TWiV 593: Coronavirus update – flatten the curve

March 22, 2020
CoV_bank

Daniel Griffin joins Ori and the TWiV team for an update on the SARS-CoV-2 pandemic, including gastrointestinal illness associated with infection, use of hydroxychloroquine and other antivirals, his experiences treating many patients in the New York area, and much more.

Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove, Rich Condit, Kathy Spindler, and Brianne Barker

Guest: Daniel Griffin, Ori Lieberman, and Valeria Cagno

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Intro music is by Ronald Jenkees.

Send your virology questions and comments to twiv@microbe.tv

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17 comments on “TWiV 593: Coronavirus update – flatten the curve

  1. Cameron Rogers Mar 22, 2020

    Hi TWiV team,
    Thanks for doing so many podcasts during this pandemic.
    Here in Australia they are still refusing to close schools, one state, Victoria has started their school holidays early, the rest are still open. They seem to think since children don’t tend to become symptomatic very often, they therefore have a low risk of transmitting the virus. From papers that I have read that is not the case, and IMHO a mistake.

    We are steadily getting more and more cases. There are now more than 1350 confirmed cases here but fortunately only 7 deaths so far. Do you have any other papers or evidence for transmission in children / schools?

    We are not handling the pandemic well in Australia, they just let 2,600 passengers leave the Ruby Princess, straight into Sydney and then they found there were many cases of COVID-19 that were later detected, even though around 150 people had already reported being sick before being let off the ship.

    Cheers,
    Cam

    Quote from a peer reviewed study that I found:
    CONCLUSIONS: Children at all ages appeared susceptible to COVID-19, and there was no significant gender difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adults’ patients, young children, particularly infants, were vulnerable to infection. The distribution of children’s COVID-19 cases varied with time and space, and most of the cases concentrated in Hubei province and surrounding areas. Furthermore, this study provides strong evidence for human-to-human transmission.

    https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf

  2. Nir Unger Adin Mar 22, 2020

    Greetings.. and thanks for the listening space you created.. Could you review the hemopurifier (https://www.aethlonmedical.com/) with some one who worked with it? And isnt this approach would be assisting
    late awakening public health system?

  3. Update Louisiana has issued a stay at home order

    https://wgno.com/news/health/coronavirus/watch-live-governor-edwards-gives-coronavirus-update/

    BATON ROUGE – Louisiana Governor John Bel Edwards has issued a statewide “stay at home” order.

    Edwards announced the measure at an afternoon press conference on March 22. The order itself is slated to go into effect at 5 p.m. on March 23.

    “In Louisiana we have taken aggressive measures to mitigate the spread of COVID-19 and flatten the curve; however, this is not enough,” Edwards said. “As our number of cases continue to grow, I am directing all Louisianans to stay at home unless it is absolutely necessary for you to leave. I am implementing this measure to help prevent you from becoming infected or infecting someone else. People can leave their homes to do essential things like buying groceries or food, pick up medicine or go to work only if their job is essential. If you have to go out, make sure you practice social distancing measures and keep 6 feet between you and the people around you. People are encouraged to go outside and to stay active during this time, as long as they practice social distancing when they are around their neighbors. This order is not something I take lightly, but it is necessary to protect the health, safety and well-being of our people, our communities and our way of life.”

    The order will stay in place through Monday. April 13, and it defines which businesses are considered essential and which ones are not.

  4. Dear TWIV: I can’t find information about culturing live SARS-CoV-2 in stool samples, although RNA is often reported. Has “live” virus been cultured (in the laboratory) from stool samples?

    • I second PattiMichelle question. Assuming infectious virus can be isolated from stool samples, untreated sewage could potentially become a reservoir of the virus and lead to the spread of infections. Is there any (new) data on faecal-oral transmission?

      PS: I’m learning so much listening to your podcast, not just on the COVID-19 but from all the podcasts from the pre-COVID-19 era. Thank you TWIVers!

  5. Ben Nevis Mar 22, 2020

    Is there any validity in assertions of Dr. Wolfgang Wodarg?
    https://youtu.be/yn074EB5NNY

  6. Most modern fabrics are different plastics spun into threads – so the result for plastic surfaces (with regard to time of persistence) might apply? However, walking around is not “laboratory conditions” (under which the study was done).

