Where are We? Coronavirus Episode 8

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This has been a crazy two days since I last blogged. I’ve seen some promising things reported and some concerning things. Italy remains in a bad place and Germany who had been managing has now had to institute their own shutdown. Let’s dig in.

The Good News

Since every news report these days begins with really bad news, I thought I’d begin this one with the good news.

  1. If you’re a patient in pain or have other health problems, everyone from United to Cigna to the Blues to Medicare is now permitting telehealth visits! The feds have also relaxed HIPPA standards to allow this to occur on any existing platform. What does this mean for you?

You can now get on a video conferencing system like Zoom or Skype and have a visit with your doctor from home and insurance will pay for that visit, usually without a copay! Regenexx will have its own system up and running soon, which solves many of the problems of how to gather the right information from someone with neck, back, shoulder, knee, or hip pain.

2. A Vaccine trial started in Seattle this week (19)! While it will be many months before they know if this is working, this is a ray of hope for next year if this virus rebounds.

3. A large Chinese randomized controlled trial was published on the use of a Japanese anti-viral already approved there for use in the flu.  The tests on 340 patients showed a decrease in the time period during which patients showed positive tests for the coronavirus from the usual 11 days down to just four days. The drug also improved the lung condition on x-rays of around 91 percent of patients treated with this drug (favipiravir), compared to just 62 percent of those who got the placebo. The drug wasn’t effective for patients with more severe disease (1).

4. More stem cell treatment news is out, with this last story being more sketchy than promising. The Daily Mail is reporting that a Chinese company associated with a US physician (Brian Mehling) has been using umbilical cord stem cells (2). The company is reporting more good results with culture-expanded umbilical cord stem cells, but I can find no research paper on this one. I have to say after digging into this report I’m a bit less impressed than the other two reports I found on stem cells helping severe COVID-19 patients (3,4).

5. The President discussed that the US is willing to deploy MASH (Mobile Army Surgical Hospital) units to various hotspots to help with expanding ICU capability (5). The first part of that mobilization has begun with two hospital ships being deployed to provide extra capacity to treat more common illnesses to free up land-based beds for coronavirus victims (6). The Department of Defense has also confirmed that many of it’s rapidly deployable medical assets have been placed on alert.

6. An old Malaria drug called Chloroquine shows promise in treating COVID-19. Multiple small studies have shown the ability of the drug to clear the virus more quickly, so much so that the Chinese Ministry of Health is including it in their COVID-19 treatment guidelines (16). Bayer just donated 3 million chloroquine tablets (15).

The Bad News

  1. More stem cell scams have been detected. I have now lost count. These are clinics offering dead umbilical cord cells and claiming that they are the same as the stem cells being used in these Chinese studies. THEY ARE NOT!
  2. We now have three coronavirus tests approved: Roche, Thermofischer, and Abbott (7). Between these three tests, all of which use existing machines in hospitals, we should be seeing hundreds of thousands of tests a week come online. This could expand to a million or more tests a week. However, the earliest of these approvals, Roche, has yet to announce to physician offices that this 400K tests a week capacity can be used or how. Scott Gottlieb from AEI reports weekly on our national testing capability, so I am hoping that he announces a dramatic increase in testing ability up from 37,500 which was his total last week (9).
  3. Germany had been doing a great job at containing and treating the disease, but cases ticked up big time this week so they shut it all down as well (10). Their fatality rate is still very low. South Korea continues to do a great job of managing its cases and its fatality rate is also still low (11).
  4. US cases continue to grow and we all need to expect that as testing comes online and we begin to ID more people in the community, that number will appear to explode.
  5. A Science paper was just published that discussed two key things (12). First, in China, 86% of infections were undocumented. This is a good news/bad news fact. On the good news side, this means that all of the Wuhan fatality rates were actually lower than reported because there was a bigger pool of people out there that had the disease and that were never included in the denominator of that calculation. The bad news is that there are many people who can spread this disease for up to two weeks who don’t know they have it.
  6. More reports of younger people getting ill are filtering in. This is a breakdown of the US data so far: This is published by the CDC and shows that of almost 2,500 people hospitalized for coronavirus, about 2% were very young, about 15% were 20-44, about 25% were middle-aged at 45-54, and 25% were 55-64 (14)! Realize that the case fatality rates here are calculated based on this group of 2,500 and NOT on everyone who actually had coronavirus in that community! However, of people going into the hospital, if you were ages 20-44, the risk of death was 1 in 1,000 to 1 in 500. What we don’t know about this group is how sick most of these people were before they got COVID-19.

