The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic.  The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.

REBEL COVID-19

will serve as a summary of what is currently known, how to screen, when to test, and how to prevent spread, and any new data/information on COVID-19.

February 27, 2021

Background: As the COVID pandemic rages on, we continue to search for treatments to help combat the disease. Severely ill patients commonly have low levels of vitamin D and it has been suggested that optimal levels of Hydroxyvitamin D may have some immunomodulatory and anti-inflammatory properties which could benefit patients.  Vitamin D supplementation is cheap and has relatively minimal side effects making it an intriguing treatment modality. However, the data is limited.

February 20, 2021

Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness.  Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and resource intensive. [BLAZE-1] [REGN-COV2]Easily accessible effective treatments are badly needed for patients with mild COVID-19 not requiring hospitalization. Many reports have shown an under representation of patients with asthma and chronic obstruct pulmonary disease in patients hospitalized with COVID-19. One hypothesis is this may be due to the use of inhaled glucocorticoids in these patients.  Inhaled glucocorticoids have been shown to reduce exacerbations of both asthma and COPD.

February 19, 2021

Update: This article was removed from the Lancet server on February 19th, 2021 (Link)

Background: Vitamin D deficiency is common amongst critically ill patients and there has been ample speculation about a possible role for supplementation (with calcifediol) in the treatment of patients with COVID19. Calcifediol is cheap, readily available and, has minimal side effects making it an ideal therapeutic - if it works. To date, there is limited high-quality evidence on efficacy.

February 13, 2021

Background: Science by press release. Not the way any of us would choose to operate but, the COVID pandemic has made this a reality. It’s vital that we understand that while pharmaceutical companies have a responsibility to release this information, we as clinicians should not be practicing medicine based on press releases. Of course, these press releases don’t only originate from pharma. On January 22nd, 2021, the Montreal Heart Institute released a statement about the results from the COLCORONA study investigating the use of colchicine in COVID-19. The press release painted a very positive picture but, does the pre-peer reviewed publication stand up?

February 12, 2021

Background: Publication of the RECOVERY trial results on Dexamethasone were game changing - the drug had a clear reduction in mortality in patients requiring oxygen. Since then, we have had little to celebrate in terms of therapeutics in those with moderate to severe disease. The beneficial effects of corticosteroids in COVID-19 patients with hypoxic lung damage suggests other, more specific immunomodulatory agents may provide additional patient-oriented improvements.

Enter Tocilizumab.  This is a recombinant anti-IL6 receptor monoclonal antibody that inhibits binding of IL-6 to receptors that signal inflammation.  The results of tocilizumab from randomized trials thus far have shown mixed results for benefit.  Many of the trials not showing benefit were smaller, however the larger REMAP-CAP trial [2] did report benefit in patients requiring organ support. Further data is clearly needed to guide clinicians.

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