  7. Bailout redistribution (2:01:35): half of all Americans are poor (https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2017 ) and have been for decades. Most of my friends are poor and will have families nearly destroyed by the collapse of employment, the fallout from the necessary responses to this pandemic. Are there groups specifically targeting these poor, many of whom won’t make rent money this month? (or likely for several months)

  8. Bob Landers Mar 23, 2020
  9. Im Sorry of the Board of Pharmacy DEA and FDA does not warn the rest of the public of overdosing on Chloroquine to allegedly prevent COVID-19 more people will end up dead or the Plasmodium would be resistant to Chloroquine at some point.

    https://www.abc15.com/news/state/valley-man-dies-wife-hospitalized-after-taking-chemicals-to-protect-from-coronavirus

    PHOENIX — Banner Health experts are warning the public against using “inappropriate medications” after a Valley man died and his wife was hospitalized after taking chemicals they believed could help protect against coronavirus

    On Sunday, the man and his wife, both in their 60s, took chloroquine phosphate, an additive commonly used to clean fish tanks, and within 30 minutes experienced effects that required admittance to a nearby Banner Health facility. The man died and his wife remains under critical care, according to a hospital spokesperson.

    A family friend reached out to ABC15 and identified the couple as Gary and Wanda. The family has asked that their last name not be included due to privacy concerns.

    Wanda, who was able to throw up the chemicals, is likely going to survive, said the spokesperson.

    Wanda also reportedly told hospital staffers that she and her husband ingested the product after reading a “fake” article online and saw symptoms shortly after taking it.

    “Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so,” said Dr. Daniel Brooks, Banner Poison and Drug Information Center medical director. “The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health.”

    By: abc15.com staff, ABC News staff
    items.[0].image.alt
    Gary and Wanda Valley man dies, wife hospitalized after taking chemicals to protect from coronavirusVirus Outbreak Hospitals Prepare
    PHOENIX — Banner Health experts are warning the public against using “inappropriate medications” after a Valley man died and his wife was hospitalized after taking chemicals they believed could help protect against coronavirus.

    FULL COVERAGE: Coronavirus in Arizona

    On Sunday, the man and his wife, both in their 60s, took chloroquine phosphate, an additive commonly used to clean fish tanks, and within 30 minutes experienced effects that required admittance to a nearby Banner Health facility. The man died and his wife remains under critical care, according to a hospital spokesperson.

    A family friend reached out to ABC15 and identified the couple as Gary and Wanda. The family has asked that their last name not be included due to privacy concerns.

    Wanda, who was able to throw up the chemicals, is likely going to survive, said the spokesperson.

    Wanda also reportedly told hospital staffers that she and her husband ingested the product after reading a “fake” article online and saw symptoms shortly after taking it.

    “Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so,” said Dr. Daniel Brooks, Banner Poison and Drug Information Center medical director. “The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health.”

    Some physicians have recently come out saying that the medication chloroquine, which has been used to treat malaria since the 1940s, can be effective at preventing as well as treating the virus that causes severe acute respiratory syndrome, or SARS, a close cousin of COVID-19.

    But Banner Health experts say the use of specific treatments, including those described as “anti-COVID-19” is not recommended for any non-hospitalized patients.

    “We are strongly urging the medical community to not prescribe this medication to any non-hospitalized patients,” Brooks said of chloroquine.

    Last week, President Trump declared chloroquine a “game changer” in the effort to develop a coronavirus treatment and announced the drug had been “approved.”

    Chloroquine, or hydroxychloroquine, has been approved to treat and prevent malaria since 1944. But no drug has been approved to treat COVID-19, and a vaccine is estimated to remain at least a year away.

    According to Banner, most of the patients who do become sick with coronavirus will only require care for their specific symptoms and should self-isolate to prevent infecting others.

  10. Caroline Roth Mar 24, 2020

    Hello!

    I just wanted to share this with y’all:
    https://www.mercurynews.com/2020/03/21/coronavirus-test-45-minute-cepheid-sunnyvale-covid-19-test/

    This company, Cepheid, just got FDA approval for their 45-minute SARS-coronavirus-2 test.

  11. Bob Landers Mar 24, 2020

    https://apnews.com/073c449a4eb30c98872a881307edddad

    WASHINGTON (AP) — Hospitals are gearing up to test if a century-old treatment used to fight off flu and measles outbreaks in the days before vaccines, and tried more recently against SARS and Ebola, just might work for COVID-19, too: using blood donated from patients who’ve recovered.

    Doctors in China attempted the first COVID-19 treatments using what the history books call “convalescent serum” — today, known as donated plasma — from survivors of the new virus.

    Now a network of U.S. hospitals is waiting on permission from the Food and Drug Administration begin large studies of the infusions both as a possible treatment for the sick and as vaccine-like temporary protection for people at high risk of infection.

    There’s no guarantee it will work.

    “We won’t know until we do it, but the historical evidence is encouraging,” Dr. Arturo Casadevall of Johns Hopkins University’s school of public health told The Associated Press.

