On Tuesday evening, October 5, Navigating the Medical System began its tenth year with a virtual lecture on COVID updates. It was hosted by Congregation Etz Chaim. Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone. He stated, “Here tonight, you will hear the truth about what we do know about COVID and what we don’t know about COVID.”
Dr. George Rodriguez, infectious Diseases Clinical Pharmacist at NewYork-Presbyterian, shared a detailed lecture on the history of various COVID treatments and what works and what doesn’t work. Dr. Rodriguez oversees COVID management in NewYork-Presbyterian Queens Hospital. He explained that phase one of COVID-19 is the viral phase. This is when the virus replicates in the body and symptoms include fatigue, sore throat, loss of taste and smell, fever, headache, and aches. Phase two is the inflammatory phase, and not everyone reaches this phase. Symptoms in this phase include severe shortness of breath. In between these two phases is a pneumonia-like situation. Drugs need to be specific to each phase. Nearly 200,000 papers and studies have been written on COVID treatment.
The first drug that was tried was Hydroxychloroquine. It was first used to inhibit the virus in a lab. Studies were performed in Italy using Hydroxychloroquine and Azithromycin together on COVID. Of the 42 patients tested, only six received the combination. This type of study is a red flag, he explained. A small number of patients in a study means it is not reliable. He said that further study is needed, but they did not see benefit with this drug in NewYork-Presbyterian Queens. “Eventually, we saw more harm than benefit with Hydroxychloroquine, so it is not recommended.”
Remdesivir decreases viral replication. It worked in the lab against COVID. “We were the first hospital using it. The first two patients recovered with it.” Remdesivir received FDA approval. It decreases symptoms and duration of the COVID virus. It is given for five days. It has to be given early on during the viral stage. There is no benefit from it during the inflammatory stage. “So, if a person experiences shortness of breath, he should come to the hospital immediately. Remdesivir dispensed early on seems to help decrease symptoms.”
Tocilizumab wasn’t promising, and there is a risk for infection with this drug. In a study in the UK, it was administered in the first three days of hospitalization in the inflammatory stage. It can reduce the need for a ventilator.
Convalescent Plasma from patients who recovered from COVID was thought to provide passive immunity. There are mixed results with this. Not every plasma sample is the same. It is not reliable, so it is no longer recommended.
Anti-inflammatory steroids were the most important discovery in June 2020. A low dose of steroid for patients for a certain time was helpful. In a study in the UK, it decreased three percent mortality rate. “This changed everything for COVID-19.” He explained that the benefit only was seen in patients who needed oxygen.
Long-term steroid use can cause invasive infections, because they prevent the immune system response. Steroids should be limited to seven-to-ten days maximum.
Monoclonal Antibodies are a synthetic version of an antibody. They bind to the virus and stop it from entering our cells. This is excellent preventive therapy; if you have COVID, however, some variants are not treatable with these. It can prevent the need for hospitalization. They treated 500 patients and only ten needed hospitalization. It must be given within ten days of the onset of symptoms. It is highly effective against the Delta variant. The side effect from it is chills. It is recommended for patients who are high risk or as post-exposure prophylaxis. If you are vaccinated and you are immunocompromised, it is recommended. These antibodies last two to three months. If you have them, you have to wait three months before receiving the vaccine.
Not everyone needs this treatment. Your doctor can contact NewYork- Presbyterian about it.
Ivermectin, which is used for parasitic infection, was tested and thought to block the virus. Sixteen studies where published and six showed potential benefit. Ten showed no benefit. These studies were done with a small number of patients and the studies were all designed differently.
Now, all patients receive steroids and Remdesivir if they come to the NewYork- Presbyterian Hospital.
He then addressed the question of how the vaccines were pushed through so quickly. “Years of research laid the foundation for this vaccine. The FDA allowed studies to be done simultaneously, which allowed it to come out sooner. Johnson & Johnson was approved in February for emergency use.”
If a person is allergic to polyethylene glycol or polysorbate, he or she shouldn’t take the vaccine.
Next, Dr. Segal Mauer, Infectious Disease Specialist at NewYork-Presbyterian Hospital, spoke. She stated that the first law of medicine is “Do no harm.” It is imperative to use as much science and safety for patients as possible. She shared that we need bigger studies. “It is very clear that prevention is first and foremost. The only way to get this pandemic under control is with vaccines.” She noted how we have embraced vaccines to prevent 70%-80% of child mortality. There is no reason we should not embrace COVID vaccines for the same reason. She said that people spread false information about the risks of the vaccines. “Embracing vaccine and tried-and-true healthcare tenets will help us to return to normal life.”
She explained that the vaccine helps create protection, because it primes your immune cells and certain chemicals that they make. She recommends the booster shot for those above the age 65, but you can’t mix vaccines. If you had the Moderna, you have to wait for that booster shot to become available.
Effects of COVID include brain fog, severe fatigue, and blood clots.
The community thanks Dr. Breite and Congregation Etz Chaim for this informative lecture.
By Susie Garber