Sept. 10, 2020 -- This past spring, health care providers at hospitals around the country scrambled to treat people who were critically ill with a virus they’d only just heard of themselves. Usually, when a severely ill person arrives at the hospital, doctors already know or can quickly find established guidelines, based on years of research, for treating the sickness. But in the spring of 2020, nothing was established about COVID-19.

Coronavirus in Context: How COVID Devastated My FamilyWebMD's Chief Medical Officer, John Whyte, speaks with Joe Fusco, Survivor of Coronavirus, about how COVID devastated his entire family.607

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JOHN WHYTE: You're watching

Coronavirus in Context.

I'm Dr. John Whyte,

the chief medical officer

at WebMD.

Coronavirus certainly has had

an impact on many families.

My guest today is Joseph Fusco.

Five members of his family

have died from COVID-19.

Even more have been impacted.

Mr. Fusco is here today

to-- to help explain what's

happened,

as well as how we might be

able to-- to stem this pandemic.

Joe, thanks for joining me.



JOE FUSCO: Thank you for having

me.

I appreciate it.



JOHN WHYTE: Take us back to when

this first happened

several months ago.

How-- how did it all unfold?



JOE FUSCO: Well, my one brother,

Vinny, who we suspect kind of

brought it around, had--

he had been

sick for like a month.

He's-- you know, he said I got

a cold, I got this.

And then, uh, it moved to, like,

March 4th, we were at my parents

house, and he wasn't there,

actually.

He wasn't there.

My-- my older brother, Carmine,

who had-- who is deceased now,

he said-- we were just sitting

there, and he said,

I feel a chill.

Is anyone else chilled?

[INAUDIBLE] no one's

[? chilled. ?]



So we sat down.

He came back, when he came back

to my house, he went right

to bed.

I woke up that next morning,

and I was beat up.

I felt like I ran over by a bus.

I couldn't move.

And I'm never like that.

[INAUDIBLE] I can't remember

last time I was ever like that.



JOHN WHYTE: Mhm.



JOE FUSCO: I texted all

my family members, I said, hey,

anyone feel like this? [? And ?]

[? everyone-- ?] and he said,

no, I feel good.

I said, Carmine, you said you

got the chills.

He goes, yeah.



JOHN WHYTE: Were you even

thinking COVID?

Did that even come

into your mind?



JOE FUSCO: Well, it did

because the next day I went

to the doc.

Called the doctor to see if I

could get in, and the next day I

went to the doctor, my doctor,

and said, you know, I--

I just felt so bad.

She was like, listen,

I'll check you out,

I'll listen to your lungs.

You're fine.

Whatever you had,

it was probably going

through you.

I said, yeah,

but with this COVID going

around,

is there any possibility?

She's like, I'll check you out.

You're-- you're fine.



JOHN WHYTE: Mhm.



JOE FUSCO: The next day was,

uh-- the following day was

a Friday.

I didn't feel totally better,

but I was better.

I-- I-- you know, I wasn't beat

up like I was on the Wednesday.

And then Saturday and Sunday,

I wasn't feeling good.

I knew something was up.

I was feeling it.

And Sunday, we went to my mom's

house to my niece's birthday,

her 30th birthday, and I stayed

away from everybody.

Monday, I went back

to the doctor, and she said,

nah, you-- you're all right.

She gave me a z-pack

or something, something for--



JOHN WHYTE: OK.



JOE FUSCO: --my ear.

And, uh, it just didn't feel

right.

The next day was Tuesday.

And then, you know,

I got reports from my mom

and my sister.

You know, they really weren't

feeling well.

And I went over there,

and I-- and I looked at them

and I said, you guys gotta

go to the hospital.

We've gotta take you.

And my mom didn't want to go

to the hospital.

She-- you know,

ever since my dad passed three

years ago, she's skittish.



She didn't want to go.

So we got her to go.

I brought her and my older

sister, who passed,

and I brought them

to the hospital.

Me and my other two sisters,

Toni and Maria,

we went to the clinic.

The clinic took x-rays

of my sister Maria

and they said, no, you got

something in your lungs,

you gotta go.

