World Health Organization Scientific Brief regarding “ Immunity Passports” for Covid-19 April 24, 2020. The WHO has stepped into the controversy regarding the usefulness of individual serologic tests for Covid-19. This Scientific Brief appears to be prompted by recent efforts to expand immunologic testing on the population, and utilize such test results to determine who is immune. The WHO strongly disagrees with that approach.
Entries by Maui Derm News
The Veterans Administration recently shared the results of a nationwide, retrospective analysis of the outcomes of patients hospitalized with COVID-19 from March 9 to April 11.
The emergence of COVID-19 during the winter months has caused scientists re-examine the mechanisms underlying the seasonal nature of respiratory viral infections in order to determine actionable steps to limit SARS-CoV-2 infections. The importance of temperature and humidity are highlighted in this article as factors which modulate intrinsic, innate and adaptive immune responses to viral URIs. This article provides an in-depth look at the immunology of seasonal viral infections and provides potential behavioral steps aimed at potentially mitigating COVID-19 and other seasonal upper respiratory viruses.
Is antibody testing the answer? And do we know how to do it in a valid fashion? Accurate antibody testing should allow us to determine who has been infected, and how the virus has spread. It should enable better contact identification and testing, and help us determine how to “re-open” the country
Unfortunately there is much we still won’t know: Is immunity (positive antibody titers) truly protective? Do you need a robust response to be clinically protected?
Is severity of illness and/or treatment associated with robustness of immune response? And given the multitude of mostly non-FDA approved and variably accurate test kits out there, can we trust results? We have a long way to go, but data is accumulating that may be of help.
It is well known that viruses mutate over time in large part because the replication process does not always lead to a perfect copy of the genes being replicated. While single nucleotide variants (SNVs) are abundant in SARS-CoV-2, until this publication no mutation has been directly linked to functional changes in SARS-CoV-2 that would affect the virus’ pathogenicity.
In this excellent paper in Nature Reviews Immunology, a rheumatologist, a dermatologist, and a gastroenterologist from Erlangen, Germany discuss biologic treatment of patients with chronic inflammatory diseases, including psoriasis, psoriatic arthritis, and atopic dermatitis. They effectively argue and conclude that most classes of biologics (including TNF, IL-12/23, IL-17A, IL-23, and IL-4/IL-13 blockers) utilized to treat chronic inflammatory diseases are likely to be safe in the context of the current COVID-19 pandemic. A word of caution is advised, however, on one type of drug class, JAK inhibitors, which may make patients more susceptible to viral infections in general. The bottom line is that the authors deliver a powerful science-based message that is extremely relevant to our patients, and we should take it to heart.
The Spanish Flu of 1918 was the last time the world felt biologic devastation similar to what we are now experiencing with Covid-19. US cities then chose to confront the epidemic utilizing non pharmacologic interventions, (NPI) in distinct ways, with significantly different outcomes. In National Geographic’s most recent publication, Strochli and Champine catalogue these different approaches, and illustrate how these varying approaches at the known onset of the disease, significantly impacted the degree of devastation that ensued.
The risk of vertical transmission of COVID-19 appears to be low, although some cases of apparent asymptomatic neonatal infection have now been reported.
This model provides a comprehensive epidemiology modeling and forecasting of the current COVID-19 pandemic as it pertains to hospital bed stays, ICU-days, ventilator days and deaths by US states over the next 4 months.
Commentary by Ted Rosen, MD on two recent New England Journal of Medicine articles on the ethics of COVID-19.