Your Essential Guide to COVID-19

The coronavirus pandemic has upended our day-to-day lives and saturated the news and social media feeds. With so much information (and non-information) coming at us, it's hard to filter through to what is actually important. Our team is going through and doing the work for you. Keep checking back for updates!

April 16, 2020 Status Report

• According to the CDC, there have been 632,548 cases and 31,071 deaths in the US.

• A study conducted of COVID-19 patients in an academic hospital in New York City suggested that obesity increases the need for hospitalization and critical care. The study surveyed 3,615 patients and found that 21% (775) had a body mass index (BMI) 30-34 and 16% (595) had a BMI above 35. An individual is considered obese with a BMI greater than or equal to 30. The researchers concluded that "though patients aged <60 years are generally considered a lower risk group of Covid-19 disease severity, based on data from our institution, obesity appears to be a previously unrecognized risk factor for hospital admission and need for critical care." Given that nearly 40% of adults in the United States are obese, this study could have serious implications.

• The question on everyone's mind is when will a COVID-19 vaccine be ready for distribution? At the beginning of April, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that it would take 12 to 18 months for a vaccine to develop, test, and then be approved for public distribution. On April 4, WHO reported that 60 candidate vaccines are currently in development worldwide and two have entered the first phase of clinical evaluation.

Top 3 things to do...

STAY INSIDE - maintain social distancing (or physical distancing) by staying at home as much as possible. Only go out for essentials (groceries and toiletries). Feel free to go to parks/trails for hikes, but maintain at least 6 feet of distance from others. If you do go to the store, only send one person, go with a list, and be mindful of those around you.

WASH YOUR HANDS - Regularly wash your hands with soap and water. If soap and water is not available, use hand sanitizer with at least 65% alcohol content. Wash your hands after every outing.

CLEAN SURFACES - Regularly wipe down doorknobs, phones, countertops, light switches, and other frequently used items.

Is there a tea to cure COVID-19?

There has been a viral post making its way around social media claiming that drinking tea will cure COVID-19 (see below). There is no evidence suggesting that tea could help you fend off the coronavirus.

"There is also no evidence that Dr Li Wenliang was researching the effect of methylxanthines, and the fact that he was an eye specialist and not a virus specialist makes that particular claim unlikely."

It is correct that methylxanthines are found in tea and other food and drink, such as chocolate and coffee. Theophylline and dyphylline can also be used to treat respiratory illnesses like asthma and bronchitis, but require much larger quantities than is found in tea. As of today, the World Health Organization says that there is no medicine that can prevent or treat COVID-19.

Should I wear a mask or respirator? Which one?

Good news! If you're able to shelter at home, you don't need a mask at all! Here are the different options that you will hear about, and when they are appropriate...

1. Surgical face mask

Face masks are effective as preventing the spread of contagions FROM you, but they are not very effective at blocking contagions in the air. What does that mean? If you are symptomatic, then wearing a mask will help decrease the spread to others (but self-quarantine is the BEST way to prevent spread).

UPDATE 3/31/20: If you are not symptomatic, you may consider wearing a mask in public. The CDC is re-evaluating its previous stance on reserving masks for the sick and those caring for the sick because of the high rate of asymptomatic COVID-19 carriers. We again encourage you to reserve masks for healthcare workers, but wearing a scarf or cloth mask will still help prevent the spread of respiratory droplets while speaking.

2. N-95 respirators

Respirators will protect you from inhaling the virus by filtering the air before it is inhaled. These masks come in sizes and must be fit for each individual to ensure efficacy. Right now, all of these respirators should be reserved for our healthcare providers on the front lines. If you have any N-95 respirators, please consider donating them to your local hospital, doctor's office, or pharmacy.

Fortunately, Duke University researchers recently found that respirators can be sterilized and re-used using vaporized hydrogen peroxide. See more of their research HERE.

3. Cloth masks

I'm sure you've seen a lot of people making face masks for our healthcare workers, and that's incredible. Unfortunately, the research we have so far shows that cloth masks are very ineffective at preventing inhalation of the virus (MacIntyre CR, Seale H, Dung TC, et al. BMJ Open. 2015;5(4).) While cloth masks are better than nothing, this research reminds us that it's even more important for respirators to be reserved for hospitals!

Are there any medications that will work?

Possible therapies have been tested all over the world, and some have shown some minor efficacy. The American Society of Health-System Pharmacists is an excellent resource for more technical information. Their COVID-19 dashboard can be found HERE and is the source for the summaries below.

A quick note on all of these medications: the current supply chain is limited. Treatment should be reserved for the sickest patients - those admitted to the hospital. Please, please do not try to acquire prescriptions for these medications "just in case."

Hydroxychloroquine/Chloroquine

Why are we using it? Both of these medications have in vitro (in a test tube) activity against the virus and effects on the immune system that may be beneficial during infection

Does it work? So far, there is limited data to determine whether there is a benefit, however, several case reports suggest that there may be benefit.

Aquarium products contain chloroquine...can I just take that? Please don't! These products also contain harmful chemicals! Recently, a man died and his wife is in critical care after taking these products as a "preventive treatment."

Lopinavir/Ritonavir (Kaletra)

Why are we using it? This medication is an antiretroviral with in vitro (in a test tube) activity against SARS-CoV and MERS-CoV (other novel coronaviruses).

Does it work? A small, open-label trial did not show benefit from using Kaletra and had to be stopped early in several patients due to adverse effects.

Remdesivir

Why are we using it? Remdesivir is a novel, broad-spectrum antiviral not currently commercially available.

Does it work? Three trials are on-going, but this is the most promising treatment for COVID-19 at this time.

Vitamin C

Why are we using it? Vitamin C is an antioxidant and may support host defenses during infection.

Does it work? IV Vitamin C is currently used for patients with sepsis and shows benefit. LIttle clinical evidence is available for use in patients with COVID-19, but one trial with ICU patients is ongoing.

Azithromycin

Why are we using it? Isn't is an antibiotic? Yes, azithromycin is an antibiotic, but it has some antiviral activity. Additionally, it has anti-inflammatory properties that may be beneficial.

Does it work? There is very little evidence to show that azithromycin will be beneficial for patients with COVID-19. Studies with MER-CoV did not show benefit. Additionally, both azithromycin and hydroxychloroquine prolong the QT interval, which may lead to life-threatening arrhythmias.

We are here to answer your questions - please send them our way!

#stayhome and stay safe.

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