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Covid-19 - Emerging treatment news thread (no politics, no tin foil hats)

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VikingsGuy

VikingsGuy

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HT has threads to discuss covid-19 effects on wall street, covid-19 humor, covid-19 effect on hunting seasons, but thought some may appreciate aggregating links (and thoughtful discussion) regarding emerging understanding of treatment/vaccine options. Let's listen and learn from one another. Disagreement is fine, but should be based on scientific critique or counter-posts, not memes, politics, generalized attacks on the pharma industry or conspiracy theory.


He is a recent article I offer for your reading:

www.wsj.com

Haywire Immune Response Eyed in Coronavirus Deaths, Treatment

An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.
www.wsj.com www.wsj.com
 
VikingsGuy said:
HT has threads to discuss covid-19 effects on wall street, covid-19 humor, covid-19 effect on hunting seasons, but thought some may appreciate aggregating links (and thoughtful discussion) regarding emerging understanding of treatment/vaccine options. Let's listen and learn from one another. Disagreement is fine, but should be based on scientific critique or counter-posts, not memes, politics, generalized attacks on the pharma industry or conspiracy theory.


He is a recent article I offer for your reading:

www.wsj.com

Haywire Immune Response Eyed in Coronavirus Deaths, Treatment

An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.
www.wsj.com www.wsj.com
Click to expand...

Interesting. Can’t access the article, but I get the gist. IIRC, that was the same mechanism that led to most mortalities associated with avian influenza H5N1 infections.
 
Hunting Wife said:
Interesting. Can’t access the article, but I get the gist. IIRC, that was the same mechanism that led to most mortalities associated with avian influenza H5N1 infections.
Click to expand...
Bummer, usually their twitter link gets past the paywall. Here is the article text:

Haywire Immune Response Eyed In Coronavirus Deaths, Treatment
Joseph Walker and Jared S. Hopkins


An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.

Much remains unknown about the path the virus takes in the sickest patients, but an increasing number of experts believe a hyperactive immune response, rather than the virus, is what ultimately kills many Covid-19 patients.

The out-of-control immune response eventually causes the patients’ lungs to stop delivering oxygen to the rest of organs, leading to respiratory failure and in some cases death, the experts say. The malfunctioning immune system may be driving the rapid decline in lung function experienced by some patients, including younger and relatively healthy ones, after the initial onset of symptoms, doctors say.

1586442260658.png

As scientists race to better understand the phenomena, pharmaceutical companies including Roche Holding AG are partnering with hospitals to explore whether drugs proven to tamp down an out-of-control immune response could help the sickest Covid-19 patients.

Some doctors are already administering the drugs to patients who are unable to breathe without the support of ventilators, or to prevent deterioration of patients who appear ready to slip into respiratory failure.

“You remove one piece of the storm, and it can quiet the whole thing,” said Kevin Tracey, president of the Feinstein Institutes for Medical Research at Northwell Health, which is testing Kevzara, an anti-inflammatory drug from Regeneron Pharmaceuticals Inc.

Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

In the most severe coronavirus patients, the disease appears to have two stages, doctors and researchers say. First the immune system fails to respond quickly or effectively enough to the virus. Then the immune response becomes too aggressive and floods the body with cytokines.

The surge of cytokines damages blood vessels and allows fluids to seep into the lungs, filling them up like water balloons, doctors say.

“The virus initiated it,” said Ya-Chi Ho, an assistant professor at the Yale School of Medicine who studies infectious diseases. “The second problem is our immune system handled it wrong, and induces this cytokine storm and clogs our lungs. That’s why patients die.”

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

On Tuesday, a federal agency that supports health research said it is committing $25 million to accelerate a late-stage study of Actemra in Covid-19 patients.

Last month, doctors from Seattle’s Swedish Health Services used Actemra to treat a 45-year-old emergency-room physician who was infected while caring for patients from a nursing home in Kirkland, Wash.

The man was transferred to Swedish and put on life support after his lungs and kidneys began to fail, said Samuel J. Youssef, a cardiothoracic surgeon at Swedish. Lab tests showed the man’s inflammation levels were 200 times greater than the normal range, indicating he might be suffering from a cytokine storm.

The doctors at Swedish decided to administer Actemra after discussing a small Chinese study that had shown that 21 Covid-19 patients with high levels of inflammation had been successfully treated with the drug.

Over the next two days, the patient’s inflammation levels began to decline and his blood-oxygen levels increased, Dr. Youssef said. After a week, he was well enough to be taken off life support on March 23, and was released from the hospital on Sunday.

“All we did was quiet the storm and support his body—his kidneys, his lungs, his heart—to give him the time to fight the virus,” said Dr. Youssef, who attributes the recovery both to Actemra as well as other interventions like being put on life support.

CytoDyn Inc., a Vancouver, Wash.-based biotech company, said 10 severely sick Covid-19 patients showed signs of recovering three days after being infused with its experimental HIV drug leronlimab, which may block the production of inflammatory cytokines. Three of the patients were taken off ventilators, including two who have since been discharged from care, according to CytoDyn.

