Current infections
UK
Cases, + 20, 641
Active, 264,034
US
Cases, + 301,438 (last 7 days)
President Trump’s meds
Dr. Sean Conley
Oxygen dropped twice
Did not need oxygen for long at all
Slight cough
Viral load not established yet
Fever
Now
No fever, reducing meds for past 72 hours
No evidence of live virus
Normally 10 days after day 1
Most viral shedding in first 5 days
Not out of the woods yet
Remdesivir
Regeneron treatment, REGEN-CoV-2
Dexamethasone
Zinc
Vitamin D
Famotidine
Melatonin
Daily aspirin
Remdesivir
5 days, intravenous
FDA emergency approval for anyone in hospital with COVID
Probably needs to be given very early
Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19, A Randomized Clinical Trial, (JAMA, 21st August)
n = 584
Moderate COVID-19
Remdesivir group and standard care group
7-point ordinal scale on study day 11
5 day course, statistically significant difference in clinical status
Difference was of uncertain clinical importance
10 day course, no statistical difference from standard care
Antibody therapy (Friday 2nd October, morning)
MABs are produced from cell cultures
REGEN-CoV-2
8 grams
2 antibodies which attach to the spike protein
2 monoclonal antibodies
Only available for trial use
Given as compassionate use
Passive immunity
Probably lasts for 4 to 6 weeks
Recovery trial
RECOVERY COVID-19 phase 3 trial to evaluate Regeneron’s REGN-COV2 investigational antibody cocktail in the UK
14th September
2,000 patients in each group
Dexamethasone
Recovery trial
Early use may reduce immune response
Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report, (NEJM, 17th July
Experimental group, n = 2,104
Standard care group, n = 4,321
In patients hospitalized with Covid-19,
Dexamethasone reduced 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone
No benefit in those receiving no respiratory support.
Greatest benefit in those being ventilated
Zinc
The Role of Zinc in Antiviral Immunity, (Advances in Nutrition, July 2019)
Hundreds of key enzymes
Transcription factor
Second-most abundant trace metal in the body
Zinc deficiency results in a compromised immune system
Required to mount an effective antiviral response
Direct antiviral properties (e.g. influenza)
Critical in generating innate and acquired antiviral responses
The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis (Frontiers in Immunology, July, 2020)
Preserve natural tissue barriers
Respiratory epithelium, preventing pathogen entry
Probably useful, especially in zinc deficiency
Studies are needed
Testing the effect of zinc as therapeutic option for established disease
Cost-efficient
Globally available
Simple to use
Little to no side effects
Vitamin D
Spanish clinical trial
Calcifediol group, 2% required admission to the ICU
Control group 50% admitted to ICU
Famotidine
H2-receptor antagonists
Cimetidine, ranitidine
Melatonin
Hormone
Pineal gland
Regulates the sleep–wake cycle
Interacts with the immune system
Reduces inflammation
Safety and Efficacy of Melatonin in Outpatients Infected With COVID-19
Phase 2
Daily aspirin
300 mg
600 mg
900 mg
Low dose
75 mg day
Statins
Talk to Karen about art books like the one she sent me