    Casadevall drew on that history in filing the FDA application. The FDA is “working expeditiously to facilitate the development and availability of convalescent plasma” a spokesman said.

    Here are some questions and answers about this latest quest for a treatment.

    WHAT EXACTLY IS THIS POSSIBLE THERAPY?

    It may sound like “back to the Stone Age,” but there’s good scientific reason to try using survivors’ blood, said Dr. Jeffrey Henderson of Washington University School of Medicine in St. Louis, who coauthored the FDA application with Casadevall and another colleague at the Mayo Clinic.

    When a person gets infected by a particular germ, the body starts making specially designed proteins called antibodies to fight the infection. After the person recovers, those antibodies float in survivors’ blood — specifically plasma, the liquid part of blood — for months, even years.

    One of the planned studies would test if giving infusions of survivors’ antibody-rich plasma to newly ill COVID-19 patients would boost their own body’s attempts to fight off the virus. To see if it works, researchers would measure if the treatment gave patients a better chance of living or reduced the need for breathing machines.

    One caution: While regular plasma transfusions are a mainstay of medicine, very rarely they can cause a lung-damaging side effect.

    COULD IT ALSO ACT LIKE A VACCINE?

    Sort of, but unlike a vaccine, any protection would only be temporary.

    A vaccine trains people’s immune systems to make their own antibodies against a target germ. The plasma infusion approach would give people a temporary shot of someone else’s antibodies that are short-lived and require repeated doses.
    Still, if FDA agrees, a second study would give antibody-rich plasma infusions to certain people at high risk from repeated exposures to COVID-19, such as hospital workers or first responders, said Dr. Liise-anne Pirofski of New York’s Montefiore Health System and Albert Einstein College of Medicine. That also might include nursing homes when a resident becomes ill, in hopes of giving the other people in the home some protection, she said.

    “We need both things desperately,” Pirofski said. “We need to be able to break the cycle of transmission and we also need to be able to help people who are ill.”

    WHAT’S THE HISTORY?

    These plasma infusions were used most famously during the 1918 flu pandemic, and against numerous other infections, such as measles and bacterial pneumonia, before vaccines and modern medicines came along. Long-ago research is sketchy. But in the Journal of Clinical Investigation earlier this month, Casadevall and Pirofski cited evidence that 1918 flu patients given the infusions were less likely to die. And a 1935 medical report detailed how doctors stopped a measles outbreak from sweeping through a boarding school using “serum” from prior patients.

    The old-fashioned approach still is dusted off every so often to tackle surprise outbreaks such as SARS in 2002, and in 2014 when Ebola survivors’ plasma was used to treat other patients during the West Africa epidemic. Even during those recent outbreaks, strict studies of the technique were not done, but Casadevall said there were clues that the plasma helped.

    Casadevall thinks that when it didn’t work, it may have been used too late. “Somebody at the end of their lives, it’s very hard to affect” any disease at that point, he cautioned.

    A more modern approach is to brew this type of antibody in the lab, something Regeneron Pharmaceuticals and other companies are working on. Using blood from COVID-19 survivors is a decidedly more labor-intensive approach — but researchers could start banking the plasma as soon as regulators give the OK.

    HOW WOULD DOCTORS GET THE PLASMA?

    Blood banks take plasma donations much like they take donations of whole blood; regular plasma is used in hospitals and emergency rooms every day. If someone’s donating only plasma, their blood is drawn through a tube, the plasma is separated and the rest infused back into the donor’s body. Then that plasma is tested and purified to be sure it doesn’t harbor any blood-borne viruses and is safe to use.

    For COVID-19 research, the difference would be who does the donating — people who have recovered from the coronavirus. Scientists would measure how many antibodies are in a unit of donated plasma — tests just now being developed that aren’t available to the general public — as they figure out what’s a good dose, and how often a survivor could donate.

    Researchers aren’t worried about finding volunteer donors but caution it will take some time to build up a stock.

    “I get multiple emails a day from people saying, ‘Can I help, can I give my plasma?’” Pirofski said.

  12. Sabdiel Morales Montes de Oca Mar 25, 2020

    Hi, i´m from Aguascalientes Mexico, i´m 31 years old, i have 2 kids (3 years old and 1.5 the younger) they started with fever (37.6) the same time, the same day (today) they have runny nose, litlle bit coufing. They have today an apointment at allergologist pediatrician, but my question is: COVID19 really do not affect on kids? thanks….

  13. Stephene Mar 31, 2020

    I was notified today that the military forces will not publish information on COVID-19 positive cases any longer. Is this specifically because of Russian concern? I have a son in the Navy so I’m concerned.

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