The company is studying its drug in a trial for patients with mild-to-moderate symptoms and expects to start one for severely sick patients.

Swedish Orphan Biovitrum AB expects results in July from a study evaluating its rheumatoid-arthritis drug Kineret in combination with an antibody called emapalumab in patients in Italy, said Milan Zdravkovic, Sobi’s head of research and development.

Novartis AG and Incyte Corp. said they plan to start clinical trials of their drug ruxolitinib in Covid-19 patients with cytokine storm. The drug, marketed as Jakafi in the U.S., is approved to treat rare blood cancers.
 
The Chinese found this out early. They found it had a very similar pathology sequence as SARS. It attacked the cilia cells in lungs and the person's immune response often attacked both the infected cells and healthy cells in an over-reaction. In the most severe cases (dead, for sure) the X-rays showed the telltale honeycomb structure from SARS. The fact that it doesn't affect younger people and does affect old may have something to do with how many different variations of viruses those people has lived through, or it may have some genetic component. There are other conditions, like Type I diabetes, where the body does the same - attacking of healthy cells. They study those quite extensively and definitive conclusions have ben evasive. The good news here is that treatments may be able to get people though the most dangerous period.
 
VikingsGuy said:
Bummer, usually their twitter link gets past the paywall. Here is the article text:

Haywire Immune Response Eyed In Coronavirus Deaths, Treatment
Joseph Walker and Jared S. Hopkins


An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.

Much remains unknown about the path the virus takes in the sickest patients, but an increasing number of experts believe a hyperactive immune response, rather than the virus, is what ultimately kills many Covid-19 patients.

The out-of-control immune response eventually causes the patients’ lungs to stop delivering oxygen to the rest of organs, leading to respiratory failure and in some cases death, the experts say. The malfunctioning immune system may be driving the rapid decline in lung function experienced by some patients, including younger and relatively healthy ones, after the initial onset of symptoms, doctors say.

View attachment 135281

As scientists race to better understand the phenomena, pharmaceutical companies including Roche Holding AG are partnering with hospitals to explore whether drugs proven to tamp down an out-of-control immune response could help the sickest Covid-19 patients.

Some doctors are already administering the drugs to patients who are unable to breathe without the support of ventilators, or to prevent deterioration of patients who appear ready to slip into respiratory failure.

“You remove one piece of the storm, and it can quiet the whole thing,” said Kevin Tracey, president of the Feinstein Institutes for Medical Research at Northwell Health, which is testing Kevzara, an anti-inflammatory drug from Regeneron Pharmaceuticals Inc.

Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.

Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.

As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients, doctors say. Genetics may be a factor.

In the most severe coronavirus patients, the disease appears to have two stages, doctors and researchers say. First the immune system fails to respond quickly or effectively enough to the virus. Then the immune response becomes too aggressive and floods the body with cytokines.

The surge of cytokines damages blood vessels and allows fluids to seep into the lungs, filling them up like water balloons, doctors say.

“The virus initiated it,” said Ya-Chi Ho, an assistant professor at the Yale School of Medicine who studies infectious diseases. “The second problem is our immune system handled it wrong, and induces this cytokine storm and clogs our lungs. That’s why patients die.”

Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.

Drugs targeting specific cytokines rather than the entire immune system may be more effective, doctors say.

Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.

On Tuesday, a federal agency that supports health research said it is committing $25 million to accelerate a late-stage study of Actemra in Covid-19 patients.

Last month, doctors from Seattle’s Swedish Health Services used Actemra to treat a 45-year-old emergency-room physician who was infected while caring for patients from a nursing home in Kirkland, Wash.

The man was transferred to Swedish and put on life support after his lungs and kidneys began to fail, said Samuel J. Youssef, a cardiothoracic surgeon at Swedish. Lab tests showed the man’s inflammation levels were 200 times greater than the normal range, indicating he might be suffering from a cytokine storm.

The doctors at Swedish decided to administer Actemra after discussing a small Chinese study that had shown that 21 Covid-19 patients with high levels of inflammation had been successfully treated with the drug.

Over the next two days, the patient’s inflammation levels began to decline and his blood-oxygen levels increased, Dr. Youssef said. After a week, he was well enough to be taken off life support on March 23, and was released from the hospital on Sunday.

“All we did was quiet the storm and support his body—his kidneys, his lungs, his heart—to give him the time to fight the virus,” said Dr. Youssef, who attributes the recovery both to Actemra as well as other interventions like being put on life support.

CytoDyn Inc., a Vancouver, Wash.-based biotech company, said 10 severely sick Covid-19 patients showed signs of recovering three days after being infused with its experimental HIV drug leronlimab, which may block the production of inflammatory cytokines. Three of the patients were taken off ventilators, including two who have since been discharged from care, according to CytoDyn.

The company is studying its drug in a trial for patients with mild-to-moderate symptoms and expects to start one for severely sick patients.

