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October 14, 2020

Test-Track-Isolate to Control Coronavirus

Test-Track-Isolate:  When New York State was able to shut down for weeks last Spring to control the surge of Covid-19, the number of cases dropped progressively.  The curve of daily new positive cases looked like a really tall mountain with a gradual decline to a stable low baseline.  The state then reopened in phases, very slowly, and by region, and the cases and deaths continued to decline.  Each day the state was testing 60,000 -100,000 people, and recently it has been more than 100,000 tests per day - with 1% daily positive cases or less in New York State and New York City for several months.   Read More Below.


In the last week hot spots developed and were detected by the daily testing.  Most of the infections followed large gatherings with limited to no mask wearing.  The Dept of Health was able to pinpoint the clusters to specific zip codes, in Brooklyn, Queens and several surrounding counties.  The areas were divided into yellow - orange - and red zones by the number of new cases, and each of the zones had new imposed limits placed on the people.  I walk in my neighborhood in Manhattan early every morning and almost everyone is wearing masks - including even the youngest toddlers in strollers.  Everyone wants to prevent a surge in the virus infections and deaths this Fall.


October 10, 2020

Regeneron Antibodies in the News

We witnessed, in a very public way last week, the evaluation and treatment of a famous patient with Covid-19.  I previously mentioned Monoclonal Antibodies on August 26th in these blog posts.  But it seemed like a good time to review REGN-COV2, one of the two monoclonal antibody drugs that are early in their clinical trials in the US.  It was administered to President Trump early in his Covid-19 infection with a compassionate approval.  Read Below


Early Results: 

REGN-COV2 is a mixture of two manufactured monoclonal antibodies to different binding sites on the SARS-CoV-2 virus spikes.  The Regeneron company currently has 3 clinical trials listed on governmenttrials.com: one in ambulatory patients, one in hospitalized patients, and one in individuals exposed to a Covid-19 patient.  There is limited data from these trials which only began several months ago.  All of the following information was presented at an investor meeting on Sept 29th for the first 275 patients enrolled in the ambulatory patient trial (Goal = 2000 volunteers).  

Trial participants all had positive virus tests and received a low dose, a high dose. or a placebo infusion   Patients' antibodies were also measured before treatment and results were analyzed based on whether they had already developed antibodies or not. Patients who received the REGN-COV2 antibody infusions reduced their virus loads and symptoms faster than placebo patients, and those who had not already produced their own antibodies had the greatest responses. Both doses were well tolerated.  Infusion reactions occurred in 4 patients - 2 on REGN-Covid2 and 2 on placebo - which is always a mystery to me.  

October 7, 2020

My Test Was Negative So I Didn't Wear a Mask

Last week there was a Super Spreader event at the White House and now guests have Covid-19.  The President's virus test was positive 5 days after the event. Everyone who attended the Rose Garden Party for Amy Coney Barrett had a rapid Covid-19 genetic virus test on arrival.   Guests were told that all of the tests were negative and therefore no one needed to wear masks.   At least 150 guests in the Rose Garden were photographed  - without social distancing or masks.  Everyone at the event should still have been socially distanced and wearing masks.  Read More about the test below.


The White House uses the Abbott ID Now point of care molecular virus test.  The test was given FDA Emergency Use Authority for symptomatic patients with symptoms for < 7 days.  Articles I reviewed demonstrated, in some studies, that the test sensitivity wasn't high enough to pick up early cases of Covid-19, i.e. those samples that had low virus loads (up to 20% false negative tests).

A test like this is only helpful for rapidly testing symptomatic individuals, the results of the genetic test takes 5 minutes if positive and 13 minutes if negative. However, using this test to screen a population of asymptomatic individuals could mean missing many patients with early, transmissible SARS-CoV-2 as appeared to happen at the White House.



October 3, 2020

What is Herd Immunity?

Viruses don't go away without vaccines. Measles, a highly contagious virus, was eradicated with vaccination, but occasionally pockets of infection do erupt in susceptible groups who refuse to be vaccinated.

Herd Immunity was recognized in the early 1900s, first by veterinarians, and then in humans.  When a high enough percentage of individuals in a community are exposed to a virus, the rate of transmission and infection slows down because there aren't enough susceptible people to pass along the virus.  Herd immunity needs approximately 70% of a community to either have been infected or vaccinated. 

The vaccines in the US must be at least 50% effective in order to get FDA approval.  If 100 patients are vaccinated 50 of them would develop immunity and protection.  If many patients don't accept vaccination, we can do another calculation:  If 100 people are offered a vaccine, and only 60% get vaccinated, and only 50% of them develop a strong immune response, only 30 patients of the original 100 patients would be counted in the development of herd immunity.  READ BELOW


Dr.Tony Fauci, from NIAID/NIH, estimates that only 10% of the population in the US was infected so far.  Therefore vaccination is extremely important in the development of herd immunity to Covid-19.   

Bottom Line:  Develop a very safe vaccine, with high effectiveness (preferably 70%), and vaccinate as many people as possible.  Only then will our lives return to pre-pandemic freedom.  But we would still need to follow the Public Health Guidelines to control breakouts. 


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