Me and my sister Toni,

they checked us out,

they said, nah, you're fine.

They listened to us, they're

fine.



Wednesday came along.

Me and my sister Toni

weren't-- still weren't feeling

well.

We went back to that clinic.

And she said, no, you're--

[INAUDIBLE] you're-- you're

fine.

You-- you look good [INAUDIBLE].



JOHN WHYTE: Are you getting

frustrated by this?

You keep going to the doctor,

and they keep saying you're

fine.



JOE FUSCO: Yeah.

And so the next day, we--

we went there, and the lady said

you're fine.

And she said, but I told you,

if you didn't feel good,

go to the hospital.

OK, good idea.

So we went to the hospital.

The hospital checked me out.

They said, oh, your lungs are

good, [INAUDIBLE] you sound

good.

We're gonna take an x-ray.

They took an x-ray of me

and said, you know what, we're

gonna admit you.

We don't like the way

your x-rays look compared

to your other x-rays, because I

had melanoma, so I have

a history of x-rays--



JOHN WHYTE: Mhm.



JOE FUSCO: --for-- for a while.

And, uh, basically then all hell

broke loose.

The next thing I know,

the following morning--

the Friday morning, I got word

that my older sister had passed,

the one that went

to the hospital with my mom.

And I-- that-- you know,

I got that word.

And-- and at that point,

you know, I was very upset

and very lost,

but it was shortly thereafter

where I told the doctors,

I can't do this no more.

I can't breathe.

It's-- it's-- it's too tough.

And they said, good, we'll put--

we're gonna put you

on a ventilator.

It's the smartest move.

And--



JOHN WHYTE: And you were

on a ventilator for 30 days,

is that right?



JOE FUSCO: 30 days

I was on a ventilator.

I woke up on Easter Sunday.

They took me off.



JOHN WHYTE: And then

during that time, other family

members passed away?



JOE FUSCO: Well, shortly

thereafter, my-- my--

my older brother, Carmine,

the one that had gotten

the chill on that--

that night at my mom's house,

he passed.

The dates I'm still

sketchy about,

but it was within, you know,

the following probably

Wednesday or whatever.

And then a day later, my mom

passed, and two days later,

or maybe the next day, my--

my brother Vinny passed.



JOHN WHYTE: Wow.

I'm sorry to hear that.

How is everyone doing?

How are you doing?

How's the rest of your family?



JOE FUSCO: You know, me,

emotionally,

I was always prepared

for my parents to die.

My dad passed three years ago.

My mom-- my mom

wanted to be with my dad.

So it was no shock that she

went.

And she wanted to be with him.

I wasn't shocked.

Waking up-- hearing my sister

passed, and then waking up

and my brothers were gone,

it's rough.

I still-- I miss them.

I-- I can't make sense of it,

but it's life.

And preparing myself

for my parents to die my whole

life, it-- it-- it's helping me

along that--

that I was able to do that.



JOHN WHYTE: Now, the media kind

of used your story early on

to kind of give

this cautionary tale

about gatherings.

But there's also been

some developments in terms

of looking at the genetics,

is that right?

And in terms of trying to look

at some genetic analysis

and-- and DNA that they're now

taking from toothbrushes

and hairbrushes.

Is that right?



JOE FUSCO: Yes.

The Johns Hopkins is doing

a genetic study.

I mean, it's not

an overnight study.

I mean, from what we're told,

this is a couple years study.

We'll get bits and pieces

as they go along,

but the large part of it,

any breakthrough

is not gonna

be around the corner.

But yes, they are doing

a genetic study, because they

feel it's more than--

this is just crazy what

happened, that four members,

and my mom's sister,

would pass like-- like the way

they did.



JOHN WHYTE: So there's something

going on here,

as well as-- other than just

transmissibility.

Um, Mr. Fusco, you wanted

to-- to comment and tell

your story, and you've talked

about that you get mad when you

see people aren't wearing masks

and, you know,

social distancing.

Talk to us about what we all can

learn from--

from your story that, you know,

we all feel very sorry for what,

you know, you've

had to experience.



JOE FUSCO: I--

I'm very angry at-- at whoever

it is.

