightly loaded question. I have mixed feelings about the CDC data. I think some of what they present is very accurate, and some of what they portray is meant to scare people. My most trusted sources are the local department of health websites, because they tend to have the most accurate localized information in terms of states.
Other than that, I am crowd-sourcing information via colleagues and other physicians on Twitter, where almost a second-level of peer review occurs among physicians around the world, where they take studies and analyze what they did and their results.