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October 21, 2020

Pregnancy and Covid-19

There is still a need for further clinical studies on the effect of SARS-CoV-2 on pregnancy.  In general it is recommended that women follow all the public health safety measures to prevent getting Covid-19 at all during pregnancy.  The studies show that Covid-19 is slightly more severe during pregnancy and there is a higher incidence of ventilators.  But there is no increase in mortality.  There is only very rare transmission of the virus to the babies, and it is not clear whether that occurred prior to or after delivery.  The babies rarely have problems due to the virus and it is not transmitted in breast milk. Mothers who want to breast feed are recommended to perform strict hand washing and mask wearing while feeding the babies. Read Below. 


Doctors at NYU Hospitals in New York studied 149 mother-child dyads and it is one of the largest studies published to date.  Forty% of the mothers were asymptomatic and picked up on screening.  15% of the symptomatic mothers required some type of respiratory support.  Symptomatic mothers had a significant increase in preterm births ( 16% vs 3%  P=0.02).  Only 1 newborn was + for SARS-CoV-2 and that was believed to have happened post-partum.  There were 3 sets of twins, 3 still births, and 1 post-natal death. (Publication in Pediatrics journal this month).

October 17, 2020

Sniffer Covid-19 Dogs

Sniffer Dogs Make the News:

Humans have 6 million receptors for smell in their nose, dogs have 300 million receptors, making them very good at detecting volatile organic compounds made in our bodies.   They have been trained to detect malaria infections, bacterial and viral infections, bombs, contraband in luggage, and some types of cancer.  Several weeks ago the New Your Times published a story about sniffer dogs being trained to detect infected covid-19 patients in the Helsinki airport.  Read More Below.


They trained 16 dogs and expect to have 10 in the airport by the end of November.  Six dogs weren't able to work in the noisy environment. 

The dogs can detect Covid-19 infections in less than 1 minute and can be used with a trainer to screen travelers in lines in airports.    The dogs can detect the Covid-19 infection in asymptomatic people, and test sensitivity is as high as 85 to near 100%, with equally high specificity. Dogs who have been trained for other scents can learn to detect Covid-19 infections in 1 week,   If they have never been trained with other scents, it takes significantly longer. 

Similar trials are being conducted in the UK, France, Germany, Lebanon and the US (at U Penn Vet School).   Dogs are being trained to sniff saliva, nasopharyngeal secretions, sweat, and urine.  In Helsinki passengers wipe their necks with a wipe and then put the wipe in a cup for testing.  

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 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.   


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