Treatment and Medication Clinical Trials, & H1N1 Influenza A (Lecture 19)
Welcome to another MedCram lecture update from the road. I’m currently at a medical conference in Hawaii, but we’ll continue to try to do these updates as they come up. If we go to the WorldOmeter website, we can see that they’ve broken down the cases now into Active Cases versus Closed Cases, and you can see that they are still increasing. These numbers are under-represented. We will get into more of that later.
Then we come to the graph that is looking at the total cases outside of China, and those are still continuing to grow. Although it doesn’t appear as though it’s logarithmic in nature. If we switch over to logarithmic, we can see that it’s less than linear.
If we look at daily cases excluding mainland China, it seems to be more sporadic with some days with up to 79 and the most recent at 22. And if we look at these total death cases here going from the beginning of the year until mid-February is quite obvious. They’re still continuing to grow. What’s unique about this virus is that it has infected not just another mammalian species, specifically humans, but it’s infected a species that can think, act and retaliate against this virus. And that’s where we come to today.
Some of you have asked us to talk about some of the medications that are being developed. There’s a nice article in Nature that was published just a few days ago. There are more than 80 clinical trials currently launching the test coronavirus treatments, and the big thrust of this article is that there are so many trials going on in China looking at every single thing that you could possibly imagine to see if it’s going to work that there’s no standardization. What exactly is a recovery? What is the definition of a recovery? And if things are not being blinded, but things are being looked at, is their nefarious work there either intentionally or unintentionally.
So we’ll put a link to this article in the description below. But it talks about exactly what the WHO is doing to try to standardize these trials to make sure that they can be compared amongst each other, and that the outcomes are true in nature, and not just the push medications or favorite drugs onto this coronavirus.
There are a lot of medications and drugs, for instance, chloroquine phosphate, which has shown in vitro to have some pretty promising effects against the coronavirus. It inhibits coronavirus’s growth. And currently, this is being tested in about ten hospitals in 100 patients. Another drug that’s being looked at is Favipiravir, which is being looked at in a clinical trial of about 70 patients.
And of course the other one, Remdesivir, and that is currently being looked at in ten hospitals in Wuhan. Of course, this one was developed for Ebola, and it worked in vitro, but it doesn’t seem to be working in vivo for Ebola, but it’s being used as a potential source of a medication to be used against this coronavirus.
Another thing that they’re looking at is something called convalescent plasma. This is basically the plasma of patients who had recovery from this coronavirus. So presumably there are antibodies that have already been developed against the virus, and if you take this plasma from these donors and put it into patients who have severe infections of the coronavirus, which all brings us to the big question to really do the right research on this.
There has to be blind Placebo randomized controlled trials. The question that I have, and a lot of people have, is if people are saying already that things are looking promising, that things are getting better, are they really conducting the right kind of studies? Which leads me to the next thing I want to talk about. That’s what I do.
I’m not an epidemiologist. I’m not an administrator. I don’t work for the WHO. I’m just a critical care doctor who takes care of patients. So when patients are coming into the Intensive Care Unit, and they’re crashing, I’m the one that puts the central line in. I’m the one that puts the arterial line in. We intubate the patient. We do the bronchoscopy. So this virus has been a real interest for me. So my full-time job is taking care of patients.
And I wanted to show you what’s been going on at least what I’ve noticed. In my practice in southern California in the last month or so, I’ve seen personally at least three or four cases of influenza A. Let’s come in, and these patients have not done well.
Recently had a young person come in who went from just having reports of the flu to having severe pneumonia, requiring intubation within about two to three days, and she went on to actually require ECMO, or E-C-M-O, which is where they do heart-lung bypass.
And what you’re looking at here is a graph of the influenza-positive tests by the CDC, and you can see the vast majority of these cases are H1N1 from 2009, which was a very bad year. We’re noticing that these patients have particularly bad cardiac reactions to influenza. I’ve seen a patient code and go asystolic after being intubated. I had another one who had ST segment elevation from xxx Myocarditis.
The bottom line being is that this strain H1N1 is covered in the annual vaccine. That’s been covered since 2009, and so because I’m seeing such a huge amount of this, this is kind of a callout to those who are susceptible. It’s not too late. As you can see here. The flu season still has some weeks to burn through here, to get vaccinated against this potentially deadly strain of the influenza A. Thank you for joining us!