COVID19 update, March 29, 2020: two brief items+new French hydroxychloroquine study

Day job (remotely) absorbed my day, so today I only have two brief items

(1) (H/t: a friend): Systems biologist, Prof. Ron Milo from the Weizmann Institute has released coronavirus by the numbers, with nearly daily updates. The “numbers” are accompanied by explanatory text written in a way that non-biologists can follow it — not “obscured by clouds” of jargon.

(2) I had an online conversation with a leading neuroscientist about our response to stress in such a situation. In a nutshell: our stress response system is optimized for a very different scenario: a lion or pack of wolves coming after you. Heart rate and blood pressure going up, blood sugar and cortisol levels… all great if you need your running speed and reflexes boosted to escape from a predator.

The trouble is with more diffuse, long-term threats like a COVID19 epidemic leading to “chronic stress”. The results is anxiety, sleep deprivation, depressed immune response, … He suggested meditation [his response when I suggested old-school Jewish prayer instead was rather bemused ;)], exercise (even in the house if confined there, outdoors if possible), and any sort of enrichment activity that you derive joy from.
At my observation that obsessive news readers may simply have to “ration” the news updates, since it’s possible to be distracted 24/7 by them and kept in a permanent state of anxiety, the neuroscientist nodded.

(3) Via Instapundit: The same French team at the Mediterranean Institute for Infectious Diseases in Marseille, which reported an initial pilot clinical trial with an hydroxyquinoline-azithromycin combo now has a larger study out:

In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin, the team found a clinical improvement in all but one 86 year-old patient who died, and one 74-year old patient still in intensive care unit. The team also found that, by administering hydroxychloroquine combined with azithromycin, they were able to observe an improvement in all cases, except in one patient who arrived with an advanced form, who was over the age of 86, and in whom the evolution was irreversible, according to a new paper published today in IHU Méditerranée Infection.

“For all other patients in the cohort of 80 people, the combination of hydroxychloroquine and azithromycin resulted in a clinical improvement that appeared significant when compared to the natural evolution in patients with a definite outcome, as described in the literature. In a cohort of 191 Chinese inpatients, of whom 95% received antibiotics and 21% received an association of lopinavir and ritonavir, the median duration of fever was 12 days and that of cough 19 days in survivors, with a 28% case-fatality rate (18),” the research team said.

The team went on to say: “Thus, in addition to its direct therapeutic role, this association can play a role in controlling the disease epidemic by limiting the duration of virus shedding, which can last for several weeks in the absence of specific treatment. In our Institute, which contains 75 individual rooms for treating highly contagious patients, we currently have a turnover rate of 1/3 which allows us to receive a large number of these contagious patients with early discharge. Chloroquine and hydroxychloroquine are extremely well-known drugs which have already been prescribed to billions of people.”

“In conclusion, we confirm the efficacy of hydroxychloroquine associated with azithromycin in the treatment of COVID-19 and its potential effectiveness in the early impairment of contagiousness. Given the urgent therapeutic need to manage this disease with effective and safe drugs and given the negligible cost of both hydroxychloroquine and azithromycin, we believe that other teams should urgently evaluate this therapeutic strategy both to avoid the spread of the disease and to treat patients before severe irreversible respiratory complications take hold,” the team concluded.

Preprint online at https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

Related, Carmi Sheffer, an Israeli doctor working in Italy shares some experiences in the Times Of Israel.

In Padua, the autoimmune medicine Tocilizumab has proven effective, but can only be used once it is established that no other viruses or bacteria are present in the patients’ bodies, he said. The hospital where he works has also seen positive results from the antiviral drug Remdesivir, he added.

[…] One technique he said had yielded dramatic results was to have patients lie on their stomach instead of on their back while on a ventilator. “Suddenly the oxygen level in the blood jumped [up],” he said.

[A source in Belgium told me they had started doing this as well.]

Dr. Sheffer believes, “I think the worst is behind us. We will control the virus and flatten the curve within a few weeks, but the closure will continue until June,” he predicted. 

3 thoughts on “COVID19 update, March 29, 2020: two brief items+new French hydroxychloroquine study

  1. I mowed the yard and put out fertilizer. 1.6 miles back and forth… Got my exercise for the day! Also interesting points are being made about the ‘review’ of the data from the Princess cruise ship. The naysayers are poo-pooing the results saying they were ‘quarantined’ to their rooms. BUT, what they are forgetting is that there is only ONE airhandling system, so the ship was effectively not quarantined, and the food deliveries were performed by staff without proper PPE…

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