COVID19: What We Know on Easter via TWIV

If you define "experts" as people with reliable, tested solutions, then COVID19 has no experts. But if you listen to the virologists on This Week in Virology podcast it will restore your faith in experts, and in humanity. There are folks who have studied viruses long before and now during COVID19. For them, this virus is just another in a long line of DNA/RNA actors. They get into depth, and it takes an hour each episode, which is beyond the attention span of most listeners, certainly of most journalists, but it's there for those who care to learn. In particular, their guest, Dr. Daniel Griffin, elucidates how physicians have learned from their mistakes to treat the COVID19 patients more successfully.

--Comment from a New Hampshire reader in The New York Times to a Ross Douthat article about not trusting experts when it comes to COVID19.




Episode #600 of This Week In Virology has aired and the Phantom, once again, will attempt, with apologies, to summarize, boil down and translate.

The Phantom is humbled by the task, and feels unworthy, knowing the virologists and physicians he reports may cringe to hear his simplifications.

But the Phantom hears too often from people he has pushed to tune into to this estimable podcast that:
1/ It is simply too long.
2/ Too many of the words and the concepts are unfamilier: i.e., you have to be a doctor or a biologist to understand what they are talking about.

Actually, the Phantom thinks the TWIV geeks are pretty good at explaining and "making accessible" but he will try to get it into a more digestible form.

Here is a link to the actual episode #600
https://www.microbe.tv/twiv/twiv-600/


This week the Phantom learned:

1/ Pregnant mothers who are COVID19 + are being separated from their newborns and this is a bad move. IF the mothers breast feed, they'll likely pass their antibodies on to the baby and that will be good for the baby.

2/ Hydroxychloroquine (HC) may worsen the disease if given at the wrong moment in the illness, but if given at day 7, it may be helpful.
Daniel Griffin, the physician from Long Island, who is a professor at Columbia, is launching a study, a real, double blind prospective study to answer two questions:
  A. Can hydroxychloroquine (HC) successfully "treat" COVID19?
B. Can hydroxychloroquine (HC) prevent health care workers from getting the disease?

How would you know if HC is an effective treatment?
If you treat a patient with strep throat with penicillin, you can see the patient improve with respect to throat pain, fever and malaise rapidly and you can swab their throat after the penicillin is done and find no positive throat culture.
With COVID 19 there is no convenient or practical way to culture after therapy--mostly what you've got is a PCR swab which will remain positive after therapy because it measures pieces of the virus and this flotsam may float around for days to weeks after the virus has been neutralized. If the patient gets better, if his blood oxygen improves, his fever comes down and his respiratory rate returns to normal, that's a good sign the HC worked, but all that happens in patients who are not treated, so how do you know it was the HC that did the trick?

That what science is all about--testing, designing studies to separate coincidence from effect.

Daniel Griffin, MD

Daniel Griffin, MD, who is running the studies, points out you are actually more likely to be injured by the drugs used in the studies than helped by them. If 95-99% of people recover from COVID19 and if 5% of patients receiving HC get complications (seizure, cardiac arrest, rash, liver dysfunction) then the odds of your benefiting from being a study subject are against you. He says some studies are being marketed to the public as if it's all gain--step right up, get your mother enrolled today! And he makes a really eloquent argument for science, rationality and for not falling prey to the wishful thinking which emerges in every epidemic.

3/ "Steroid" (glucocorticoid, prednisone, cortisone) therapy given at the wrong stage of the illness can cause worsening as the immune system which is trying to kill the virus is stopped in its tracks. Later on, when the immune system is carpet bombing the lungs, it may well help.

4/ Anti virals, which interfere with various actions of the virus in entering the cells, or making more virus, may be useful in some stages of the disease. There are also drugs which interfere with host enzymes which the virus uses to split it's own protein coat--very much as the Greeks (the virus particles) were contained inside the wooden horse, but they needed someone on the outside, the hosts (the Trojans) to first drag the horse inside the walls of Troy and then open up the horse so the Greeks could spill out and sack the city.

5/ Vaccines will be the ultimate answer, but there is no good way to rush their development. There are good ways to rush the production and to ramp it up quickly, but first you need to identify the right vaccine.

6/Antibody tests will be vital to figure out who has had the disease and recovered. But there are two problems: some antibody tests have been inaccurate. The false positive tests occur because antibodies to the common cold, another coronavirus, can cross react to give a false positive for antibodies to COVID19.
It is not certain that the presence of antibodies will protect against another infection with COVID19 or, if they do protect, for how long. Some immunity may last only weeks or months.