In the initial weeks and months of the COVID-19 pandemic the media terrorized the public into thinking this virus was the next “black plague” and a threat to humanity. The Centers for Disease Control and Prevention (CDC) was itself giving mixed messages as to the dangers of the virus and how to best deal with it. We were initially advised to wipe down all surfaces, including the outside of groceries, packages and metal surfaces. We were led to believe that the virus could live for days on metal surfaces and to be especially careful with the gas pump handle when filing our vehicles at gas stations. As a medical person this advice did not make sense to me but who am I to question the authorities at the CDC? Viruses are bits of DNA or RNA, pieces of genetic material that can not survive outside a living cell for an extended period. Bacteria are a different story since they possess everything they need to survive for prolonged periods of time. So now the CDC is informing that we don’t need to take precautions with wiping down our groceries or packages from UPS or FedEx. That gas pump may be safe from the virus but then you should still wash your hands or use hand sanitizer because there could still be bacteria on that handle from dirty hands touching it before you! We have received different messages at various times regarding wearing a mask and with the need for testing. It is confusing to the average person, but keep in mind that the mortality rate from an infection is LESS than 1%. Most people who are infected have “cold-like” symptoms and recover. The elderly and those with chronic medical conditions and obesity are at risk of a more serious illness. We were also told that we could be re-infected once we were “cured” of an acute infection with the virus. There is good news on that front as well since South Korea released a report on this very topic. A May 19 report by the Korean Centers for Disease Control and Prevention found an inability to isolate infectious virus from 108 “cured” patients who retested positive for the virus. They believe this indicates that samples from “re-infected” patients are picking up on genetic material from noninfectious or dead viruses. The absence of infectious virus suggests these individuals are not re-infected nor contagious.
In the realm of treatment, researchers at the Johns Hopkins Kimmel Cancer Center have found a common drug (prazosin), when given early, can lower the risk of death in patients infected with the COVID-19 virus. Prazosin is a non-selective alpha-blocking drug that has been used to lower blood pressure and treat enlarged prostates. Blocking alpha receptors dilates blood vessels and relaxes the sphincter at the junction of the bladder & prostate. The chief side effect of the drug is orthostatic hypotension. This was not a controlled study but the researchers believe that when given early the drug seems to prevent the overactive inflammatory process referred to as “cytokine storm.” It is this cytokine storm that leads to acute respiratory distress syndrome (ARDS) and the diffuse hypercoagulable state. The researchers emphasized that once the inflammatory process had begun the drug would likely be ineffective. In mice studies prazosin was found to block catecholamines (epinephrine, nor-epinephrine) and reduce levels of cytokines. It is inexpensive and may be given by mouth but blood pressure should be monitored. Inhaled nitric oxide gas has also been granted emergency approval by the FDA in the treatment of COVID-19. It is a known bronchodilator and vasodilator and has improved oxygenation in hypoxemic patients. It did not decrease mortality when used in patients with ARDS but has not yet been clinically studied in COVID-19 patients. Treatment continues to evolve, but there is hope that the majority of Americans need not be afraid to resume some form of normalcy.