The upshot? Please stay home unless you have a doctor’s appointment or are going to the grocery store! I’ve been telling our kids that this is their “World War II” moment. That time when the world bans together to achieve one goal and great sacrifices are expected of everyone. So please do your part!

_____________________

References:

(1) The Guardian. Japanese flu drug ‘clearly effective’ in treating coronavirus, says China. https://www.theguardian.com/world/2020/mar/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-says-china Accessed 3/19/20.

(2) The Daily Mail. EXCLUSIVE: Chinese doctor claims he made a breakthrough in coronavirus pandemic with stem cell injections – having 100% success rate after treating nine mostly elderly patients. https://www.dailymail.co.uk/news/article-8116881/Doctor-claims-breakthrough-stem-cell-injections-treat-coronavirus.html. Accessed 3/19/20.

(3) 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.

(4) Leng Z et al. Transplantation of ACE2- Mesenchymal Stem Cells Improves the Outcome of Patients with COVID-19 Pneumonia. Aging and Disease.
2020 , 0 (0): 216-228 https://doi.org/10.14336/AD.2020.0228

(5) Fox Business. How MASH hospitals can help coronavirus outbreaks across the country. https://www.foxbusiness.com/lifestyle/mash-hospitals-help-coronavirus-outbreak. Accessed 3/19/20.

(6) US Department of Defense. Hospital Ships, Other DOD Assets Prepare for Coronavirus Response. https://www.defense.gov/Explore/News/Article/Article/2116862/hospital-ships-other-dod-assets-prepare-for-coronavirus-response/ Accessed 3/19/20.

(7) US News and World Report. U.S. Approves Abbott Coronavirus Test; Company Set to Ship 150,000. https://www.usnews.com/news/top-news/articles/2020-03-18/us-approves-abbott-coronavirus-test-company-set-to-ship-150-000. Accessed 3/19/20.

(8) Roche. Coronavirus Disease (COVID-19) Outbreak. https://diagnostics.roche.com/us/en/home.html. Accessed 3/19/20.

(9) American Enterprise Institute. COVID-19. https://www.aei.org/2019-coronavirus-coverage/. Accessed 3/19/20.

(10) DW. Coronavirus: Germany shuts down borders, halts public life. https://www.dw.com/en/coronavirus-germany-shuts-down-borders-halts-public-life/a-52813432. Accessed 3/19/20.

(11) Worldometer. COVID-19 CORONAVIRUS OUTBREAK. https://www.worldometers.info/coronavirus/ Accessed 3/19/20.

(12) Li R, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). PUBLISHED ONLINE16 MAR 2020. DOI: 10.1126/science.abb3221

(13) NIH. NIH clinical trial of investigational vaccine for COVID-19 begins. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins. Accessed 3/19/20.

(14) Centers for Disease Control. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm. Accessed 3/19/20.

(15). FiercePharma. Bayer donates millions of tablets of chloroquine to help in COVID-19 fight. https://www.fiercepharma.com/pharma/bayer-preps-u-s-donation-malaria-med-chloroquine-to-help-covid-19-fight-report Accessed 3/19/20.

(16) Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020 Mar 16;14(1):72-73. doi: 10.5582/bst.2020.01047.

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5 thoughts on “Where are We? Coronavirus Episode 8

  1. Dane Beck

    Can you discuss the use of antibodies from recovered patients to treat those still infected, or at risk of becoming infected? I’ve read this was used in past epidemics before vaccines were available and that blood banks could be setup for this pretty quick.

    1. Chris Centeno, MD Post author

      Theoretically, this may work, but we would have the same issue as a vaccine, in that it would take time to test. Antibodies produced in a lab would be easier to scale and several companies are working on that…

  2. Ariel

    Your reports are extremely valued in a time where it’s difficult to know what information to trust

    1. Chris Centeno, MD Post author

      Great!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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