I mean, the president, Pence.

And I'm a Republican, so don't

take that the wrong way.

Um, everyone who's using this

as a political ploy.

People out there, young kids who

they haven't been thrown

into this tragedy.



JOHN WHYTE: Mhm.



JOE FUSCO: I mean, all-- all

they're seeing is, no, I'm not

sick, I'm--

I'm-- I'm not sick, why should I

wear a mask?

Because you're-- you're

spreading this.

You're helping it spread.

And the worst part is you're

bringing it to people that are

susceptible to happen to what

happened to my family.

You know?

The-- the older people,

the younger kids, which god

bless that we haven't seen

younger kids dying.

God-- I mean, the one thing we

have to thank god for is that.



JOHN WHYTE: Mhm.



JOE FUSCO: They-- they never had

a chance to live.

And-- and these people are

out there, and they don't care

about that.

That's just ridiculous.

Our future they don't care

about.

It's-- it's sickening.



JOHN WHYTE: What's the message

you have to them?



JOE FUSCO: Just wear a mask.

Follow protocol.

There's not a giant government

conspiracy to get you to wear

a mask.

No one got options on masks

and they're cashing in right

now.

Wear a mask.

It's gonna stop the spread.

At least, it's gonna help

the spread a hell of a lot.

You know, we-- we need help

as a society.

This is a pandemic.

This is affecting every one

of us.

When this all started,

they said it's gonna affect

everyone on this earth,

and it's going to.

I don't believe that it won't.

I believe it will eventually hit

everybody.



JOHN WHYTE: You donated

your plasma to help out.

Why'd you decide to do

that after this tragedy

you've experienced?



JOE FUSCO: Well, I would have

done it anyway,

but the day I woke up,

I was given plasma.

The doctors don't know if it

helped me.

They don't know if it harmed me.

But one thing's for sure--

I'm here.

I woke up after 30 days.

I'm here.

I'm-- I'm getting healthier

every day.

And I don't ever want this

to happen to somebody else's

family.

If I can help someone else

survive, and their family be

good and their family be whole,

then that's what I want to do.



I mean, it's just tragic what we

went through.

We were-- we were 11 kids,

and we were always together.

And my parents, we were always

there.

And till three years ago when

my dad passed, we never--

nothing-- you know, people died,

but us 13, our core,

we were there.

And-- and we had so many

auxiliary family members

that would be there.

And we-- we were always there.

And this now, five of us gone,

is unbelievable.

It's unbelievable.



JOHN WHYTE: Mhm.

Well, Mr. Fusco, you know,

I'm sorry to hear

about your tragedy,

but I also want to thank you

for-- for sharing your story,

for providing your insights,

for helping others

with the donation,

you know, of your plasma, and--

and the messaging

that you're giving to viewers.



JOE FUSCO: Thank you.

I appreciate you taking the time

and having my voice heard.



JOHN WHYTE: And thank you

for watching Coronavirus

in Context.

John Whyte, MD, MPH. Chief Medical Officer, WebMD, Joe Fusco, Survivor of Coronavirus/delivery/aws/bd/75/bd75b8ae-7081-3ac6-a946-0836ef728892/Fusco_081120_,4500k,2500k,1000k,750k,400k,.mp408/17/2020 15:28:0018001200Fusco_080720_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Fusco_080720_1800x1200.jpg091e9c5e81fa2912

“It was a dramatic situation. We had a lot of sick people, in a very short period of time, and it was overwhelming to take care of them. There was an almost irrational exuberance to try any treatment that we could think of,” says David Kaufman, MD, director of medical intensive care at New York University Langone Health in New York City.

While doctors may have at times rushed to try anything, that trial and error over the last 6 months has helped accumulate the scientific evidence of what works and what doesn’t in the treatment of COVID-19.

“The ability of the medical community to pull together quickly to get these large critical care studies done in a very short period of time with reliable, high-quality results is amazing,” Kaufman says. “It’s like being in a wartime economy when all automobile and refrigerator factories convert to make tanks and planes.”

