Welcome to another MedCram COVID-19 update now. It's been
some time since our last COVID-19 update, so we'll want to take a look at the
numbers. Just realize that we will continue to
update on COVID-19 issues as they become relevant,
but we're also going to continue to educate on other issues as well.
Daily new cases in the United States has
been in the decline, as has been the daily new deaths in the United
States, although this seems to have leveled off recently.
The daily new cases in Canada have been increasing somewhat
here as of late. This has not yet shown up
in the daily new deaths in Canada. Over in Europe the daily new cases in
the United Kingdom are also on the rise.
As are the cases in France; they are at all-time highs.
I can tell you that in San Bernardino county
in Southern California where I practice, whereas a month and a half ago we had
eight or nine patients on the ventilator in our hospital,
in a specially designed COVID-19 unit, we now have no patients on the ventilator,
and they've essentially closed down that unit.
And as you can see here across the county, the number of confirmed cases
continues to drop, at least in San Bernardino county.
The label here in green at the bottom are the number of COVID-19 positive
ICU patients, and those continue to be on the decline.
So you can see there's a number of metrics on the San Bernardino county dashboard;
in terms of daily new cases we've gone
from a purple state down into an orange state, which is
substantial, which is a move in the right direction
In terms of the positivity rate, looking at a seven-day lag due to reporting
delays, the percentage of positives on each test
has dropped down to about 6.4 percent, which is well below the threshold for
widespread and moving in the right direction.
In terms of the COVID-19 positive hospital census
and ICU bed availability and ventilator ability, all of those seem to be
in the right status. So all of these things are being looked at as to
determine when businesses are able to open up again. So I wanted to look at the
state of Hawaii, because they have the highest unemployment rate around 20
percent, and as you can see, in August their daily
new case count went up to as high as 300 cases per day, and now that's dropped
down to almost a hundred, and you can see the seven-day moving average shows a
drop there. In terms of daily deaths, we really
haven't seen much of a materialization of that. It's also
dropped down in terms of the seven-day moving average,
and for some time the state has said that they were going to reopen.
Currently if you fly to the state of Hawaii you have to quarantine for 14
days, and they're very strict about that.
You're able to come out after those 14 days, able to go around,
even go on to the beach. So in terms of that, there was some
breaking news that was reported on the news site, Maui Now, and this was
reported on September 16th. The article is titled,
"BREAKING: Hawaii's Pre-Travel Testing Program to Start October 15."
You see for some time they were going to
have people able to skip out on that 14-day quarantine if they
were able to show that they were COVID negative.
And now it looks as though, after months of planning this and delays
and postponements, they are going to go ahead and
go with the program on October 15, approximately one month from now.
And they're going to start this pre-travel testing program,
where travelers can get a COVID-19 test within 72 hours of arriving in Hawaii
to avoid the 14-day mandatory quarantine. If the test comes back
negative for the virus, there's a couple of partners that are working
with the state of Hawaii - that is CVS and Kaiser Permanente -
and you would have to pay for your own tests, and those can be between 120
and 140 dollars per test, and if you get the results back,
and it's a CLIA certified laboratory, and you can show those results, then you
would be able to fly to Hawaii and not have to self-quarantine there,
and enjoy yourself while you're there. Interestingly, while we're talking about
Hawaii potentially opening up in the next month
the amount of COVID-19 cases in Utah is going in the other direction.
We can see here on Worldometer that the number of new cases in Utah
is going back up again, although this hasn't borne out in terms of daily
deaths at this point. And it seems as though, based on this
article in the Salt Lake Tribune, some of those cases may be related to
school. And in that article you can see here
that the confirmed cases which has gone up recently was about three to
four weeks after public schools began on August 13.
And I think we're coming up to that time to see whether or not restarting schools
was going to have that type of impact. I wanted to talk to you about a couple
of trials that are coming out about monoclonal
antibodies, and this is a press release from the
National Institutes of Health and it's from August 10
titled "Clinical trials of monoclonal antibodies to prevent COVID-19 now
enrolling," and they're talking about two phase-three, randomized,
placebo-controlled, double-blinded clinical trials.
And one of the trials is conducted jointly by the
NIAID and the trial sponsor, which is Regeneran Pharmaceuticals in New York,
but the other one is by Eli Lilly and implemented in
collaboration with the NIAID. Well, fast forward now to just a
couple of days ago, and here is a news article published in
Science titled, "Eli Lilly reports promising first
results for an antibody against COVID-19, so
let's talk a little bit about what a monoclonal antibody really is. So this
is not very difficult to understand, we've talked about this before
in terms of plasma, so here you have a COVID-19 patient that has recovered
and he's donating his plasma to a COVID-19 patient,
who's the recipient. He's actually currently battling
the COVID-19 disease. And so when you donate plasma,
you do so to the recipient, but you don't really know
what kind of antibodies the patient has. He could have a very strong
antibody response with a lot of good antibodies, it could be medium,
or it could be small. And so it's a big question mark,
but we are able to quantify how many antibodies the patient had. And if you
look back at our video MedCram COVID-19
Update 103, we go through the study that looked at plasma donation to
patients. Well, what monoclonal antibodies do is
the scientists go through and they find the antibody that works the best,
and they clone it, and after they have found an
antibody that works really well, and they've sequenced it and they know
exactly how it's made up. They then go into the lab and they make
this antibody, and this antibody has receptors here at these variable
regions that bind the coronavirus itself.
And so essentially what this process here,
this cloning and making in the laboratory, does
is it takes a lot of the variables out of this equation when you're donating
plasma, so that you're always giving somebody a
large enough dose of an effective antibody,
and we've been giving people monoclonal antibodies for years,
and we know how that type of protein works.
The key part of this is the business end of it here, where it binds
the virus. So if we go back to this Science Magazine, here we can see
that the antibody that they created is called LY CoV555.
And they gave it in three different dosage
levels, and what they found was people who got
this antibody had a 1.7 percent hospitalization rate, whereas those that
got the placebo had a 6 percent hospitalization rate. So if you
do the math there, you would have to treat
23 people with this monoclonal antibody to prevent one hospitalization.
And of course you have to give this either subcutaneously or
intravenously, and so somehow this would have to be done as an outpatient to
prevent hospitalization. Interestingly, in this trial also the
lowest and highest doses didn't work as well
as the middle range dose. So again, they're not sure whether or not
that middle dose's efficaciousness was due to
chance or actually because it worked. Now this was a relatively small trial
with only 452 patients so far, but Lilly is aiming to enroll 800
patients and is testing another type of antibody
that binds to a different target. There's also more results coming from
that Regeneron company about their trial, and that
should be coming up later this month, in hospitalized and non-hospitalized
patients. Perhaps these trials will show even
better results in large numbers of patients.
So I think monoclonal antibodies hold significant potential as a treatment,
but there's another possible use. Some monoclonal antibodies can stick around
your blood for months, so these could be looked at for
prophylactic use, almost like a temporary vaccine that helps protect for a season.
I think we'll learn a lot more soon and if monoclonal antibodies get
FDA authorization, we'll learn a lot more about pricing.
I fear that only a couple of companies are making them and could come to market
at a high cost, at least initially. Okay, thanks for
joining us, and check out MedCram Update 103 for
more information about convalescent plasma and its use in
COVID-19, and don't forget to see all of our
MedCram videos at our website, medcram.com. We'll see you next time!