Edited to add: We have seen daily new US cases average over 40k for the last 5+ days. This suggests a jump in daily deaths to over 2,000 per day within 10 days, as the average time from hospitalization to death is 10 days. So there is a lag between rise in cases and rise in deaths.
Dexamethasone
This was the week that dexamethasone hit the news media. They really over-played the importance of the study and drug. You do not give steroids to Covid-19 patients with mild or even moderate disease, nor in the early stages of what later progresses to severe. It is only for severe cases, where the cytokine storm is the main danger, because steroids suppress the immune system. So this is not the solution to the Covid-19 problem. It reduces the death rate for severe cases up to one third; that is not enough.
The reaction of the “cancel culture” to dex was predictably bad, as discussed here: Blogs.Jwatch.org and here at MedCram. There is this fear and ignorance in the outspoken but mostly anonymous internet culture. They set forth arbitrary standards based on very little knowledge, such as not to accept any study or information unless it is a peer-reviewed officially published RCT. The truth is that good information comes from other types of studies, and that a good paper does not need peer review. The physicians and researchers reading the paper can tell if it is a good study.
Comparison: Dex vs. DMB
Covid.us.org reviews a study here which found vitamin D, magnesium, and B12 (“DMB”) effective in reducing need for oxygen and/or ICU care. Patients given DMB were 85% less likely to need one or the other or both. The study does not examine the case fatality rate, but if you don’t need O2 or ICU, you are not on the path to death. The patients who are dying of Covid-19 are largely dying on mechanical ventilation and/or in the ICU.
So DMB is far more effective than dexamethasone, and is applicable to all patients, not only late-stage disease patients, and yet it gets very little notice in the media. That is a serious problem. Many physicians hear about new meds through the mass media; they are not scouring research studies to find the best new treatments.
A related problem is the huge push toward using remdesivir, which seems all out of proportion to the paucity of scientific evidence. The dexamethasone study was an RCT, but there’s no RCT yet for remdesivir (of which I’m aware). And yet the publicity and sudden increase in use of remdesivir is immense.
Lottery System for Drugs in Short Supply
A JAMA article proposes a lottery system for which patients get Covid-19 medications that are in short supply, like Remdesivir. I covered this, rather sarcastically, in my Running Commentary this past week here. In all seriousness, it is a monumentally bad idea.
A lottery makes the drug seem more essential than it is. This will make patients demand to be put into the lottery, when they are perhaps not the best candidates for the use of that drug. And it may even effect the decisions of physicians, for what is rare and sought seems to have greater value.
Another issue is that of unfairness. Randomness is not fairness. You don’t give out organs for transplants randomly, but to the best fit, to the patient who will benefit most. There are many factors weighed in distributing the rare medical treatment of organs. A lottery would give a drug to someone who needed it less, and deny it to someone who needed it more, potentially increasing the death rate over a medical decision on who gets the rarer medication or treatment.
Ivermectin and Doxycycline are better
A study comparimg Ivermectin/Doxycycline to Hydroxychloroquine/Azithromycin found that — for mild to moderate cases — the former pair of meds is better than the latter. Lots of press for hydroxychloroquine and azithromycin, and little for ivermectin and doxycycline have caused the lesser treatment to be given out to many more patients than the better treatment.
Selenium is good
A study in the American Journal of Clinical Nutrition compared cure rate and death rate to selenium status in hair and to selenium intake. The conclusion is that higher selenium status or intake improves the cure rate and lowers the death rate. The study has substantial limitations. But since the authors are merely proposing an intake of selenium that is below the tolerable upper limit, for an essential trace mineral, correcting selenium deficiency is unlikely to do harm.
However, note that not all minerals are effective in improving disease status. Iron seems to help the virus, harming the patient, for example.
“Limiting iron availability to infected cells by iron chelators curbs the growth of HIV-1, HCMV, vaccinia virus, herpes simplex virus 1 and hepatitis B virus in vitro. In patients who are infected with HCV, iron removal ameliorates disease.” [Nature Reviews microbiology]
So we cannot assume that increasing every vitamin and mineral will necessarily help a Covid-19 patient. At this point, though, selenium supplementation seems to do more good than harm.
Molecular Docking News
A molecular docking study of famotidine (PDF here) found that the drug inhibits a dozen different viral targets in Covid-19. Even so, it is possible that the drug’s main effectiveness is from some other mechanism, as the low dosage of the medication might not be sufficient for inhibition.
A different molecular docking study found that memantine (Namenda), the dementia medication, is an inhibitor of the E-protein of SARS-CoV-2. The E-protein or E-channel is a protein that spans the viral membrane and allows calcium to traverse the lipid bilayer. This calcium-related function of the channel raises the question as to whether calcium supplements will help Covid-19 patients, or not.
That’s all for this week.
Ronald L. Conte Jr.
Covid.us.org
Note: the author of this article is not a doctor, nurse, or healthcare provider.
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