Protesting Amid COVID19, Racial Disparities, Global Trends, Hydroxychloroquin & Convalescent Plasma
Written by Dr. Larry, powered by Averpoint
“Let’s start with the numbers. There have been about 6.39 million confirmed cases and 383,300 deaths globally. In the United States, there have been about 1.85 million confirmed cases and 107,000 deaths. (1)
RACE & ETHNIC DISPARITIES
As crowded protests demand racial justice around the country, everyone’s wondering what will happen to coronavirus – especially to the black and latinX communities. For months, scientists have been studying how COVID19 relates to race and ethnicity. Here’s what we know so far: Some studies find that black patients are both hospitalized and dying at much higher rates. What we don’t know – and need to better understand is if it’s racial, socioeconomic, or both. We’ll definitely revisit as the science becomes more clear. (2) Will we see an increase from protesting?
COVID19 INCUBATION PERIOD & HOW TO PROTEST SAFELY
Remember the time from when someone is exposed until the time they get sick with COVID19 and show symptoms is 4-5 days on average, according to the CDC (3). So if someone protesting Friday, May 29, got exposed to COVID19 then 4 or 5 days later would be Tuesday May 2, or Wednesday, May 3. So, we might expect to see an increase of cases at the end of this week or early next week, depending on when people come in to get tested. Keep your eyes on that data to see exactly how protesting affects COVID19 cases in your town by googling your public health department COVID19 case numbers. And if you protest, always do your best to stay safe by keeping social distance and wearing a mask. (4)
GENETICS TO PREDICT COVID19 RISK
Genetics? Now what if we could predict how well or badly a person does with COVID19 infection based on something scripted by their genes? An Italian and Spanish research collaboration analyzed the genomes of many people looking for genetic markers determining risk of respiratory failure. While this study is pending peer review, results show that people with blood type A have a higher risk of respiratory failure while blood type O was somehow protective. (5) Interestingly, a group of Chinese investigators published similar observational findings back in March. (6)
CONSIDER CONVALESCENT PLASMA
What is convalescent plasma? When someone recovers from COVID19, they develop immunity in the form of antibodies. When these antibodies are transfused to another sick COVID19 patient, we call the treatment “Convalescent plasma.” (7)
This past week on June 3, 2020, a JAMA article out of China studied the use convalescent plasma on hospitalized COVID19 patients. While the study was ultimately inconclusive, there was evidence that COVID19 antibodies may help patients recover faster, especially if given before someone is critically ill in the ICU. In the study, it appeared that once someone is critically ill on a ventilator, this treatment doesn’t help someone get better faster. (8)
If you have gotten COVID19 and recovered, consider donating your plasma to further research that may lead to better COVID19 treatments that we have today, and ultimately, save lives. (9)
Currently the US has both the highest number of cases and the highest number of deaths related to COVID19. Brazil has reached over 30,000 deaths, with the NYT reporting that country’s president as stating: “We are sorry for all the dead, but that’s everyone’s destiny.” Brazil, along with India, Peru and Iran top the list of countries showing the greatest growth of newly reported cases. (1) While the reasons for this increase may be related to better reporting or simply represent new footholds of the virus, it is clear that this story is far from over.
HYDROXYCHLOROQUIN DOES NOT WORK
On the other hand, hydroxychloroquin continues to fall out of favor. While some initial studies showed promise on Hydroxychloroquin as a treatment for COVID19 (12), it has fallen out of favor recently due to concerns of efficacy (13) and safety. But could it be helpful as a preventative for COVID19, for example once you are exposed? President Trump himself said he was taking it for this very reason.
“I happen to be taking it, a lot of good things have come out. You’d be surprised at how many people are taking it, especially the front-line workers. Before you catch it. The front-line workers, many, many are taking it.”
– President Trump, May 18, 2020.
“I’m taking it, hydroxychloroquin. Right now, yeah. Couple of weeks ago, I started taking it. Cause I think it’s good, I’ve heard a lot of good stories.”
– President Trump, May 18, 2020, during a roundtable event at the White House (14).
A study from the prestigious New England Journal of Medicine came out this week (15) that showed unfortunately no evidence that Hydroxychloroquin prevents COVID19 once exposed. The randomized double blinded placed controlled trial–the gold standard in research — of a solid number of 821 patients showed NO DIFFERENCE in the number who became infected (11-14% after the exposure), there were more reported side effects after taking hydroxychloroquin, but nothing serious.
The study states:
“After high-risk or moderate-risk exposure to COVID19, hydroxychloroquin did not prevent illness compatible with COVID19 or confirmed infection when used as post exposure prophylaxis within 4 days after exposure.” David R. Boulware et.al in The New England Journal of Medicine, 06/02/2020
In my practice in the ER, I have never prescribed Hydroxychloroquin to prevent COVID19, nor do most of my colleagues. This study adds evidence that it does not help prevent COVID19 once exposed.
Thank you for tuning in this week.
Please share this information, we believe solid evidence and fact based information can be life saving in our battle against COVID19.
(1) 0:18-0:35 “Coronavirus disease (SOVID-19) Situation Report – 136,” World Health Organization. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200604-covid-19-sitrep-136.pdf?sfvrsn=fd36550b_2
(2) Hospitalization and Mortality among Black Patients and White Patients with Covid-19. NEJM. May 27, 2020 DOI: 10.1056/NEJMsa2011686
(3) 1:45 “Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)” Incubation period, Center for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html#:~:text=The%20incubation%20period%20for%20COVID,CoV%2D2%20infection.
(4) 2:15 “How to Protect Yourself & Others” Center for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
(7) 3:10 “Convalescent Plasma Therapy,” Mayo Clinic. https://www.mayoclinic.org/tests-procedures/convalescent-plasma-therapy/about/pac-20486440
(8) 3:05 Convalescent Plasma Therapy and Clinical Improvement in Severe and Life-threatening COVID-19 JAMA. Published online June 3, 2020. doi:10.1001/jama.2020.10044
(9) How to Donate Plasma for COVID19. “Plasma Donations from Recovered COVID019 Patients.” The American Red Cross.https://www.redcrossblood.org/donate-blood/dlp/plasma-donations-from-recovered-covid-19-patients.html
(11) 5:43 Hydroxychloroquine for the Prevention of Covid-19 — Searching for Evidence
(12) Efficacy of Hydroxychloroquin in patients with COVID-19: results of a randomized clinical trial, Chen et al. https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3
(13) Association of Treatment With Hydroxychloroquin or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State https://jamanetwork.com/journals/jama/fullarticle/2766117. JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.8630
(14) 5:37 “Trump says he takes hydroxychloroquin to prevent coronavirus infection even though it’s an unproven treatment” CNBC. https://www.cnbc.com/2020/05/18/trump-says-he-takes-hydroxychloroquine-to-prevent-coronavirus-infection.html
(15) 6:10 A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19, NEJM June 3, 2020. DOI: 10.1056/NEJMoa2016638