The Case for Steroids

At the start of the pandemic, doctors didn’t have a go-to medication they could give to critically sick COVID-19 patients admitted to their ERs and ICUs. Today, corticosteroids are that medication. Last week, on the heels of several scientific studies that supported the move, the World Health Organization (WHO) released its official recommendation that people with severe COVID-19 receive steroids to improve their chances of survival.

“Low-dose steroids for 10 days or until the patient is discharged, whichever one comes first, can actually help with symptoms, can avoid escalating to a ventilator, and can lower the risk of death,” says Javier Lorenzo, MD, a critical care anesthesiologist at Stanford Hospital and Clinics in Stanford, CA.

That’s because steroids act as anti-inflammatories. The worst cases of COVID-19 are marked by extreme inflammation that doesn’t let up. A little inflammation at the beginning of a viral infection helps fight it off. But in serious cases of COVID-19, the inflammation gets out of control and can eventually lead to organ failure and death.

“Steroids may not be good for people who have only had the infection for a few days because they may actually limit the body’s ability to fight infection,” Kaufman says. “But in people who are critically ill because of over-inflammation, steroids help put a lid on it.”

Growing Evidence for Remdesivir

In May, the FDA authorized hospitals to give remdesivir to adults and children with severe COVID-19. In late August, the agency expanded that authorization to anyone hospitalized with the virus.

In a study of 1,063 adults in the hospital with COVID-19, the ones who got remdesivir recovered in about 11 days compared to about 15 for those who got a placebo.

“This data is not quite as robust as it is for steroids,” Lorenzo says, “but we know that patients who get remdesivir can experience faster resolution of symptoms, shorter duration of hospitalization, and be less likely to need a ventilator.”

Controversy Over Convalescent Plasma

Also in late August, the FDA granted health care providers emergency use authorization for convalescent plasma in the treatment of COVID-19.

Coronavirus in Context: Do Antibodies Provide Protection?WebMD's Chief Medical Officer, John Whyte, speaks with Alexander Greninger, MD, PhD, Assistant Director of the UW Medicine Clinical Virology Laboratory, University of Washington, about the effectiveness of antibodies for COVID-19 immunity and transmission.673

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JOHN WHYTE: You're watching

Coronavirus in Context.

I'm Dr. John Whyte,

chief medical officer at WebMD.

What's the role of antibodies

against coronavirus infection?

It's one of the biggest

questions

that we've had over the past six

months.



To provide some insight,

I've asked Dr. Alexander

Greninger, a virologist

from the University

of Washington, to join me.

Dr. Greninger, thanks for taking

time to speak today.



ALEXANDER GRENINGER: Thanks

for-- thanks for having me.

It's great to be here.



JOHN WHYTE: Now there was a very

interesting study from a fishing

vessel that leads us to believe

that perhaps antibodies can

provide protection

against COVID infection.

Can you tell us

about this study?



ALEXANDER GRENINGER: Sure.

So, uh, we're the Clinical

Virology Lab at the University

of Washington Medical Center.

We've done about 600,000,

620,000 tests so

far for PCR tests for COVID

as well as about 50,000

serology tests.



JOHN WHYTE: Wow.



ALEXANDER GRENINGER: Serology

doesn't have much

of a penetration, uh,

compared to the PCR tests.

People are much more interested

in ac--

testing for active infection.



Um, and so we do a lot

of testing for different groups,

um, and we were doing testing

for the fisheries,

uh, trying to prevent outbreaks

on boats.

Uh, and on a couple

of the-- the-- the fishery

boats, there-- there were

outbreaks.

In this one in particular,

there was, uh, an outbreak that

affected 85% of the individuals

on board.

Then with that high attack

rate-- this was in May.

And with that higher attack

rate, that allows you to get

statistical significance

with not a lot of people

if you're looking at protection.



And since we had blood

from individuals before they got

on the boat

and we had follow up over,

you know, 30 days after they got

off the boat,

we were able to look

at correlates of protection

before they got on the boat.



And, um, sure enough we saw that

the three individuals who had

neutralizing antibodies-- now we

don't necessarily know they had

prior infection, but presumably

they had prior infection--

that neutralizing antibody

titers that weren't super high,

they did not get infected

on the boat.

