Latest TWiV Episode with Update from Daniel Griffin at Columbia --
Hitting some of the high points of the conversation, less new info in this one.
Finally seeing admission rates decreasing at NY area hospitals, however now in a conundrum that almost all of the new admissions are very sick patients that will most likely see mortality rate increase of people who are admitted into hospitals in coming weeks. Thankful that many people of gotten the message only seek medical care if you are struggling to breathe and need oxygen.
Having issues getting oxygen to patients. Just don't have the capacity.
Avoid steroids first week (will double mortality risk), but give 2nd week when you begin to see oxygen requirements.
Hypercoagulability -- seeing this more in patients who were doing better then tend to get worse. D-dimer predictive marker of poorer outcomes, along with IL-6. D-dimer is going up while all other markers improving. Patients are developing clots leading to oxygen delivery issues. Will clog blood vessels to lungs, and other organs leading to organ failure.
Approach to treating as ARDS not working. When patients go on vents, mortality 50/50. When patients went on ventilator, they began to get worse with PEEP. Symptoms more like high altitude sickness so trying to use lower pressures and other tricks like keeping patients on belly. Also tolerating lower oxygen saturation ( < 80%) before putting on ventilator.
On hydroxycholorquine -- the way it is used currently (given 2nd week) makes no sense. Giving it when viral titers are already on the decline. Have found it makes no difference or actually makes it worse. Associated with worse clinical outcomes.
Again discharging patients before they are clear of the virus -- they are still shedders. Guidelines are that you shouldn't be out for at least a week after leaving the hospital, but may need to adjust that out longer, perhaps even 30+ days.
On virus binding heme -- doesn't make sense and all based on computer simulations, no evidence.
Everything settling down a bit, less hysteria -- must remember oath to do no harm. Still some trying to capitalize by offering "the latest therapy" when that therapy is not proven and may actually do more harm than good.
Greater risk to pregnant women doesn't seem to exist like there was in MERS or H1N1 outbreaks (10x mortality risk). Pregnant women seem to be doing just as well, haven't seen any signal that says they are doing worse. Still some risks -- don't know what infection does in first trimester and not really following up after birth yet. Would not take baby away from mother, advocates breast feeding to potentially pass protective antibodies.
Griffin is the primary investigator on two different clinical trials (patchstudy.com) with hydroxychloroquine -- Patch 2 study is someone acutely infected and will be given drug or placebo. 500 total patients, primary end point (data readout) will be whether or not you ended up in the hospital. Patch 3 study is prophylactic for healthcare workers at a higher dose than what is being given in Patch 2 study. All Patch studies double-blinded and controlled. Expect results end of this month/beginning of May.
On serology tests -- thought this was interesting -- one issue in developing test has been cross-reactivity for antibodies with the "common cold" coronaviruses. HKU1, another beta-coronavirus, has a spike protein that is similar enough that it is showing cross-reactivity in a lot of the tests. Have worked through this and now they have a specific test for SARS-CoV-2 that are beginning to role out. However this may explain some of the "bad readings" on tests you've seen so far in the news and may also offer hints to people who are asymptomatic or have "milder cases", and not seeing it in children (my personal opinion).
Not sure how to deal with individuals taking steroids (low dose) for things like allergies (Flonase). Would like to say stop taking these things or else it may help viral replication, but just don't have enough data right now to really know.
On ACE inhibitors -- keep taking them if you are prescribed.
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That's it on the Griffin interview. Will update if anything else interesting comes up.
Hitting some of the high points of the conversation, less new info in this one.
Finally seeing admission rates decreasing at NY area hospitals, however now in a conundrum that almost all of the new admissions are very sick patients that will most likely see mortality rate increase of people who are admitted into hospitals in coming weeks. Thankful that many people of gotten the message only seek medical care if you are struggling to breathe and need oxygen.
Having issues getting oxygen to patients. Just don't have the capacity.
Avoid steroids first week (will double mortality risk), but give 2nd week when you begin to see oxygen requirements.
Hypercoagulability -- seeing this more in patients who were doing better then tend to get worse. D-dimer predictive marker of poorer outcomes, along with IL-6. D-dimer is going up while all other markers improving. Patients are developing clots leading to oxygen delivery issues. Will clog blood vessels to lungs, and other organs leading to organ failure.
Approach to treating as ARDS not working. When patients go on vents, mortality 50/50. When patients went on ventilator, they began to get worse with PEEP. Symptoms more like high altitude sickness so trying to use lower pressures and other tricks like keeping patients on belly. Also tolerating lower oxygen saturation ( < 80%) before putting on ventilator.
On hydroxycholorquine -- the way it is used currently (given 2nd week) makes no sense. Giving it when viral titers are already on the decline. Have found it makes no difference or actually makes it worse. Associated with worse clinical outcomes.
Again discharging patients before they are clear of the virus -- they are still shedders. Guidelines are that you shouldn't be out for at least a week after leaving the hospital, but may need to adjust that out longer, perhaps even 30+ days.
On virus binding heme -- doesn't make sense and all based on computer simulations, no evidence.
Everything settling down a bit, less hysteria -- must remember oath to do no harm. Still some trying to capitalize by offering "the latest therapy" when that therapy is not proven and may actually do more harm than good.
Greater risk to pregnant women doesn't seem to exist like there was in MERS or H1N1 outbreaks (10x mortality risk). Pregnant women seem to be doing just as well, haven't seen any signal that says they are doing worse. Still some risks -- don't know what infection does in first trimester and not really following up after birth yet. Would not take baby away from mother, advocates breast feeding to potentially pass protective antibodies.
Griffin is the primary investigator on two different clinical trials (patchstudy.com) with hydroxychloroquine -- Patch 2 study is someone acutely infected and will be given drug or placebo. 500 total patients, primary end point (data readout) will be whether or not you ended up in the hospital. Patch 3 study is prophylactic for healthcare workers at a higher dose than what is being given in Patch 2 study. All Patch studies double-blinded and controlled. Expect results end of this month/beginning of May.
On serology tests -- thought this was interesting -- one issue in developing test has been cross-reactivity for antibodies with the "common cold" coronaviruses. HKU1, another beta-coronavirus, has a spike protein that is similar enough that it is showing cross-reactivity in a lot of the tests. Have worked through this and now they have a specific test for SARS-CoV-2 that are beginning to role out. However this may explain some of the "bad readings" on tests you've seen so far in the news and may also offer hints to people who are asymptomatic or have "milder cases", and not seeing it in children (my personal opinion).
Not sure how to deal with individuals taking steroids (low dose) for things like allergies (Flonase). Would like to say stop taking these things or else it may help viral replication, but just don't have enough data right now to really know.
On ACE inhibitors -- keep taking them if you are prescribed.
-----
That's it on the Griffin interview. Will update if anything else interesting comes up.
