It’s been a rough week for everyone here in the U.S. The stock market is crashing, schools are largely closed, and the country is preparing for the economic shock of a coronavirus shut down. In this episode, I’ll update where we are and I’ll also cover a company that wants to offer exosomes as a treatment for COVID19. What are exosomes? Let’s dig in.
The Tale of Two Fatality Rates Continues
We still see a significant divergence in fatality rates between what is being reported out of Italy and what’s being reported out of countries with good control of this disease. At this point, even if you look at the raw numbers being reported, which will overestimate mortality due to the fact that there are many recovered cases that were never tested, we see huge gaps (1):
- Germany: 7,636 cases, 20 deaths=0.26% fatality rate
- South Korea: 8,320 cases, 81 deaths=0.97% fatality rate
- Italy: 27,980 cases, 2,158 deaths=7.71% fatality rate (yesterday’s numbers as Italy always reports late in our day)
Italy is close to Germany. South Korea and China have huge back and forth as far as tourism and trade. So these countries should have similar mortality rates.
So why these stark differences? As I have said before, it’s all about not overloading your health system.
Overloading the Health System
It’s hard for most people who don’t work in healthcare every day to believe that our health care system in the U.S. has limits, but it does. We have a certain number of hospital and ICU beds. We have a certain number of ventilators capable of treating this disease. If you exceed that number like Italy has, then people die not because they couldn’t be saved, but because they can’t get the care they need. In fact, it was reported back on 3/11 when Italy only had 7,900 cases (as of 3/9/20) that doctors were already prioritizing ventilators toward the young (2).
Germany has had one thing going for it, widespread testing. It didn’t close its schools or its shops/restaurants until yesterday (3/16/20) (3). It also closed its borders yesterday as well.
South Korea (and many Asian countries including Taiwan) have experienced virus response teams from dealing with multiple SARS viruses out of China. They test, check for temps at their borders, check for temps before people can enter office buildings, have an extensive contact tracing program, and have even mobilized the military to get things in place quickly. Businesses are still functioning because the systems in place are good at finding and isolating cases.
So Where Does the US Fit?
The good news is that Trump closed our border to Chinese nationals quickly. The other good news is that many state and local governments are shutting down large gatherings, shops, gyms, bars, and restaurants. The bad news is that we are still woefully behind on testing.
The Testing Debacle
As I said at the end of last week, I had expected widescale testing of anyone who was suspected of having COVID-19 to begin last week. That never happened. THAT IS A HUGE PROBLEM. As of today, 3/17/20, we had a weekly testing capacity of about 37,000 tests according to the AEI (4):
That’s nowhere near enough. We should be testing several hundred thousand a week at this time.
High throughput testing at 400K a week was supposed to come online this week through Roche diagnostics and Thermo Fischer, but I have yet to see any indication online of when that begins. Roche is working with 32 reference labs around the country and Thermo Fischer is working with Quest and Lab Corp. Calls from our office to Quest and Lab Corp showed that both groups are overwhelmed at this point so hopefully that will change this week. I can’t stress enough that we need to get this online.
Can Exosomes Help?
If you’re a regular long-time reader of this blog you know that exosomes are extra-cellular vesicles released by cells when they communicate. Several companies have tried to misregister these as tissues that require no FDA approval and the FDA has pushed back saying that exosomes created by culturing cells are a drug and shouldn’t be on the market now. To learn more about exosomes, see my video below:
One of the companies that is manufacturing exosomes called Kimera posted this on their website:
The idea is that since we have an unpublished case report of one patient in China who recovered after getting umbilical cord mesenchymal stem cells hence exosomes produced from a similar source might also be effective (5). The piece discusses a possible mechanism of action of how exosomes might help patients in severe respiratory distress (ARDS).
My concern, just like the stem cell coronavirus sales pitch I covered the other day, is that without any clinical evidence that exosomes actually work in humans for any medical condition, some clinics will begin offering exosome treatments for the “worried well” or barely sick. I think that’s not a matter of if but when. This may delay people from getting the urgent care they need to survive. In addition, the chiropractic and alternative medicine offices that frequently use these products are not designed to control the spread of a communicable disease in the same way as a physician’s office or hospital.
What Can You Do?
- Wash your hands frequently for 20 seconds with soap and water
- Use social distancing of at least 3 feet between others
- If you have a temp of 100.4 or greater, don’t go to work and stay home
- See your doctor if you feel like you have the bad flu with a fever, dry cough, with or without nausea and/or vomiting
- If you test positive, obey strict quarantine as instructed
- DO NOT go to bars, restaurants, or shops or gatherings of over 20 people
- The only places you should be going at this point are work if you’re in an essential industry, the doctor, hospital ER, pharmacy, or grocery store
- Pray for the Italians and others who got behind the spread curve of COVID-19 instead of ahead of it
What the US Needs to Be Doing NOW
- Scaling up testing as discussed
- Using the Army corps of engineers to build temporary ICU units adjacent to hospitals
- Sourcing ventilators, N-95 masks, and personal protective gear for healthcare workers
- Containing hot spots like Seattle and NY
The upshot? The US has better get its butt in gear and begin offering widespread testing at scale NOW. That would be hundreds of thousands of tests a week. We also still need to shut everything down for a least 3 weeks. Remember, we want to have German or South Korean type fatality rates because we don’t overwhelm our health care system. We DO NOT want to become Italy!
(1) Worldometer. COVID-19 CORONAVIRUS OUTBREAK. https://www.worldometers.info/coronavirus/ Accessed 3/17/20 at 7 am
(2) Politico. Italian doctors on coronavirus frontline face tough calls on whom to save. https://www.politico.eu/article/coronavirus-italy-doctors-tough-calls-survival/ Accessed 3/17/20
(3) DW. Coronavirus: Germany brings in unprecedented restrictions on public life. https://www.dw.com/en/coronavirus-germany-brings-in-unprecedented-restrictions-on-public-life/a-52801471 Accessed 3/17/20
(4) American Enterprise Institute. Twitter Feed @ScottGottliebMD). https://twitter.com/ScottGottliebMD/status/1239610277345329152 Accessed 3/17/20.
(5) (1) Liang B, et al. Clinical remission of a critically ill COVID-19 patient treated by
human umbilical cord mesenchymal stem cells. https://3n30av2dln0g4fmlc03hpv0p-wpengine.netdna-ssl.com/wp-content/uploads/2020/03/202002.00084v1.pdf.pdf. Accessed 3/15/20.