April 29, 2020: Public Health Update

From: Tom McLarney, MD
Subject: Public Health Update
Date: April 29, 2020

To the Wesleyan Community,

Wishing you all health and safety. My thoughts go out to those of you who have been personally been affected by Covid-19.

As is often the case, the more you know about something, the more there is to know.  This is certainly true about Covid-19.  I would like to summarize a number of current issues, knowing that this information will continue to evolve as we learn more.

First, we are becoming aware of the wide variety of ways that Covid-19 can present. From the very beginning, we have all known about the symptoms of fever, cough, and shortness of breath that gradually build (in contrast to influenza, which typically hits hard and fast). This week, the Centers for Disease Control and Prevention (CDC) officially added six other symptoms commonly seen with the coronavirus, including: loss of taste and smell, chills, shaking chills (rigors), headache, muscle aches, and sore throat. In addition, the medical community has seen patients with Covid-19 present in other ways, including with:

  • Gastrointestinal symptoms, such as diarrhea.
  • Acute abrupt symptoms with significantly low oxygen levels.
  • Heart attacks, strokes and clots to the lungs, which we think is a result of a “cytokine storm,” which leads to a cascade of reactions within the body leading to blood clot formation.
  • “Covid toes,” or bruised-appearing toes in children who otherwise appear well, related to the hypercoagulable state (abnormal increase in blood clotting) caused by Covid.
  • No symptoms or mild symptoms, which can occur in a fairly large percentage of people.

Doctors are also learning more about how different medications or therapies might help or hurt those with Covid-19. Some hospitals are beginning to use a passive antibody therapy called convalescent sera, or the serum from a patient who has recovered from Covid-19 and thus has formed the protective antibodies against the virus. Limited data from China has shown that this may reduce the viral load in the recipient and is safe overall, though more data is needed. Those who have been diagnosed with Covid-19 and who are past 28 days of recovery may donate plasma for this therapy, provided they have high levels of antibody and no evidence of residual Covid-19.

You may have also heard of the malaria drugs Chloroquine and Hydroxychloroquine as possible treatments for the coronavirus. While initial studies from China and France showed decreased viral loads in patients treated with these drugs, data from studies in Brazil and the U.S. have shown increased deaths with these treatments. The concern is that the medications can cause heart rhythm disturbances. Studies are ongoing in hospital settings where heart monitoring is available. Bottom line: these medications should NOT be used at this time unless they are part of an inpatient clinical trial.

Other medications that are being looked at, but are currently considered not effective or potentially dangerous, include Tamiflu, Lopinavir/Ritonavir, and Corticosteroids. Another medication, Remdesivir, is an antiviral that is currently in clinical trials.

Finally, I’d like to address a few common questions I’ve heard about other medications. Some have said that taking NSAIDs, such as ibuprofen or naproxen, can increase the severity of Covid-19. Presently, there is no convincing evidence that NSAIDs are especially dangerous for patients with Covid-19, although these medications can cause gastrointestinal bleeding and kidney dysfunction in anyone. This could be problematic in a critically ill person with or without Covid-19. A prudent alternative would be to take Acetaminophen (Tylenol/Paracetamol) for fever and/or pain until there are controlled studies to fully define this.

There have also been theories that ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin receptor blocker), medications that lower blood pressure, protect the kidneys, and preserve heart function, can worsen Covid-19.  We know that people with these conditions tend to have worse outcomes with Covid-19 infections, but there is no evidence to show that the medications have a detrimental effect. Both the American College of Cardiology and the American Heart Association advise that people on these medications continue to take them. Bottom line: consult your doctor regarding any medication questions.

I will continue to provide weekly updates, and welcome you to send me your questions related to Covid at tmclarney@wesleyan.edu.

Be well and stay safe,

Tom McLarney