COVID 9
Rick Hodes, MD, MACP
JDC-Ethiopia
Newsletter #9:
30 July, 2020
I am sorry to see the rise in COVID cases – Over 500 on last count at the Johns Hopkins COVID site: https://coronavirus.jhu.edu/map.html
Overall: The best word to sum up the situation is “Complex.”
“More challenging than Ebola, Zika, or HIV,” Dr. Fauci
Dr. Fauci: “It’s the combination of a new microbe that has a spectacular degree of capability of transmitting, and has a considerable degree of morbidity and mortality. And here it is, it’s happened — your worst nightmare, the perfect storm... I’ve never seen one in which the protean (frequently changing) manifestations are so extreme. You get 20% to 40% of the population that can be asymptomatic infection. They don’t even know they’re infected unless they get tested. Then you get some that get minor symptoms, moderate symptoms, severe symptoms, hospitalization and death.
(1)
Treatments: What works:
Dear Ethiopian friends and colleagues:
I am happy to see that Ethiopia is more peaceful, and internet is restored.
a) Prone position – including letting patients choose their own position, perhaps while wearing an oxygen meter.
b) Steroids:
This study in the NEJM showed that patients on dexamethasone had significantly lower incidence of death in those on mechanical ventilation or oxygen, at randomization. I know of no other drugs which lower the rate of death.
References below:
Online NEJM discussion:
https://www.nejm.org/doi/full/10.1056/NEJMe2025927?query=featured_home
Abstract:
https://www.nejm.org/doi/full/10.1056/NEJMoa2021436?query=featured_coro navirus
What probably does not work :
a) Hydroxychloroquine: see the 2 Newsweek articles attached, along with 1 NEJM abstract, on this topic. Sadly, the data is sometimes viewed through political lenses, rather than science.
What might work:
There are many generics being tried: prazosin, ivermectin, low-dose radiation therapy, famotidine, and hepatitis C medication. Monoclonal antibodies are in development.
Questions:
The role of antibodies and how protective they are? See this article.
Impact of Age:
Ethiopians might be assumed to do better because of the age distribution in Ethiopia compared to the US. The median age in Ethiopia is 19.5; the median age in the US is 38.2, about double.
One new idea:
I have been following this for some time: UVC, also known as “far UV light.” Normal ultraviolet light is 256 nm, and, while used sometimes in TB wards, can be harmful to the human eye. A light of 222 nm is said to be safe, and lethal to airborne SARS CoV-2- virus.
This could be useful in hospitals, schools, and shopping centers. However, it’s quite expensive – it is only now becoming commercially available. I got a price quote from a Texas manufacturer in which units ranged in price from USD $2700 to USD $18,000.
https://newseu.cgtn.com/news/2020-07-27/COVID-19-Brain-Threat-RAZOR-full- episode-SmPsOtEwsE/index.html
Reopening of Schools:
In many countries, this has become a contentious issue. And in the US, schools function as places to feed poorer students as well. Over 22 million US students rely on free or cheaper school meals. A former president of the American Academy of Pediatrics told me he estimates 1/3 of American students are being fed in school.
I have included 1 article with suggestions on how this might be done in a safer way. Feel free to contact me with comments and suggestions.
Wishing you all good health,
Rick
Rick Hodes, MD, MACP JDC-Ethiopia www.Rickhodes.org | info@rickhode.org