War Drags On

The COVID-19 pandemic has created a war-like atmosphere throughout the world.  Each nation is dealing with the coronavirus in its own way as the number of infections and deaths rise.  Although Italy has experienced the most fatalities to date, CDC projections suggest that we may ultimately log the highest number of deaths from the virus in the world.  The situation in the U.S. is only made worse by shortages on a number of fronts.  Perhaps the most critical shortage is in the number of ICU beds and ventilators.  Over the last several decades many rural hospitals have closed and others have consolidated to reduce costs.  Limited bed capacity is associated with staff shortages (doctors, nurses and respiratory therapists) to care for the sickest patients.  Shortages of personal protective equipment (PPE) are widespread and should not be blamed on the federal government.  Each hospital has a Disaster Preparedness Plan and should have an adequate supply of PPE plus a means available to obtain additional supplies in a crisis.  I’m sick and tired of everyone looking to blame “someone else” for their own piss poor planning!  Many American companies have begun retrofitting their equipment enabling them to produce much needed materials.  Duke Health research and clinical teams have established a safe and effective method of decontaminating the N95 face mask allowing it to be reused rather than disposed of after a single use.  The method utilizes specialized equipment to vaporize hydrogen peroxide which kills germs and viruses without degrading the mask itself.  Robert Kraft, owner of the New England Patriots Football Team, allowed his plane to be used to fly PPE supplies into the State of Massachusetts from China to help alleviate the shortages.  Vladimir Putin also has sent supplies from Russia to assist us with our COVID-19 onslaught.  In the meantime it has come to light that 3M is selling N95 masks to other countries while shortages remain within the U.S.  The President has already verbally shamed the company but perhaps there should be some other penalties levied against 3M.  We are in the equivalent of a war and every resource must be mobilized to fight this virus.

On the treatment front Dr. Oz reported encouraging results from a randomized treatment trial in China using hydroxychloroquine.  The study was small (62 patients) but was randomized with the only difference between the two groups of patients was that one group received 5 days of treatment with hydroxychloroquine (treatment group) and the other group received more traditional supportive care (control group).  Those in the treatment group had fever for 2.2 days while the control group had fever for 3.2 days.  The treatment group had a cough for 2 days while the control group had a cough for 3.1 days.  In patients with pneumonia 81% of the treatment group showed improvement and 55% of the control group showed similar improvement.  Finally in the treatment group there were NO bad outcomes (deaths) but there were 4 deaths in the control group.  This was a small study conducted in China but it certainly suggests the efficacy of hydroxychloroquine in treating COVID-19.  Another interesting Chinese discovery was that no patient taking hydroxychloroquine for Lupus contracted the COVID-19 virus.  What this also suggests is that perhaps the drug could be used preventively in certain “high-risk” patients.  The China study begs for a larger, controlled American study to see if the Chinese findings are consistent and repeatable.  The production and importation of hydroxychloroquine has risen so that an adequate supply should be available if providers and patients wish to utilize it in their treatment plans.  Governor Cuomo issued an executive order forbidding NY State physicians from prescribing the drug for any condition other than Lupus or Rheumatoid Arthritis.  As the supply increases further he will hopefully rescind the order.  All clinicians must weigh the potential harm vs potential benefit to be gained from a medication’s use.  In this case the balance appears to be in favor of benefit.

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