This is from my Cousin's friend from School. The Friend is a DR in NYC and is on the frontline of this daily. He's been giving updates when he can. It's a fun and enjoyable read and honestly this is where I get most of my info now on COVID-19. I just wait for his own reports as he has everything mapped out in categories and explains a lot of stuff. This is just easier for me to get info then sifting through articles that might be biased either way. People on both sides have been politicizing this for sure so when you can talk to actual drs dealing with this, it's the best way to get anything meaningful.
From The Trenches 10/7/2020....I am Dominic Valentino III, DO - a Pulmonary/Critical Care Physician treating COVID-19 patients in the hospital and ICUs, and outpatient settings (as well as the regular span of lung, sleep, and critical care diseases we are used to seeing). I’ve been lax on my writing. Partially because I am on day 22 of 23 in a row working (no, not a burst of COVID patients, just people who need care and are getting things addressed that were put off); also because I, like many of you, have grown weary of what is droning on in the news about COVID. However, there are real points buried in some stories and there are questions people wanted to see addressed. So here goes…
HALLOWEEN – Can we do it? This is a tradition that I know kids and adults alike look forward to. While there are plenty of fearmongers and scare tactics employed around even leaving one’s home these days, there are some things to look at on how this can be done safely. No reaching hands into a bag or bowl to get the candy. No use of unwrapped candy (who does this now anyway?). Can use tongs to put candy into kids’ bags without touching. Be sure to wash hands/use alcohol gel before you give out the candy or put it into a bowl. Alternative – Put a clothesline on your front and use clothespins to attach the candy to it. Kids can pull down one each. I have seen some drawing for chutes as well (kid puts bag at end of chute, homeowner slides it down into bag). Costumes will need to be thoughtful of keeping a mask on, but plenty of ways to make that part of the costume. (and those giving out candy should have one too). Lot’s of ways to allow this part of childhood to continue. Last I checked hayrides were outdoors and one can space well on the cart (have a set number allowed on it only). So with some American ingenuity and thought, this CAN work. The easy thing for local and state governments to do is ban it or place ridiculous time limits on it (ie- you may only trick or treat for 3 hrs).
TREATMENT
Regeneron experimental “cocktail” – No, this isn’t happy hour approved, but what it is would be a combination of 2 neutralizing antibodies. These are the same neutralizing antibodies I have been writing about the last several months. This company just decided to combine two which may offer better protection against the virus even if it mutates slightly. What the headlines did not explain clearly when it was administered to the POTUS this week was that it already was in Phase 3 testing (larger-scale human trials – see my older posts for an explanation of the phases). This was not some random science experiment pulled off the shelf in one day. The fact is that prelim data showed it to be helpful in patients with mild to moderate COVID and especially in those who did not mount good antibody responses. This was no different than how we tested and distributed remdesivir a few months ago. Hopefully, this cocktail and several neutralizing antibodies in development gain approval soon. We need therapies like this to be used earlier in the disease which will help prevent more severe cases and ultimately reduce deaths.
SCHOOL STUFF…
A tale of two schools…as a testament to the fractured, often non-science-based approaches out there to COVID, there are two high schools near me. One had a case of COVID, made sure the person was quarantined and local contacts informed and tested, room sanitized, and students/parents/staff informed. The school stayed open. There were no mass outbreaks. Kids kept engaged in learning.
In the other high school, just before school returns, there were pictures circulating of some students at a BBQ/pool party. In school classes canceled for 2 weeks. Kids had to stay home for virtual learning. Conflicting messages to students/parents if there were even any infections. The principal sends a letter insinuating this was a result of defiance when students were told not to gather (guess it is easy to overlook the fact that summer camps did operate in some states this year and did so without massive outbreaks). Wrong approach. Clear communication can be done. Testing when outbreak is suspected can be done (and now we have the BinaxNOW test from Abbott – see testing section). This roll the dice approach in many locals only inspires mistrust, fear, and confusion.
TESTING
BinaxNOW – You will hear more on this test (and have already both here and in an announcement in last 2 weeks from the government). This is the $5 at home self-administered test that will give you an answer in 15 minutes if you have symptoms and need to know if it is COVID or not. Sensitivity is 97.1%, specificity is 98.5%. Head and shoulders beyond the current test of the nasal PCR assay we use (which is for BOTH asymptomatic and symptomatic patients). Abbott makes this test (not to be confused with IDNOW, which is their older test which requires a machine to run the test upon.) and is making 50 million per month starting in October. In Mandalorian speak…this IS the way!
Speaking of test #s – we are testing more than ever now. As such, you test more, you will find more positive. So this should not be shocking (but is being portrayed as such in the news). Looking at hospital bed and ICU bed use is important. That has remained lower in most parts of the country since the end of Summer. I think steroids are making a difference and keeping people out of the hospitals and when they do come in preventing the progressions we witnessed in the horrific months of March and April (at least where I live and work).
