November 21, 2020

Background: Face masks can reduce transmission of respiratory viruses by both being a potential physical barrier and by reducing droplet transmission.  Additionally, the presence of a mask reduces the users frequency of touching their face which may also reduce transmission.  Despite strong, consistent public health messaging about the utility of wearing masks, their use continues to be debated. Both the CDC and WHO strongly recommend the use of masks as a means of source control, but the WHO acknowledges the lack of robust evidence in healthy persons.

November 13, 2020

Background: There have been lots of trials sitting on my computer desktop awaiting my review, but like many of you time has been thin from clinical work and increasing cases of COVID-19 where I work.  I thought it might be more effective to give you the Cliff’s Notes highlights of each since the time for deep dives remains elusive.  As always, I urge you to read each of the papers yourselves and come to your own conclusions. Thus far in the pandemic, there have been few treatment options available to manage COVID-19. Many clinicians have been using repurposed drugs with scant data as well as other non-drug interventions.  Let’s get into some recent data behind these interventions.

October 18, 2020

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.  Below are two videos I created discussing 10 topics on COVID-19 (Both videos were recorded on Oct 13th, 2020).

September 24, 2020

Background: Convalescent plasma therapy (CPT) is not a novel treatment modality.  It has been used in other illnesses such as SARS, MERS, and Ebola with variable results. The theory behind CPT is to take antibody rich blood from patients who have recovered from an illness and then administer it to help others recover who currently have the illness.  The US Food and Drug Administration authorized emergency use authorization (EUA) for CPT in patients with COVID-19 (August 2020) based on results from a US Expanded Access Program (EAP) study out of the Mayo Clinic (non-peer reviewed at this time).

September 10, 2020

Background: There are three randomized clinical trials now published on remdesivir in the treatment of COVID-19 pneumonia (RCT 1, RCT 2, & RCT 3). The 1st trial, performed in China, was terminated early due the lack of patients to enroll and, as a result, did not give strong recommendations.  The 2nd trial (ACTT-1) showed a statistically significant 4-day reduction in time to recovery. However, it was also terminated early due to an interim analysis, which meant we do not have outcomes on 30% of patients enrolled.  Finally, the 3rd RCT compared a 5-day to a 10-day course of remdesivir and showed no difference in outcomes with more acute kidney injury in the 10-day course. All of these trials have significant issues leaving clinicians unsure of the efficacy of the drug, when to administer it, how long to give it for and, in which patient group it should be given. We now have our 4th RCT of remdesivir evaluating the efficacy and adverse events of remdesivir administered for 5- or 10-days vs standard care in hospitalized patients with moderate COVID-19.
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