I am Dr Thomas Hoffmann. This is an update to my thoughts on COVID from late March.
The basics of the virus have not changed. The pandemic is now world-wide. The differences in responses around the world in combination with growing knowledge of the virus and disease show us what is working and what has not worked.
Virus communication is primarily (practically) driven by respiratory droplet spread. There are three types of testing – PCR, viral antibody and viral antigen. PCR for viral RNA shows if the virus is present. This type of testing is accurate. Antibody testing shows if the person has developed immunity. The chemical details of the antibody are critical to its’ utility for testing. For example: some of the antibodies work well, some don't. Some antibodies provide good protection but some don't. The selection of the exact antibody used is the critical factor in the utility and reliability of testing using that antibody. Antigen testing detects parts of viral proteins but has similar problems to antibody testing.
Social distancing and masks are the keys to reducing viral spread. This article explains how a large hospital system in Boston is controlling the spread of the virus even though they have thousands of COVID patients. They are watching and testing and can prove that their method works even in the highest risk situations. The link to the article is: https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry. The keys to controlling spread of infection are hygiene, monitoring, testing and masks.
Regular disinfectants will kill the virus. Disinfect your kitchen counters, dining room table and bathroom sinks. Use a disinfectant mouthwash like scope or listerine after any possible exposure. Stay physically active and get outdoors regularly – you don't need a mask outside if you are not near other people. You can take Vitamin C 1-3gram/day and Vitamin D 2000IU/day to reduce your risk. You can also add Quercetin (500mg/day) or eat an apple each day. Continue to eat healthy – lots of veggies and some fruit to get the vitamins and minerals needed to fight infection.
We are learning a lot about what works to treat the virus through the many ongoing studies. Remdesivir, a new antiviral drug has been shown to shorten the duration of illness in hospitalized patients. Plaquenil (also called hydroxychloroquine) does not work as well as first thought. The HIV drug lopinavir combined ribavirin and 2 doses of interferon showed promise in an early study. This is available as outpatient pills and two shots. Convalescent plasma - using the plasma and antibodies from a recovered patient is being used more and seems helpful but more information is needed. Anticoagulation and suppressing the immune overreaction (or cytokine storm) helps in ICU patients. These are being widely used and are helpful even though not fully proven.
There are many treatments in research and development. Antibodies have been isolated that are protective – they can prevent infection and can also be used to treat an infection. The antibodies have to be carefully chosen – this is the same problems as antibody testing. Some of the worlds’ best scientists have put together a recommendation for treatments. This article also explains how the government needs to change some standard procedures for approval of testing and treatments to allow faster development of new options. This article is at: https://s.wsj.net/public/resources/documents/Scientists_to_Stop_COVID19_2020_04_23_FINAL.pdf
Vaccines are also in development. The US government is breaking standard procedure in this area – spending money to prepare multiple types of vaccines for production at the same time as doing the studies to identify the best, most reliable vaccine. This will accelerate production of a vaccine to (hopefully) about 6-9 months, much faster than the standard of several years.
The initial crisis phase is mostly over, where people can now get treatments and ventilators if needed although new crisis centers continue to emerge as the virus spreads around the world. We will need to maintain our distance, use masks, and control the spread until more effective treatments and a good vaccine are widely available. The better we do this then the fewer people will die. We should be able to reduce control precautions by the end of 2020 with continued work and effort.
