TWiV 606: Evidence-based science and medicine for COVID-19

April 26, 2020
CoV_bank

Daniel Griffin provides his weekly update on the COVID-19 clinical situation, followed by our discussion of tests of an inactivated vaccine, results of serological surveys, an inhibitor of the cell protease needed for virus entry, and answers to listener questions.

Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Kathy Spindler

Guest: Daniel Griffin

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Intro music is by Ronald Jenkees.

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14 comments on “TWiV 606: Evidence-based science and medicine for COVID-19

  1. Teepu Siddique, MD, DSc (hc), FAAN Apr 26, 2020

    Evidence based medicine ( EBD) sets up therapeutic goal posts for a population, but it is not very useful in treating individual patients. Each human is genetically different with environmentally different life long experience and requires a personalized medicine approach. EBD assumes all individuals are the same, based on clinical trials even though there is variance to response in the population. It does not differentiate between responders and not responders. . In the intravenous Vitamin C study fewer people died who received IV Vitamin C. Mortality was for some reason was set as a secondary end point and the study was dismissed as a negative study. In practice of clinical medicine it makes little sense.. Humans are treated not clinical trials.

  2. Michael Irvine Apr 26, 2020

    ” Professor Frazer said the challenge is that coronaviruses have historically been hard to make safe vaccines for, partly because the virus infects the upper respiratory tract, which our immune system isn’t great at protecting … It’s a bit like trying to get a vaccine to kill a virus on the surface of your skin ”

    https://www.abc.net.au/news/health/2020-04-17/coronavirus-vaccine-ian-frazer/12146616

  3. Priscilla Apr 26, 2020

    Listening as I’m weeding…

    Thank you very much to Dr. Griffin for his excellent updates! (and the TWIV team too). As an anesthesiologist, I find these very helpful.
    1. The mechanism of decreased SpO2 is different for COVID vs. OSA. OSA is upper airway obstruction, so the apnea and obstruction are worse when entirely prone. If though the head, neck, and airway are turned laterally, then that could help even in on a prone belly. Basically you want a clear path for air to rush in.

    2. Also regarding desat’s, I wonder what percentage of the sudden acute resp. decompensation seen in the second week of COVID are due to not intraalveolar process (though that still happening just not the immediate cause) but pulm emboli?

    3. Maybe in the inactivated viral vaccine, the researchers placed an inoculating dose by the “carina” but the auto check changed it. Carina makes sense because they were for sure to get a dose into the lungs.

  4. K. Mackey Apr 26, 2020

    Question for Dr. Daniel Griffin:
    Article below discusses the use of IV famotidine. Does he have any experience with that?

    https://www.sciencemag.org/news/2020/04/new-york-clinical-trial-quietly-tests-heartburn-remedy-against-coronavirus

  5. Chris Carlson Apr 26, 2020

    You need to speak to bioethics when even considering challenge trials with COVID 2. Get a bioethicist in to speak on this.

  6. Ashish Apr 27, 2020

    Thanks for this excellent podcast.
    I am a non medical person:
    1. Can you please discuss if re-infection is possible and what the likely outcome is.
    2. last few episodes have discussed bio-markers, would silent hypoxia be a bio-marker. Would you recommend getting a pulse oximeter and monitoring oxygen levels at home.
    3. Could you please summarize important bio markers and when they happen along the timeline of the disease progression and what action a patient/doctor should take.

  7. Just want to give a “shout out” to Vince for his unequivocal dismissal of the approach suggested by the Physicist from Yale to inject human subjects with SARS Covid 2. Did I miss the part of the podcast where this physicist volunteered (skin in the game)?

  8. Michael Irvine Apr 27, 2020

    60 Minute COVID-SARS2 TEST

    Guelph company shifts focus and creates a 60-minute COVID-19 test. The device is the brainchild of Precision Biomonitoring.

    https://www.guelphtoday.com/coronavirus-covid-19-local-news/guelph-company-shifts-focus-and-creates-a-60-minute-covid-19-test-2285974

  9. Shin Enomoto Apr 27, 2020

    Will you comment on this article?
    “Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure”
    https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa152/5814216
    I am torn on this. What if such testing happens under a horrible political situation and the outcome of the vaccine is positive, would we be able to use the vaccine?

  10. Gregory McIsaac Apr 28, 2020

    Around 1 hour and 25 minutes into this program, there was discussion of UVC light and how dangerous it is to humans. According to this press release from Columbia University:
    https://news.columbia.edu/ultraviolet-technology-virus-covid-19-UV-light

    there is a team there that has been investigating and developing the use of far-UVC light wavelength to kill the CoVid-19 virus in public places with people present, without harm to the people.

    I will appreciate any comments you may have about this.
    Thanks for your work and best regards.

  11. Regarding terminology for quantitation of RNA detected in PCR, in our clinical lab we speak of “target copies.” As in, the primer targeted segment of the RNA we are amplifying. Our quantitative assays are reported as copies/mL. Most of our assays are qualitative and yield Ct (threshold cycle) values, which are not reported to clinicians, only the detected or not detected interpretation. I anticipate the saliva test will be qualitative.

  12. Richard Cornell Apr 30, 2020

    There was a film done in the Viet Nam war aboard a navel ship. A doctor spent a good part of a morning trying to save soldier who was torn apart. Everything he did he could not save him. Some he saves and some he can not. This one hit home.
    He walk over to a wall lean back against and cried his eye out.
    Like this plague many doctors have seen people on the edge of living their heart gives out. Listening to this series so much you have and just as much does not work.
    Rough being in the medical field these days.

  13. Neil Ravin May 1, 2020

    Rich Condit really got on to something when he commented on Daniel Griffin’s analysis about the ideal of evidence based medicine, and how you proceed in working through problems while trying to cleave to the ideal of basing decisions on prospective controlled blinded clinical trials. Condit noted that as he got more experienced and more comfortable in the lab, he simply got more efficient and better at doing his experiments and there were so many variables and so many things he had learned in the lower parts of his brain it amounted to a “magic sauce” he could not explain and that helped him work better. Clinical practice on the ward must be like that as well. There simply is not a well done study for every problem, e.g. turning a patient prone to increase oxygenation.

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