And they are the only three

people who had those-- uh,

those antibodies,

based on our algorithm.



JOHN WHYTE: What does this tell

us about the presence

of antibodies and infection?

This has been one of the biggest

debates for the past six months.



ALEXANDER GRENINGER: Well, it

says that they're a correlative

of protection, which means

that they are a correlative.

So you're not actually proving

that the antibodies are-- are--

doing-- are doing the work.

But, uh, you know, basically

from sort of analogy,

we sort of use different,

uh, levels of evidence

and causality here based um,

uh, on [? some ?] analogy as

well as our prior experience,

we think that antibodies are

going to have a role here.



And here we show that they were

statistically, uh, significant

and associated with protection

from the virus.

So, yeah, I think that, based

on the overall evidence,

I'd be pretty comfortable saying

the antibodies are definitely

associated and probably

protective.

And then the next questions

become, like, how long, right?

How long [INAUDIBLE]?



JOHN WHYTE: We don't know

that yet, do we?



ALEXANDER GRENINGER: Yeah.

That takes time--



JOHN WHYTE: Yeah.



ALEXANDER GRENINGER: --right?

So--



JOHN WHYTE: What's your best

guess as a virologist?



ALEXANDER GRENINGER: Woo.

That's a tough one, I mean,

right?

So people-- so it's going--

the-- the-- the hedge,

right, is it depends.

Um, and the reason it depends is

because we see, you know,

somewhere between a 50-

to 100-fold difference

in the titers in--

of antibodies that people

generate after infection.

Uh, so you see

that big diversity of response.

And so if you're going to see

some declining titers over time,

you would expect it really

depends on how high you started,

and so it's going depend

on different individuals.



So, you know, we're starting

to see-- we've seen some reports

out of Europe and Hong Kong

and I think we've seen

a few cases too, uh, potentially

of reinfection.

Those are individuals probably

infected, you know, at least,

uh--



JOHN WHYTE: Well, I want to ask

you about that--



ALEXANDER GRENINGER: Yeah.



JOHN WHYTE: --reinfection.

Those were people

with moderate disease, right?

In your study that you looked

at, these were people with low

to moderate titers, that

measurement for-- for--



ALEXANDER GRENINGER: Yeah.



JOHN WHYTE: --people in terms

of how many antibodies, yet they

still were protected.

So what-- what are you thinking

about reinfection?

Do you think

it's-- it's possible?

And I'm still going to push back

on you in terms of how long

you think--



ALEXANDER GRENINGER: Oh,

of course.



JOHN WHYTE: --antibodies may

provide protection for [? us. ?]



ALEXANDER GRENINGER: So I think,

you know,

if I had to throw a number

on it, I'd say probably

about six months you should be

able to get, um, out

of protection.

And then, you know,

basically the coronavirus

is, especially

for significant infections

where you drive those titers

quite high, uh, you're looking--

you would be looking at year--

a couple years.

Um, and so--



JOHN WHYTE: So more antibodies

probably means more protection,

for those folks that--



ALEXANDER GRENINGER: I-- I think

I'm--



JOHN WHYTE: [INAUDIBLE]

virology.



ALEXANDER GRENINGER: Yeah,

that's what we'd see

from other viruses, that titer

matters.

And so the higher titer

you start, then the longer

you're going to be protected.



JOHN WHYTE: Do you think

reinfection occurs?



ALEXANDER GRENINGER: Uh, yeah.

I'm-- I-- I'd bet it does.

I mean, it's-- we have

individuals who, on mild

infections-- we even 10% people

sometimes-- this is not our work

but other people's work showing

that 10% of people don't really

show a very strong immune

response at all in mild

infection.

And so those people would be

at a much higher risk

for, uh, for reinfection.

Now, typically

those reinfections are milder.

They're asymptomatic usually.

There's some memory response

that gets-- gets-- gets jolted,

and there's also some antibody,

and there's some T cells.

So, you know, it's all--

it's all--

that's all good news.



It's just really going to be

how high can we drive the titers

in these vaccine studies,

and how long lived are they?

