Dr. Ali Hasan, VitalityHealth Chief Medical & Healthcare Officer, shares his expert views on the latest developments in the fight against COVID-19, as well as emerging trends in UK medicine:
Welcome to this week’s round-up of hand-picked papers and articles on the latest clinical developments on COVID-19. We hope you find it interesting and informative.
This week’s update:
• Despite the range of publications and backlash against hydroxychloroquine, another paper supportive of hydroxychloroquine and azithromycin has come from France. I haven’t digested this paper completely yet, but in the presence of published data from RCTs including the RECOVERY and WHO trials, I am not sure this retrospective analysis will win over many clinicians on its own merit.
• Much research has emerged to help rationalise the low level of antibody-detectable immunity in populations, which has undoubtedly disappointed those who thought we’d be further along the “herd immunity” journey than we are. One paper states two in five symptomatic infections sustain antibody responses whereas one in eight asymptomatic infections do, and a high frequency of pathological CT findings in asymptomatic patients, amongst many other important points. In Sweden, where the approach to the management of the pandemic has been widely debated, there is a suggestion that only 6% of the population is immune, based on antibody tests. Is there more to it?
• On the point above about the presence of asymptomatic infections – a study from Lombardy suggested ¾ of people infected did not demonstrate symptoms. This adds to the body of evidence on the high frequency of asymptomatic infections. Take extra caution – your workplace controls can reduce some risk, but not if you assume only those who are symptomatic are infectious.
• Another study supports the evidence that children have fewer or no symptoms (which is known), and onwards transmission from school is rare (which is less known; they specifically said “there was no evidence of onwards transmission from children in the school setting”). This goes alongside another study which estimates that interventions aimed at children may have a lower impact, as those under 20 may only be half as susceptible as those over 20.
• In the US, one study suggests “over 80% infected patients [were] remaining undetected”, further evidence of the high rate of non-presenting and asymptomatic cases. This does not mean that the undetected patients do not have clear pathology, or indeed that younger people are not at risk of severe illness or death. I found it hard not to yearn for the pandemic-free alternate reality where an otherwise well woman in her 20s didn’t end up catching coronavirus and needing a double lung transplant.
• Sometimes we complain about the NHS, or the cost of PMI, here in the UK. We sometimes forget the significantly higher charges in the US for healthcare and the case of the $2300 coronavirus test is a particularly egregious tale. Despite this, private facilities in the US have taken a severe hit. Forty-two hospitals closed or filed for bankruptcy this year, and hospitals are expected to lose $200bn (well over the overall NHS budget) in the four months to June 30.
I hope this helps make a little more sense of the science and provides you with a balanced insight on the developments of the pandemic.
Until next week, stay safe!