No Brainer - By the way…case reports of people having cerebrospinal fluid leak from the nasal swab have surfaced. This is caused when someone inserts the swab and points upward with it (where there is a thin part of the skull bone that can be cracked and cause CSF to leak. The swab goes in the nose and then should be pointed back towards the wall behind you, not the ceiling.
ANTIBODY TESTING – as of its 10/2/2020 update on their site the FDA has EUA (emergency use authorization) approved 46 (up from 41 as of 9/11/2020) antibody assays for COVID. This means they meet the minimum requirements for sensitivity and specificity and have been independently validated to replicate results claimed by the manufacturer. LabCorp has the Abbott Alinity IgG and the DiaSorin LIASON IgG antibody tests which I have been using because we have LabCorp draw centers near us (no I have no financial relationship with Abbott or LabCorp, I just like the scientific data on their tests). Please ask questions of the test if it is recommended for you. If you do decide to get tested be sure it is with one of these antibody tests. If you have someone swearing they had COVID but were never tested when sick, this test will tell if they had it (not actively have it)
LONG TERM
A particular area of interest for me is what happens to the lungs long term after severe COVID. We are starting to see some observational studies on this topic. More to follow, but I am very interested in developing a mechanism to screen these patients in the outpatient setting. For you, the patients, if you have had COVID more than 16 weeks ago, and still have lingering cough or shortness of breath OR you have low oxygen levels after COVID that have not improved, then talk to your Doc about getting pulmonary function testing (measures lung function and capacities) and consider getting seen by a lung doctor. It IS COMMON to have a cough or fatigue or weakness or shortness of breath for many weeks after ANY pneumonia. So if you just had COVID 3 weeks ago, and still aren’t your normal self, do not get upset. It is too soon. Some centers are starting up post COVID clinics (UPENN has one). However, while these will offer multidiscipline support which is key and helpful, there are no miracle cures available and one of the goals of these centers will be to recruit patients for studies and followup, which is also essential. If you think you are in need and one is near you, not a bad idea to call them.
FLU & COVID – In the Spring, news media quoted “experts” or put up talking heads who were claiming the warm weather of Summer would kill off COVID. I wrote why I did not think science supported that claim and why it would not work. We all know how that went….so here we are in Fall. Winter is coming (always wanted to write that) and with it, talking heads resurface claiming 1) This will be a more severe flu season because it will be flu and COVID together. 2) COVID transmission will be higher because in winter we are indoors more. Please consider 1) There is no way to know this as some years the flu shot coverage is excellent and community spread it minimized. Additionally, we are taking more precautions this year than ever due to what we do with COVID (distancing, masks, etc). We may be indoors more, but we are distanced more as well. Travel is still not what it was either. These modalities slow transmission of other resp viruses too. Flu being one of them. Get your flu shot. Don’t fear Winter.
CRYSTAL BALL QUESTION – “Will we have a vaccine in 2020 and will you get it?” No and yes. Early Q2/Late Q1 2021 at best. FDA put out new guidelines for vaccine approval this week. The yes I will get it is not really crystal ball material, but I get asked that one a lot. I will line up for it. Most vulnerable populations first, then healthcare workers.
CHOICES – Life is all about choices. While we did not choose to be in a pandemic, we can choose our sources of inspiration, of information, and of collaboration. I choose to maintain a high index of suspicion for virtually any news story I see come across my monitor, email, social media. You should too. Avoid the face value read. Dig deeper. Use reliable resources - as much as they have made some missteps, the CDC is still a beacon, as is the FDA (they for testing and therapeutic trials info). Chose the friends you want to influence your life. We can only take so many Karens or Donnie Downers (Debbie’s melancholic brother) in our life. Rediscover things that make you who you are and inspire you. Maybe it is cooking. Maybe it is crafts. Maybe it is sharing a beer with friends around a fire. Whatever it is, keep it at the forefront. I’ve written many months that we should respect and not fear this (not pantomiming the POTUS, I am reiterating my own writing and thoughts from the last 6+ months). We are put here to live and we only have one life to do it. Make your choices count. I’ll be back soon, that's my choice.
If someone convinces Dr. Harris Cohen to come out of retirement, we will put out another Between Two Docs. I think life has caught up with us both at this point…
FOLLOW (not friend) me if you want to read my other posts on COVID. Remember, I do not friend people I do not know personally.
DISCLAIMER: Any views and opinions stated here are my own and do not represent any healthcare organization or society with which I am affiliated. The opinions and data shared here are for informational and educational purposes only. And, while I am a Physician, I am not your Physician so I cannot give you any personal medical advice on your medicines or treatment. That is best left between you and your personal Doctor or other healthcare professional.