And so I feel pretty

confident and optimistic

in the vaccines,

especially because we're not

having to fight against much

genetic diversity,

uh, of the virus,

really just having to fight

against--



JOHN WHYTE: In terms of mutate--

what about-- is the virus

mutating?

And that's not necessarily

a bad thing, correctly?



ALEXANDER GRENINGER: Oh, it's

always mutating.

I mean, so it throws down--

it throws down two mutations

a month, but the big-- the key

here is the month, right?

So it's-- it's only-- we've only

been around for 10 months

in people.



You look

at the other coronaviruses.

You look at, you know,

influenza, RSV,

other respiratory viruses,

and they've been circulating

in people for--

for hundreds of years

or in different animal hosts

that can infect people.

So there's incredible amount

of diversity.

They evolve-- some of them

evolve faster.

But even just

the other coronaviruses have

been circulating for tens

to hundreds of years in people,

and so there's a lot

of diversity.

You're having to fight

against a lot

of different strains.



JOHN WHYTE: Now help us break

this down because this can be

confusing to a lot of people.

What if the vaccine is only 50%

effective versus, say, 70%

effective?



ALEXANDER GRENINGER: The reason

people anchor on the 50% number

is because that's what the FDA

has said that's the sort

of minimal threshold, the bar

that has to be crossed for them

to authorize or approve

a vaccine,

and I think

that's a reasonable floor.



I think with six or seven shots

on goal, we'll attain that.

And it allows these companies

to move forward and invest,

and it's also

a reasonable-- like,

OK, if-- if something's not

50% effective, you know,

we probably can find another one

that's going to be

50% effective.



Let's be honest.

We've never really done this

for the coronavirus viruses.

You know, we barely made

some early candidate vaccine

for SARS and MERS.

We really haven't done it

for the other coronaviruses.

They weren't high on the list,

and, um, now we're putting all

of our attention to it,

and we're using a lot

of new modalities.



I mean, I think the--

the other silver lining

to this cloud

is that we're going to be

able to test

these different platforms,

and hopefully one or two of them

really, you know, shine through.

We're testing

some new hypotheses

around prefusion, uh, protein,

so new ways to make

these proteins, new ways

to deliver them.

New adjuvants are on board.

And hopefully one of these

will work well

and we'll be able to continue

the momentum into the rest

of the respiratory viruses.



JOHN WHYTE: When do you think

we're going to see a vaccine

that's approved

as safe and effective?



ALEXANDER GRENINGER: Yeah, uh,

that's a good question.

I think, you know--

I mean, I-- I'm-- the guy who

knows the most amount about it

is Tony Fauci, and so he says

to some [INAUDIBLE].

So why-- why would you-- why

would you go against that,

I mean, right?

You know, he's basically

practically designing

the trials.



So, you know, it's, uh, I think

that's a reasonable answer.

I think, you know, I do--

I do want to say that, you know,

compared to other viruses

such as Ebola or Zika

where there have been

recent vaccine initiatives

for sort of emerging viruses

is they sort of tailed away.

We don't talk about Zika virus

right now, right?

There aren't a ton of cases.



Uh, and, you know, that actually

complicated the vaccine trials.

By the time you rolled out

the vaccine trial, the cases

were diminishing.

Makes it harder to show that you

can prevent cases.



If we still have 30,000

to 40,000 cases or 50,000 cases

a day in the United States,

in Brazil, in South Africa,

you know, adjusted

for population, that makes--

that means that there's

a lot of cases to prevent, um,

and that makes the trials

a little easier to open, enroll,

achieve significance maybe

that first time you look

at the data.

And so it could be-- it

could be-- it could be a lot

quicker

than-- than the average vaccine

trial.



JOHN WHYTE: And in the meantime,

we'll continue to learn

about the role of antibodies,

um, and, you know,

whether or not that provides

protection.

One other quick question-- a lot

of this-- the current labs

that measure antibodies right

now, they're not measuring

neutralizing antibodies.



ALEXANDER GRENINGER: Nope.



JOHN WHYTE: Is that correct?

And that's what you looked at it

as-- as the real measure

to know, uh, about

the effectiveness of--

of, uh, antibodies.



