COVID-19 Interest Group
April 11, 2020
Greater Bay Area Data – Arlin Peters
The latest analysis by Arlin shows that number of cases is plateauing instead of declining as we may have hoped. In the GBA, doubling time is ~13, new cases arising at about 200-250/day. Good news but not as good as a declining number of cases. For more information, please visit www.berkeleyrotary.org and/or go to Arlin’s Corner in the COVID-19 tab.
Overview of Potential COVID Treatments
The FDA has granted Emergency Use Authorization (EUA) for the use of HCQ for COVID19 patients. The drug is currently approved for malaria and autoimmune diseases such as RA or Lupus, but there is insufficient clinical evidence to draw conclusions about its effectiveness in COVID19 infections.
It is estimated that thousands of patients have received the drug yet only anecdotal evidence is available that it resolves the symptoms of coronavirus. A small China study suggests that it may shorten the time to recovery, lower the rate of pneumonia (ARDS) and reduce viral load. But this study was not statistically significant.
Clinical studies with HCQ in France and Sweden have been halted due to unacceptable side effects. In other non-COVID studies, it was shown that 7% of patients experienced eye damage to the retina, and 11% experienced heart trouble (arrhythmia). Even with these potential safety concerns, there are 5 clinical studies on-going. The manufacturer (Sanofi) is making 100 million doses available in 50 countries. HCQ is unlikely to be a miracle drug. It’s just too early to know the outcome, but people are feeling desperate for a medication.
Remdesivir Anti-Viral Drug
Gilead’s anti-viral drug, Remdesivir, has been previously used against Ebola, SARS and MERS in animal studies with some success. Data from a small study of severely ill COVID patients was released yesterday. This compassionate use trial showed that two-thirds of the patients had improvements on their dependency for oxygen. The positive results are that 17 out of 30 patients were removed from ventilators. Unfortunately 13% of the patients died. Under the designation of compassionate use, Remdesivir has been used in 1,700 patients worldwide. One major customer for this drug has been the US military, wanting something to mitigate their 2,000 COVID positive cases.
5 additional trials are under way using Remdesivir in blinded, placebo controlled fashion. Until these data are available, the safety and efficacy of this anti-viral treatment is unknown. Meanwhile, Remdesivir is considered to be one of the most promising medicines available.
Anti- IL6 Treatments
Two anti-IL6 drugs are being tested in the hope they can prevent the cytokine storm that leads to rapid death during the pneumonia stage (ARDS) of the COVID infection. Both Kevzara (Regeneron) and Actemra (Roche) are currently approved for the treatment of rheumatoid arthritis and work by blocking cytokine IL6, modulating over reaction of the immune system. These are both IV administered antibodies and will be most appropriate for patients in the ICU or severely ill patients that are hospitalized. Data from these trials may be available next month.
Note: I don't know what to make of the Twitter report that Viagra has some beneficial effects...
Monday, April 13thCIG Meeting
Our Monday meeting this week will be from 4:00 to 4:30. We will adjourn at 4:30 to go to UCB School of Public Health town hall “Coronavirus: Science and Solutions”