Eager to hear next week’s news on COVID-19 today?
“This Week in Virology, or TWIV,” the longstanding podcast that previews next week’s COVID-19 news, and that some listeners refer to “The Car Talk of Virology,” is my current obsession. Parts of the podcast use such arcane language that I admit I have also used it to lull myself to sleep.
Made up of a group of eminent virologists under the leadership of Columbia University’s Dr. Vincent Racaniello, every episode opens with the somber “This Week in Virology: the podcast about viruses; the kind that make you sick.”
The podcast gets a five-star rating, though recently there have been some complaints about it delving into politics. Racaniello says that he gets emails from “people saying keep politics out of science,” to which the group cheered the reply: “If the politicians are willing to keep the politics out of science, we certainly will.”
On the conspiracy theory that the virus came from a lab in China, Racaniello states: “The virus didn’t come from a lab, it came from a bat, and that’s the end of that, and if you think otherwise, you’re just misled and foolish, okay?”
They did an entire episode on bats, the culprits in a number of virus transmissions to humans, partly due to their being the only mammals that can fly.
The podcast features robust discussions on Covid-19 led by Daniel Griffin, a physician and leader of Parasites Without Borders. Despite the horrific increase in transmission of the virus in southern and western states, the information from Griffin was mainly positive on the treatment front this week.
He noted that the medical world has learned much in understanding the clinical course of the disease. We now understand the importance of dating when symptoms start, as we know that the second week is when serious problems can start with oxygen levels, which can be checked in the home via a $30 over-the-counter oximeter, which will indicate if the patient needs to be hospitalized.
Clotting issues follow in Week 3, with the potential of infection or super-infection in Week 4.
A patient who would have been likely to die in the early phases of the spread of COVID-19 can now be treated using alternatives to ventilators, such as “proning” or putting a patient on his/her belly to help with respiration. Anti-coagulation drugs can avoid Week 3 problems and steroids have led to dramatic improvements in survival rates.
Griffin talked about a recent patient, an elderly man who returned to New York with COVID-19 after wintering in Florida. Whereas he might have died in March, the man’s treatment more than two months later was “calm and systemic.” He was hospitalized, started on steroids and anti-coagulants, and will soon be discharged. Griffin said it was a very different experience from just a few months ago.
Other take-aways from this week’s program:
Drugs: In a Yale study, Tocilizumab used with steroids increased survival rates for patients on ventilators by 75 percent and 93 percent for those not on ventilators. African-American and Hispanic patients did even better than Caucasians. On the other hand, the much-ballyhooed drug Remdesivir has had a “limited, minor role” in combatting the disease.
Houston’s increase in cases is “looking like NYC in April… and Texas is looking like “a rocket trajectory out of control.” Pregnant women are at higher risk for needing hospitalization than women who are not pregnant.
We’re still in the first wave of the virus. We opened the states too early without a testing plan. If we can’t get control, we could see continuous waves. The return of snowbirds to the north is a concern.
The virus is not able to spread as well outdoors. There was not a big uptick from the demonstrations. The new fear is, with increased summer heat, people gathering for indoor air conditioning will lead to more cases.
There are a significant number of people who have - term symptoms, as many as 8-10 weeks with fever, and continuing fatigue and burning chest symptoms.
They don’t see a vaccine within a year and think we’ll be in the same place a year from now.
The virologists are pessimistic about Americans being able to control the onset of the virus, but optimistic on saving more lives. Care is better now; mortality is down. Many doctors know what to give and what not to give and when, and when to hospitalize. The fear is that hospitals get flooded with cases.
To the question of how other doctors treating COVID-19 will learn from his experience, Griffin noted that change is slow. There are many studies, but the typical doctor does not have enough time to study them. Eventually, institutions will evaluate studies, evidence of good practice in the US and from the WHO on successful practices in other countries, and produce new guidance.
This Week in Virology can be seen or heard here. I hope you’ll become a fan, too.
Bill Walczak is a Dorchester resident and the former president/CEO of Codman Square Health Center. His column appears weekly in the Reporter.