ALEXANDER GRENINGER: Well--

well, so--

I mean, for full disclosure

here, I mean, basically we have

a clinical lab and also

Jesse's--

Jesse's lab at Fred Hutch.

And so, you know, clinical labs,

um, don't often run

neutralizing antibody tests.

Most places don't, actually.

The--



JOHN WHYTE: Is that what we

really need, though?



ALEXANDER GRENINGER: So if you

look at all

across the whole

antibody-clinical-lab spectrum,

you have two different antigens.

You have the nucleocapsid, which

wraps the genome, and you have

the spike protein, which is what

binds the cells.



Actually, most of the tests that

are done the United States

are done

against the nucleocapsid

because it's the most sensitive

assay and it's better at telling

you were you infected?



JOHN WHYTE: All right.



ALEXANDER GRENINGER: But really

what we want are antibody tests

that show that [? argon ?]

spike, the outside glycoprotein

from the virus that's involved

in attachment and entry.

And if you can get antibodies

against that, you can say more

about can you prevent infection?



JOHN WHYTE: But that's not what

current labs typically are

doing, right?



ALEXANDER GRENINGER: Yeah.

There's a mix of them.

I'd say it's like maybe--

the market is probably,

like, 75%, 80% nucleocapsid,

20% spike.

And then there's--



JOHN WHYTE: But I really want

the spike.

Is that what I [INAUDIBLE].



ALEXANDER GRENINGER: Yeah.



JOHN WHYTE: OK.



ALEXANDER GRENINGER: I mean,

I think that

for the receptor-binding domain,

uh, you want to look

at the outside of the spike,

the part that binds

the receptor.

That's what you'd like.

Um, that I think is a-- is

a-- is what's most--

most-- you're most likely going

to see in a clinical lab that

could be achievable

and will be the best, uh,

potential correlative

protection.



JOHN WHYTE: You've given us

a whole virology lesson today.

I want to-- I want to thank you,

you know,

for taking the time today,

helping us understand what is

the role of antibodies in terms

of preventing infection?

what's the risk of reinfection?

where are we on the vaccines?

We've covered a lot, uh,

and I appreciate you taking

your time.



ALEXANDER GRENINGER: All right,

thanks for taking the time

to talk to me.

Appreciate it.

Thanks for doing all this.

This is really-- the media

is so important when it comes

to this-- this pandemic.



JOHN WHYTE: And I want to thank

you for watching Coronavirus

in Context.



[MUSIC PLAYING]

John Whyte, MD, MPH. Chief Medical Officer, WebMD, <br>Alexander Greninger, MD, PhD, Assistant Director of the UW Medicine Clinical Virology Laboratory, University of Washington/delivery/aws/72/6a/726a5a3d-5caa-37c3-b60c-9307d375cdef/Greninger_082720_2_,4500k,2500k,1000k,750k,400k,.mp408/31/2020 10:41:0018001200Greninger_082720_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Greninger_082720_1800x1200.jpg091e9c5e81fbe04b

Plasma is the part of the blood that carries antibodies against viruses. In this case, the treatment uses plasma donated by survivors of COVID-19. The idea is that COVID-19 survivors have antibodies that fight the virus. Through plasma, doctors can pass those virus-fighting antibodies onto others struggling to fight the illness.

The concept dates back to at least the 1918 Spanish flu pandemic. But it’s unclear just how helpful it is in COVID-19. There hasn’t been a large, randomized, controlled clinical trial to compare the effects of convalescent plasma to placebo. Some trials are currently enrolling volunteers.

“The evidence for convalescent plasma is really weak,” Lorenzo says. “Not all plasma is equal. Not all plasma has high titers [high concentration of antibodies], and not all antibodies neutralize the virus. We’re using it, but it’s still not clear whether it’s effective or not.”

To Intubate or Not

Some critical care doctors may be holding off on intubating patients and putting them on a mechanical ventilator a little longer than they did earlier in the pandemic. Intubation requires heavy sedation and care in the ICU. Early in the pandemic, when doctors saw that patients were progressing in their need for oxygen, many erred on the side of caution and put patients on a ventilator sooner rather than later.

