July 24th Breaking News: Masks, Vaccines, and Hydroxychloroquine Again
Mel Herbert, MD and Anand Swaminathan, MD
References:
Masks:
Chu, D et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. https://doi.org/10.1016/S0140-6736(20)31142-9
Vaccines:
Zhu, F et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a randomised, double-blind, placebo-controlled, phase 2 trial. https://doi.org/10.1016/S0140-6736(20)31605-6
Folegatti, P et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. https://doi.org/10.1016/S0140-6736(20)31604-4
New York Times: Coronavirus Vaccine Tracker
Hydroxychloroquine:
Skipper, C et al. Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19. https://doi.org/10.7326/M20-4207
Cavalcanti, A et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19 DOI: 10.1056/NEJMoa2019014
Barrett M. - July 28, 2020 2:36 PM
I loved hearing you guys mention that the WHO’s early recommendations contributed to the confusion around masks, especially them saying they didn’t think asymptomatic carriage and/or transmission was a thing.
Where I work in Virginia, we are now seeing case numbers far above anything we have seen during the pandemic thus far. Despite that, I have had my Emergency Department director specifically tell me they only wear a mask when they’re in public because that is what they have been told to do, but they don’t think masks actually do anything to help. They don’t wear a mask in their office when meeting with others, or only do if you ask them to put one on. I had met them to discuss doing some targeted education refreshers for the department about PPE and how to stay safe, but ran into wall with it. I was even told, “For example: Dr. X? You’re never going to convince him to wear a mask.” This physician wears a mask in patient rooms, but not in the remainder of the department (while working within elbow distance of at least two other people at all times).
We work in an Emergency Department. We are on the front line of this pandemic, and are at incredibly high risk of exposure. I felt it deep in my soul when you said, “The people who say that, ‘It’s my right not to wear a mask,’ I just have to say: That’s not true. We live in a society. It’s not an anarchy.”
At what point does the whistle get blown? At what point does someone actually start enforcing PPE compliance? How does that happen when the department director and other medical professionals don’t believe the science? This isn’t just someone’s personal assessment of risk, of whether or not they’re willing to catch COVID. This is them risking the health of everyone around them. We now have one of our own ER physicians out sick with COVID-19, yet this type of behavior continues to run rampant.
Help!
~Virus in Virginia
Anand S. - July 28, 2020 2:39 PM
Barrett - I feel your pain. Hospital administration needs to make this mandatory. It is in my hospital. No walking around without a mask on. People still work in small offices without them on and then put them on whenever anyone else is in the office with them. Culture change is difficult.
Shu-Haur O. - August 19, 2020 3:43 PM
Writing from Melbourne (Australia) everyone is wearing a mask. We had complaints about a type of N95 which caused pressure areas - this got changed. Everyone on clinical floor is also wearing PPE (gown/ mask/ face shield) wherever they are on the floor, and then put on gloves and a removable plastic apron to see patients, after seeing patient we doff the gloves, do hand hygiene, then doff the plastic apron and do hand hygiene.
In the non clinical areas we wear mask alone. No face to face meetings of more than 4 people (funny enough meeting attendance is better via MS teams than in person ever was in the pre covid era). Only time you have mak off is when actually eating.
I suppose as Australians we don't have some of the (what I perceive) to be "cultural issues" that united states appears to have (sorry if that sounds insensitive) but to me it seems you have a group of people who cry freedom to be individuals and dismiss society requirements.
Amelia R. - July 29, 2020 6:38 PM
Hi all. Can you do an update on anti-coagulation.
Hi, I've copied a post from an ED doc on a Facebook forum. There is a lot of discussion following it about starting all Covid + patients on anti-coagulation regardless of labs or symptoms. Can you please address this issue and try to give some sage advice. What is the prevalence of this phenom. Is there any evidence to support this prophylactic use? Would starting just based on PCR +ve, or should markers be up, or CT evidence of clotting? Thank you.
----
Healthy 36yo male, diagnosed with COVID on 7/9. Was apparently mildly symptomatic at time of diagnosis and now no respiratory or GI symptoms. Comes in with BLE pain - mostly from lower abdomen to thighs, worse with movement/walking: CT A/P picks up RLL PE w/pulmonary infarct, and thrombosis of bilateral femoral veins from level of IVC down to inguinal regions. No SOB or chest pain, only leg pain. No pmhx, BMI 24.
Michael S. - August 14, 2020 5:54 AM
can you take a look at the c19study.com You referenced 2 studies that were inconclusive yet there is so much more data out there that needs to be interpreted. Thanks