Convalescent plasma has been used as a therapy for several viral infections in the recent past, including EBOLA, SARS-CoV, H5N1 avian influenza, and H1N1.
In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin we noted a clinical improvement in all but one 86-year-old patient who died, and one 74-year-old patient still in intensive care unit.
According to the FDA, there is not enough scientific evidence to link the use of NSAIDs to worsening symptoms of COVID-19
An interesting Lancet case series on pregnant mothers with confirmed COVID19 – all 9 moms survived, and delivered healthy babies with no evidence of detectable coronavirus in cord blood, throat, or amniotic fluid in any of the nine babies suggesting a low risk of transplacental transmission.
Digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19.
There is a fast track phase 3 trial of 1,000 patients here and in China. This is a therapeutic “game changer” based on its success when used in compassionate use outcomes in a limited number of people. It has a therapeutic window when used in the first 5-10 days before the cytokine storm sets in. Currently IL-6 inhibitor are being studied to attenuate the inflammatory response i.e. “cytokine storm” caused by the immune response in the lung to COVID19
It is hard to believe that less than 2 months ago we were pondering “Where have all the Viruses gone?” at Maui Derm. We were also breathing a small sigh of relief that Zika, SARs and other pandemics we have previously seen did not prove prolonged nor significant risks.
Individuals over 70 yo infected with COVID19 had > 35% mortality. This group of patients, particularly those with co-morbidities (diabetes, heart, lung disease, etc) were most severely affected. The lack of available ICU beds in the many severely affected areas likely contributed very significantly to the high mortality rate.
Commentary by Albert Yan, MD
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