https://science.sciencemag.org/content/early/2020/04/24/science.abb5793
read an interesting paper title- Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 14 Apr 2020.



First, some basics but still things that I learned:
• The two corona virus currently in cirulation are HKU1 and OC43 and they are seasonal- mainly the winter months with peaks around oct, nov, dec. ;
• HCoV-OC43 and HCoV-HKU1 infections, are the common circulating coronavirus and may be asymptomatic or are associated with mild to moderate upper respiratory tract illness” -- rarely do these kill you while obviously SARS-CoV-2 has been shown to be deadly even though the fast majority of people have been shown to be asymptomatic or with mild symptoms that can be controlled at home
• Immunity to HKU1 and OC43 wanes fairly rapidly, over the course of about a year;
https://www.ncbi.nlm.nih.gov/pubmed/2170159?dopt=Abstract


Epidemiol Infect. 1990 Oct;105(2):435-46.
“the time course of immune response to experimental coronavirus infection of man”
followed in 15 volunteers inoculated with coronavirus 229E on 10 people got infected. It then looked at the IgG and IgA antibodies at point zero, 3wks, 12wks and 52wks. remember at point zero you have baseline antibodies and you would no matter what which is a log of around 3.0 and . At 3 wks in the subjects had antibodies up around 4.0 but then at 12 weeks that number was around 3.6 and at one year they were down to around 3.3. remember at baseline is was 3.0!!!They don’t give us the actual numbers cause this is old school EBM so I just had to guess based on the graphs but they mention how this change from beginning to end of the study is statistically significant, BUT remember the 5 people who tried to get inoculated but the virus didn’t take?? Well their baseline was around 3.5 so maybe 3.3 is enough that you wouldn’t get inoculated again. In in order to know we would have to inoculate all these subjects again


At one year they re-challenged 9 patients of the 10 patients that had been previously infected the first go around and this time 6/9 became re-infected. The good news is during initial challenge, the patients were shedding virus for 5-6 days and during the re-challenge period this was only 2 days.
So the take home—if you believe antibodies prevent infection then maybe just maybe it works at 12weeks but we don’t really know since they didn’t re-test at 12 weeks and we know for certain it didn’t prevent infection or virus shedding at 52 weeks- thus if our current corona virus act anything like other coronavirus we are in a world of hurt.


s I said early we currently have no effective therapies for covid19- even though people are desperate for one infact I recent read a paper in jama IM titled
Internet Searches for Unproven COVID-19 Therapies in the United States
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2765361?guestAccessKey=8b161394-e122-412b-a3fe-812451a9396d&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=042920

in which they looked at the google searches using the words buy, order, Amazon, eBay, or Walmart in combination with chloroquine or hydroxychloroquine
per 10million searches on google that combination on feb 1 was searched 1000 times but on March 16- 3800 estimated searches, March 22 -- 170006estimated searches, and March 29 - 5000 estimated searches
which proves that people are not being scienctist they are taking what the news says and running with it- sadly they are taking what our president and the owner of tesla tweet as the spike for google searches went up over 1300% in direct relation to their endorsements – its sad, and I think that this just shows that people will believe or do anything if it comes from the right source which was a lesson I was hoping we learned to not do after WW2.


https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa152/5814216

Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure 
They bring up something that I think we should all talk about around the water cooler because although it is not the most popular idea, maybe it should be.

That acknowledge that getting a vaccine will take 12-18months. However a majority of this time is spent in phase 3 clinical trial—

https://covid19treatmentguidelines.nih.gov/
A National Institutes of Health panel has released new guidelines
against use of hydroxychloroquine plus azithromycin outside of clinical trials

https://www.ncbi.nlm.nih.gov/pubmed/32001253
Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis

Epinephrine is the cornerstone of anaphylaxis management but continues to be underutilized



ANTIBODY—

https://jamanetwork.com/journals/jama/fullarticle/2764954



“Yet, according to Theel, several companies are marketing lateral flow assays as rapid point-of-care tests to identify active COVID-19, something the FDA announced it will take action against. “We do not really know how well these assays work at this point,” Theel said in a follow-up email.”


https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspx
They say the Santa Clara Medical Examiner identified two individuals who died at home on February 6, 2020 and February 17, 2020. And the autopsy came with……..positive for SARS-CoV-2.

https://www.cdc.gov/mmwr/index.html
Titled – Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020
They used PCR to test resident and staff members at 19 homeless shelters- almost 1500 people in total and it was impressive that in those locations for which there was already at least two previous COVID19 test found the rate of positive cases was extremely high

— 17% of residents and staff members in Seattle; roughly 35% of those tested in Boston; and 66% of the residents in san Francisco. This tells us what we already know, this disease spreads like wild fire, of those that it spreads not




https://annals.org/aim/fullarticle/2764585/utility-appropriateness-content-electronic-consultations-across-medical-subspecialties-cohort-study
Utility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties: A Cohort Study
Objective of this retrospective cohort study was to assess novel metrics of electronic consult appropriateness and utilityTo assess novel metrics of e-consult appropriateness and To assess novel metrics of e-consult appropriateness and To assess novel metrics of e-consult appropriateness and To assess novel metrics of e-consult appropriateness and To assess novel metrics of e-consult appropriateness.
Most consultations were answered within one day and approximately 70% of the consultations that all 4 criteria for appropriateness indicating about 70% of time the patient could be spared a visit to a specialist and have a better conditions managed by the primary care provider with just subtle guidance from the specialistMost consultations were answered within 1 day, with variation across specialties (73.1% for psychiatry to 87.8% for infectious disease). Overall, 70.2% of e-consults met all 4 criteria for appropriateness; the frequency of unmet criteria varied among specialties.

More cover 19 information based on antibody testing, pregnancy and pre-symptomatic spread


https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1.full.pdf

https://www.nejm.org/doi/full/10.1056/NEJMc2009316?utm_source=The+Scope&utm_campaign=86f20fbd35-Weekly_Scope_Jan_12_2018_COPY_01&utm_medium=email&utm_term=0_809ad7d22b-86f20fbd35-180869057

Remdesivir for compassionate use?? Recently published in the New England Journal of Medicine- Is this the COVID19 treatment we have all be hoping for.


https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

https://jamanetwork.com/journals/jama/fullarticle/2764727?guestAccessKey=72e8a5f3-3754-4bf8-bb17-8c2f1cf358b0&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=041320

Treatment that works-- MASK!

https://annals.org/aim/fullarticle/2764367/effectiveness-surgical-cotton-masks-blocking-sars-cov-2-controlled-comparison



High Velocity Nasal Insufflation (HVNI) Therapy Application in Management of
COVID-19 Have patients wear a surgical mask—in this computer study it showed that mask do help but not necessarily mask on you but mask on the pt.

Id be happy to send you links to any of the articles talked about in this podcast but I cover the new test on the corona virus that claims to be great but the devil in the details as well as talk about more hear-say medicine and the ever popular ACE inhibitor debate

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1.full.pdf

https://www.sciencedirect.com/science/article/pii/S0399077X20300858

https://first10em.com/chloroquine-for-covid-no-good-evidence-yet/

https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000890-25/FR

https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

Question Everything-- EBM not hear-say medicine

A listener wrote in with a question about a drug, this is my response. Let me know your thoughts? Would you prescribe this drug? [email protected]

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1705848