In a paper published in JAMA, investigators from China treated five critically ill covid-19 patients with plasma donated from patients who had already recovered from SARS-CoV-2. “Convalescent plasma,” as it is known, contains antibodies that the body manufactures in bulk when fighting an infection. After the infection, the body maintains a stock of “memory cells.” Some antiviral antibodies circulate in blood, like molecular surveillance drones. If the infection re-appears the antibodies spring into action. Convalescent plasma was previously used in SARS in 2003 and H1N1 in 2009 with varying degrees of success. Patients in this study all had confirmed infection, severe pneumonia with acute respiratory distress requiring mechanical ventilation (breathing machines), and had not responded to other antiviral treatment. All patients received convalescent plasma between ten and twenty-two days into the course of their illnesses. The most important results were reported: four of five patients had substantial improvement in their breathing while using mechanical ventilation within 12 days. Three of five patients were discharged from the hospital; the remaining two are in stable condition. The real question is: did convalescent plasma therapy for critical covid-19 infection improve outcomes? Answer: hard to say. This was a non-randomized study in five patients with a disease that often improves on its own. The mainstay of treatment is “supportive care,” including helping patients get enough oxygen while their body fights off the infection. However, without a control group for comparison (or other statistical methods to make sense of the findings), we cannot say with any certainty whether the convalescent plasma helped the patients or intensive supportive care helped the patients or not. A placebo-controlled clinical trial would be better able to provide answers to this question.
Faced with shortages of personal protective equipment (PPE), hospitals are adopting very different policies about who should wear protective gear and when. In Boston, where the Boston Globe reported Thursday that more than 160 hospital employees had tested positive for coronavirus, the Mass General Brigham hospital system, which includes Massachusetts General Hospital and Brigham and Women’s Hospital, said that all employees must wear face masks “at all times while on facility premises.” Meanwhile, Brief19 has received reports from frontline staff in other hospitals, including University of Texas Southwestern that face masks are being limited only to employees considered to work in “high risk” areas and those employees working in areas not considered to be at “high risk” are actively being instructed to remove them. Meanwhile, President Trump had resisted using the Defense Production Act, a Korean war-era law, to compel companies to produce supplies like face masks, though he finally announced plans too ask General Motors to produce mechanical ventilators. You can join alongside healthcare workers in finding and making PPE by going to www.getusppe.org. Boston Globe.
After a week of negotiations, President Trump signed a $2 trillion stimulus package into law yesterday afternoon. The legislation is the third and final piece of the covid-19 relief package. Highlighted below are some of elements, buried amongst 880 pages, that stand to benefit the health care sector: Paycheck Protection Program: Businesses with less than 500 employees have access to $350 billion in loans to cover payroll and administrative costs; Hospital Funding: $100 billion of direct support to hospitals; Medicare: Several measures have been taken, including increasing the reimbursement rates for covid-19 hospitalizations by twenty percent during the crisis, suspending the sequestration through December 31, 2020, and expanding the Medicare Hospital Accelerated Payment Program; General insurance changes: Allowing more flexibility in reimbursement, face-to-face requirements for telehealth services have been waived, payers are required to cover SARS-CoV-2 testing; The Strategic National Stockpile: $16 billion was set aside to purchase PPE to augment existing equipment and supplies in the Strategic National Stockpile, as well as $1 billion under the Defense Production Act. It appears that the bill prioritizes money being made available for operational costs and supplies while burdensome restrictions are being lifted to allow for more flexible provision of care. New York Times.
Physicians and scientists have been frustrated by the lack of data available about the spread of covid-19. How many cases are there? Where are those cases? There has been talk of the National Institutes of Health creating a database, but it has yet to be seen. In the meantime, yesterday, the New York Times released the most granular data set to date. It is available to download. New York Times.