This week Fred and I review the history of treatment protocols for an infection with SARS-CoV-2 and what new therapies and protocols have been developed
In the early days of the pandemic, we knew much less about the disease and not all therapies and treatments worked well. The good news was there was early insights clinically that changed the way patients were managed that saved lives and that information was shared widely using non traditional methods.
Over time we added to our toolbox of therapies building on the early use of proning and steroids and convalescent plasma adding Monoclonal antibodies and more recently some new antivirals some of which are proving to be highly effective through to some ongoing interest in repurposed drugs like Fluvoxamine
We also discuss mask choices and the challenge of some of the rigid mandates impacting some people who are trying to take more protective approach to masking while in public spaces
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here helping employers payers and health care systems with their population health programs. So Nick, we spent a lot of time talking about a lot of the things you can do to keep yourself safe, you know, masks, distancing, better air handling all of those. And vaccines, obviously, are the key here. But there’s also been quite a bit of progress in terms of medical treatment. What’s been going on on that side? Yeah.
Nick van Terheyden
So I think one of the things that we’re seeing is, you know, declining rates of death in the hospital, even though we’ve seen a massive increase and, you know, big part of that directly. Well, I don’t know that you can directly draw the line. But I think we can intuitively say that vaccines are a big contributor to that. But we’ve learned as we do with all diseases, about treatment options at work. And in the first or the very early days, we were really quite unsure, we were unsure about the ventilation characteristics. And you know, if you heard about people that were struggling with ICU and the whole ventilation process was not working. One of the things we learned early on was just proning, which is turning people on to their stomach, so that the whole ventilation processes improved. That was a big improvement. We quickly learned that steroids commonly used very effective, I think, I want to say convalescent plasma, which is long been around and Diana barent, I think, you know, from the survivor core, if I recall, was the first individual she set up, she actually donated she’d recovered, we take plasma from people and use their antibodies to help. You know, again, there’s a limited supply of that, we developed some monoclonal antibodies. And now we actually have some antivirals in the same way that we have Tamiflu for flu. But we’ve actually got two one that I think works extraordinarily well and can be given orally, which is a great thing you can give that outside so before anybody even needs to step in those availabilities availability issues with some of these, so packs livid and mole new persevere. Let’s hope I get those right. Somebody will correct me if I didn’t, but and then, you know, we continue to explore and we’ve, you know, gone down some blind alleys. I’m not going to mention some of the drugs that, you know, for me still, I’ve seen no data to suggest that they are effective. The one that I think still stands out to me is the anti depressant, I think there’s been some data that suggests that fluvoxamine, which is an antidepressant seems to have a positive effect. Again, I think we need data, but all of that, wow, look at what we’ve done in and I’m going to say this is episode 95. It’s two years. Quite some time. But still, that’s pretty fast progress. Besides,
Fred Goldstein
yeah, there are a lot of interesting areas to explore. And one of them would be just like looking at this from a population approach. If they could figure out in essence, what’s the impact of the vaccines on the ultimate outcome, as people get vaccinated, get sick and end up in the hospital as some do? And then what’s the impact of the treatments themselves, which clearly, there’s been a fairly substantial one, when you look back to the original heyday, this in New York, and they were just overloaded with ICU patients on Vance. And suddenly, as you said, discovered some of those early ways to change the treatment approaches that appeared to have profound impacts.
Nick van Terheyden
Yeah, I’m sure looking back, we’re gonna look at places like Italy, where, you know, I think everybody saw this terrible picture unfolding, as you rightly described in New York, we saw it, but then, you know, things seem to improve. I mean, it certainly got very bad to be clear. You know, and, and some of it was about applying the wisdom as quickly as possible and, and testing things out. I was a member of WhatsApp group and a Google group that was set up specifically to sort of share insights, there was a a morphing document of treatment options that clinicians were sort of contributing to, you know, that I think was extraordinarily helpful to frontline staff. The challenge and, you know, I’m sure some people are listening and going, Well, why don’t we just, you know, we should know which ones work answer your question. And, you know, the reality is you can’t do a trial and say, okay, these people, we’re not going to vaccinate these people when we’re not going to treat and we’ll treat these ones. You can’t divide up into this group from an ethical standpoint. So designing trial Now is going to be very difficult to sort of tease that out, which is why we have to use some of these statistical tools, and some retrospective analysis of that data to say, can we find instances where we created those groups? And then look at that data to be able to answer those questions, because they’re great questions
Fred Goldstein
here. And just as a quick aside on that, I noticed there was something recently on this issue that many of the impacts that people felt from the vaccine themselves were actually placebo effect, which is also something you couldn’t do. Well, we’re going to give them a placebo, and we’re going to give them the vaccine and then see this. But you know, obviously, when you first test it, you can but later on to get that sort of data. So it’s interesting to see what are some of the impacts of this. The other area that’s been fascinating is masks. And obviously, we’ve talked about masks up to an end. 95. But there are a you mentioned it, there are masks that are better than that. respirators that understand it. And recently, there was an issue with somebody wearing a respirator. Yeah, so
Nick van Terheyden
that was even Diana, who founded survivor court, she’s very cautious. She’s actually endured long COVID, she has gathered huge amounts of data and actually worked tirelessly and contributed to the convalescent plasma, she was wearing a full on respirator, I want to say, if I try and translate it, and I’m not the expert in maths, but I think it went to the equivalent of an en 97. I think somebody described it as so it was even superior to the end 95 Mask, and she was wearing that. And unfortunately, in many instances, people have protocols that are dated, and you know, are not equipped to do establish that that is actually a superior mask. In part, one of the things that you see in money that are many of the mask mandates is no masks with vowels. And this particular mask comes with a vowel that’s built in, but it’s part of the valve that is for both in and out. And she was required to put on a surgical mask over it. And things didn’t go terribly well. Unfortunately, I’m you know, always sorry to hear that I think we can, perhaps de escalate things a bit better, we seem to have lost our capacity to sort of negotiate and do things and you know, have divided the seas almost, you know, it’s been like Moses, you’re either on this side or that side of the ocean.
Fred Goldstein
Right? It’s interesting, because I purchased one of those years ago for working with some paints and some chemicals around the house that were pretty bad. And they have the screw in, you know, filters and you can select really high end filters. But obviously the air has to go through it in that way. But it’s designed to make sure that the exhale air is not going straight out like a typical mask that might have a a valve on it. So it’d be interesting to see if somebody might publish or, or put out some guidelines that expand up into that range and say this mask is okay to wear on planes because obviously, it’s, as you said, superior to many others. I know that those fit really well when you put them on.
Nick van Terheyden
Yeah, you’re not smelling anything I’m just saying. Yeah, exactly.
Fred Goldstein
Exactly. Well, once again, it’s been another fantastic week, Nick number 95 As you pointed out, if those listening would like to get more information, please go to Accountable Health. llc.com
Nick van Terheyden
and this is Dr. Nick on the incrementalist here with incremental insights for better business, better health.