At the time, before doctors knew the benefits of steroids and remdesivir, the thought was that the patient would escalate and eventually need the ventilator no matter what.

“So if we did it early, rather than waiting until it was an emergency, when we could take our time donning the personal protective equipment, we would also reduce the risk of exposure to our health care workers,” Lorenzo says.

Doctors were also concerned that oxygen delivered through a tube in the nose – a step below a mechanical ventilator -- could push the virus out into the air and increase exposure risk for health care workers, too.

“But we now know that in some patients, if we give the steroids and remdesivir a little bit more time, and allow them to escalate a little further along with high-flow nasal [oxygen], we might just squeak by and not have to put them on a ventilator,” Lorenzo says.

In Stanford’s ICU, Lorenzo says, they are now confident their staff are protected. “The risk of aerosolization of the virus is real. But we now know that our health care provider infection rate is low. So if we maintain our full PPE guidelines, then the risk of transmission is low, and we might be able to prevent the patient from escalating to a ventilator.”

New research shows this may be a safe risk to take. A recent study found that there was no difference in survival rates among COVID-19 patients who went directly on a ventilator and those who were put on nasal oxygen first.

Prone to Recover Faster

Some patients on ventilators may recover faster by spending some time each day lying prone, or face down. It doesn’t work for everyone. But for those who benefit, the idea is that the face-down position may distribute oxygen more evenly throughout the lungs. Long before COVID-19, critical care providers flipped sedated patients on ventilators onto their stomachs in order to get more oxygen into their lungs.

But since the pandemic, some ICUs are trying it on patients who are awake and perhaps on the way to needing a ventilator. Numerous clinical trials in progress are examining the benefits for patients who are not yet on a ventilator but struggling to get oxygen.

“For some patients, the oxygen level goes up, but it’s not universal,” Kaufman says. “And soon after you stop lying on your stomach, the oxygen goes back down.”

Unprecedented Collaboration

On the road to finding what works, health care providers have thrown out many things that proved not to work, too.

“A lot of people were talking about hydroxychloroquine,” Lorenzo says. “But we now know, unequivocally, that we shouldn’t be using it. It doesn’t work. And it probably can cause more harm than good.”

They’ve learned what works and what doesn’t more quickly through unprecedented collaboration with their co-workers and frontline health care workers around the globe.

Under “normal” circumstances, researchers tightly guard data until it is published. “Now, some of these trials may release unpublished data if they feel that the benefit is real and substantial,” Lorenzo says.

Social media groups for critical care doctors, he says, are also more active than ever.

Kaufman is part of an email chain with pulmonologists and critical care doctors from all over the world. Many are in Europe and got intensive experience with COVID-19 months ahead of doctors in the U.S. “To be connected with some of the worldwide masters in mechanical ventilation who are at some of the hardest hit cities in the world is an amazing privilege. It’s like sitting at the foot of Sophocles, learning from the ancient masters,” he says.

But for all they’ve learned, much is still unknown. Doctors still don’t understand why some patients get through the virus after a week of mild symptoms while others escalate to a ventilator in the same amount of time. “We still don’t know how patients progress in this disease,” Lorenzo says.

But after a frenzied springtime in which many health care providers tried anything that might work, Lorenzo says, “We have learned from this pandemic that we can’t relax our scientific rigor. We have to abide by the same process of peer-reviewed clinical trials that we normally do or we can harm patients.”

WebMD Health News

Sources

David Kaufman, MD, director, Medical Intensive Care, New York University Langone Health, New York.

Javier Lorenzo, MD, Stanford Hospital and Clinics, Stanford, CA.

WHO: “Corticosteroids for COVID-19.”

News release, FDA.

New England Journal of Medicine: “Remdesivir for the Treatment of Covid-19 — Preliminary Report.”

Annals of Internal Medicine: “Meta-Analysis: Convalescent Blood Products for Spanish Influenza Pneumonia: A Future H5N1 Treatment?”

News release, University of Michigan Health.

Critical Care Medicine: “Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients.”

News release, Columbia University.

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