Swedish Orphan Biovitrum AB expects results in July from a study evaluating its rheumatoid-arthritis drug Kineret in combination with an antibody called emapalumab in patients in Italy, said Milan Zdravkovic, Sobi’s head of research and development.

Novartis AG and Incyte Corp. said they plan to start clinical trials of their drug ruxolitinib in Covid-19 patients with cytokine storm. The drug, marketed as Jakafi in the U.S., is approved to treat rare blood cancers.
Click to expand...
To me this kind of medical information is what is earned by buying time.
 
www.ksbw.com

New California antibody study could point to possible herd immunity to COVID-19

The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state's lower than expected case numbers.
www.ksbw.com www.ksbw.com

MONTEREY, Calif. —
Researchers at Stanford Medicine are working to find out what proportion of Californians have already had COVID-19. The new study could help policymakers make more informed decisions during the coronavirus pandemic.

The team tested 3,200 people at three Bay Area locations on Saturday using an antibody test for COVID-19 and expect to release results in the coming weeks. The data could help to prove COVID-19 arrived undetected in California much earlier than previously thought.

The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state's lower than expected case numbers.
 
I know Wiki isn’t the perfect information source, but it appears as though “cytokine storms” have been implicated in the Spanish flu of 1918 as well. It’s not exactly a new mechanism by which people die from respiratory viruses.

en.m.wikipedia.org

Spanish flu - Wikipedia

en.m.wikipedia.org en.m.wikipedia.org
 
ImBillT said:
I know Wiki isn’t the perfect information source, but it appears as though “cytokine storms” have been implicated in the Spanish flu of 1918 as well. It’s not exactly a new mechanism by which people die from respiratory viruses.

en.m.wikipedia.org

Spanish flu - Wikipedia

en.m.wikipedia.org en.m.wikipedia.org
Click to expand...

The mechanism has likely been around for as long we’ve had an immune system. But our recognition and understanding of it is relatively recent and incomplete.
 
A new hope for stimulating a “correct” response to Covid-19 infection with BCG immunization and observations that those who have had BCG immunization, even a long time ago, have more resistance and lower morbidity/mortality rate.

www.medrxiv.org

Connecting BCG Vaccination and COVID-19: Additional Data

The reasons for a wide variation in severity of coronavirus disease 2019 (COVID-19) across the affected countries of the world are not known. Two recent studies have suggested a link between the BCG vaccination policy and the morbidity and mortality due to COVID-19. In the present study we...
www.medrxiv.org www.medrxiv.org

As one who lived in Africa and received multiple “unusual” immunizations and potential exposure to “weird” diseases, this has peeked my interest.
 
Last edited:
LWC55 said:
www.ksbw.com

New California antibody study could point to possible herd immunity to COVID-19

The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state's lower than expected case numbers.
www.ksbw.com www.ksbw.com

MONTEREY, Calif. —
Researchers at Stanford Medicine are working to find out what proportion of Californians have already had COVID-19. The new study could help policymakers make more informed decisions during the coronavirus pandemic.

The team tested 3,200 people at three Bay Area locations on Saturday using an antibody test for COVID-19 and expect to release results in the coming weeks. The data could help to prove COVID-19 arrived undetected in California much earlier than previously thought.

The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state's lower than expected case numbers.
Click to expand...

We started testing IgM and IgG markers in office yesterday and have done 30 by the end of the day today and turned many away. I'm reaching out to see if they want our data as they have Los Gatos as a testing site which is where we are located.
 
jryoung said:
We started testing IgM and IgG markers in office yesterday and have done 30 by the end of the day today and turned many away. I'm reaching out to see if they want our data as they have Los Gatos as a testing site which is where we are located.
Click to expand...
Do you get the results right away? Small sample, but seeing any patterns?
 
Interesting. There is a lot left to learn about the virus, but it appears mass testing, combined with a more surgical approach to isolating cases and widespread antibody testing after the fact would not only help with overloading healthcare systems, but also allow time to get answers AND stimulate the economy at the same time.
www.fastcompany.com

Utah is running mass COVID-19 tests: Why aren’t other states?

The state is testing anyone with symptoms and will soon start randomized testing to try to get a real sense of the spread of the virus.
www.fastcompany.com www.fastcompany.com
 
Both my most recent link and MtnHunter's are a bit of a mix between medical, economic and policy. I think they both are useful for this thread, but let's all avoid this thread turning into economic policy and political finger pointing as other threads have had a tendency to go down. The focus needs to remain on the clinical treatment side, not generalized modeling arguments, the pros/cons of social distancing or "is the economic cure worse than the disease" debate.
 
Incoming . . .

www.physiciansweekly.com

Upcoming Clinical Trials, COVID-19 - Physician's Weekly

BioPortfolio abreast of clinical trials for COVID-19 on the horizon COVID-19 Ring-based Prevention Trial With Lopinavir/Ritonavir COVID-19 has rapidly evolved into a generalized global pandemic. Post-exposure prophylaxis (PEP) against on COVID-19 was identified as an urgent research priority by...
www.physiciansweekly.com www.physiciansweekly.com
 
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