The "New" Normal
My Latest COVID Findings
So much has changed in so little time . Working from home seems normal now . Avoiding personal contact is a default behaviour. I do miss sport - it would have been great to be able to play golf over the last few weeks of blistering sunshine.
My latest COVID headlines are
- There is no evidence that chloroquine or hydroxychloroquine work in COVID cases . There is lots of evidence that around 30% of patients given hydroxychloroquine develop cardiological problems and a greater proportion of treated patients die.
- Remdesivir looks likely to be an effective treatment in some cases - trial information coming through seems to indicate that at the very least it reduces time on ventilation and reduces mortality . Whether this will translate into a massive benefit for populations remains to be seen.
- Tocilizumab seems to be effective in some cases where "cytokine storm" is prevalent.
- I am told that in Italy everyone that walks through a hospital door with suspected COVID is immediately given a COX2 anti-inflammatory ( eg Celebrex ) and antibiotic plus high concentration / low pressure oxygen. However we have been warned by SAGE that anti-inflammatory medications can mask symptoms of severe infection so perhaps not such a good idea after all?
- There are a large number of trials going on which are attempting to fill in gaps in the science of COVID - what works, at what stage in the disease the treatment should be employed, how much and for how long ? The outcomes are going to be vital in the future management of coronavirus as we begin to release from lockdown and isolation
- Vaccination - in my opinion this is the only hope for return to work and normal social behaviour. But, even if the vaccines that they are working on in Oxford and Imperial are effective and safe we will have to wait for the outcome of small initial cohort trials. They won't be completed until October at the very earliest. Then commercial manufacture has to be geared up followed by distribution to healthcare professionals and then dissemination to the general population . It will be at least a year before we see the benefit and if the vaccine works several more years before we can say for sure that we have COVID-19 under control. Meanwhile we must learn how to live and return to work with it and pray that our boffins come up with a viable immunisation.
- We will learn to live with COVID with the help of antibody testing . Again , there are large gaps in the science but I think we will show that once you have had it you won`t get it again . I`m less sure that we will show that once you have had it you are no longer infectious to others that have no antibodies . My guess is that many people who successfully isolate and do not get COVID and so do not have antibodies ( that`s probably the majority of us ) will live in fear that when we start to go back to work , mingle with friends and family and use public transport we will be sitting targets for COVID . I have no idea how this will be managed until we get a vaccine. I suppose with mass testing, us "COVID virgins" will be able to ask the person we are meeting if they have antibodies or not - if they do they are most likely safe and if they don't it's on with the PPE . If one tests positive for antibody then there is at least some small reassurance that we might be safe from future infection. In China that is more or less what's happening now. However the practical difficulty of running a traffic light warning system for all citizens is fraught with dangers and complications especially in a liberal democracy like ours.
- I am currently exploring the availability of a kit but as ever I need to be sure myself that the results are reliable. Even the highly sensitive and highly specific PCR swabs for COVID-19 antigen that patients , healthcare workers and social care workers are getting ( now up to 70 thousand tests a day ) are not anywhere near 100% reliable. Blood tests are even less reliable and our scientific leaders have not recommended any test brand yet. I find it difficult to believe that there is no such reliable test available from Germany or South Korea but we are told that it is so. Therefore, if anyone decides to get a blood test done please be aware of the limitations . If you want to discuss your results with me I am available for consultation. I hope to be doing my own tests when 120 Harley Street reopens. This will signal the beginning of the end of lockdown but there will be no return to "normal" for a long time.
I hope you find this interesting and useful.
Dr Jack Edmonds
Date posted: 04 May 2020
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