On the horizon
The most important news in healthcare: Friday, April 17th
Good morning, and TGIF (we think?). On the docket today is a promising coronavirus data readout, Trump’s guidance to reopen the country, and some thoughts on how well ventilators actually work.
Early data for promising coronavirus treatment
The pulse:
Data on remdesivir, a hotly-anticipated coronavirus treatment that is currently being tested in humans, suggests that it is effective in treating severe cases of the disease. The University of Chicago revealed in a video discussion that of 113 severe cases treated with remdesivir, “most” had been resolved in six days, and only two had caused death.
Remdesi-wha?
Remdesivir is an injectable, antiviral drug produced by Gilead, a company well known for making drugs that have advanced treatment for HIV and Hepatitis C. Remdesivir failed to have an impact on its initial target, the Ebola outbreak, in the mid-2010s, but was revived after showing promise in lab tests against the coronavirus.
How good are these data?
There are caveats: actual recovery rate statistics have not been published (yet) and we don’t have placebo results to compare. Still, the fact that only 2 out of 113, or 1.8%, of severe patients died is a big deal. For context, a study out of China estimates that currently, about half of critically ill patients end up dying.
Gilead’s stock jumped 12.7% on the news.
Wow! When is remdesivir going to be widely available?
There’s still a lot of work to be done. Gilead is hoping to release data from clinical trials with a placebo comparison at the end of April. If those trials confirm the Chicago results, the FDA will likely approve the drug for patients rapidly. Gilead has already been ramping up production, and hopes to have enough doses for one million patients by the end of the year.
Bottom line it for me.
This is the most promising news that has come out for a coronavirus treatment since the crisis began.
Photo source: NBC news
Trump outlines plan to reopen states
The pulse:
In a phone call with governors on Thursday, President Trump said that states could begin easing stay-at-home regulations and detailed three “phases” for which to restart local economies. The new guidelines apply to states where cases have been declining for two weeks and where there is sufficient healthcare support.
What it means:
The phrase “calling shots” has gotten more press since Babe Ruth predicted the location of his next homerun in 1932, with Trump on Monday stating that the “President of the US calls the shots” before reversing course with the governors last night: “You are going to call your own shots.”
The federal government likely lacked the authority or operational capability to either shut down or restart the nation: these decisions were, and will continue to be made, at a state level.
Are these new guidelines binding?
No. On the same day the guidelines were released, in fact, New York extended its shutdown to May 15, even as deaths dipped to a ten-day low.
Are we ready to reopen?
The question is state-dependent, but the public generally seems to think not. A Politico poll on Thursday found that 81% of Americans favored continuing social distancing measures as long as necessary to curb disease spread. Dr. Anthony Fauci, who has been heading up the federal government’s response, has warned that normal life is unlikely to resume before a vaccine is developed, which is at least one year away in the most optimistic estimates.
With new data showing that 22 million Americans have lost their job in the past month, however, Trump is feeling pressure to reopen the economy.
Are ventilators being overused for coronavirus treatment?
The pulse:
Some critical care physicians are starting to question whether coronavirus patients are being placed on ventilators too early and too often.
How are ventilators for coronavirus patients used right now?
Severe coronavirus patients often experience large drops in their levels of blood. Physicians frequently combat this using mechanical ventilators, devices that force oxygen into patient lungs through a ten inch tube inserted down the throat. Patients are sedated to prevent them fighting against the ventilator.
Are ventilators working?
So far, not too well. For coronavirus patients placed on ventilators in NYC, the death rate has been over 80%, which is about double the normal death rate on a ventilator. High death rates on ventilators have been reported in other countries as well. These rates may be because of the nature of COVID-19: severe cases fill the lungs with a thick yellow fluid that limits oxygen uptake even when a ventilator is being used.
What’s the downside of ventilator use?
Beyond how unpleasant the experience is for patients, the force of ventilator output may cause lung damage in a quarter of patients.
Are there good alternatives for severe patients?
Less invasive methods, like a nasal cannula (a tube placed in the nose that provides extra oxygen) or continuous positive airway pressure (CPAP), which use a face mask, are viable options. Last week, a Chinese study released data suggesting that most patients who need breathing support can be adequately treated by a nasal cannula.
Final thoughts
Hospitals have been struggling with ventilator shortages, but there may be more convenient, safer options for treatment. Muriel Garland, a professor at Harvard Medical School, sums it up aptly: “Instead of asking how do we ration a scarce resource, we should be asking how do we best treat this disease?”
Rapidfire
STAT has built a model that allows you to see a Covid-19 preparedness score for your county, as well as an estimate for when numbers will peak by region. It’s a staggering reminder of the heterogeneity in healthcare infrastructure and capabilities within the US.
The criminal trial of Elizabeth Holmes, the disgraced former head of blood testing company Theranos, will be delayed until the fall due to coronavirus concerns. Her lawyers stated that pushing forward despite the obvious safety risks was unwise. Unfortunately for their client, that advice is about ten years too late.
Sunovion Pharmaceuticals just released data from a clinical trial for a new schizophrenia drug. It may help treat a broader set of schizophrenia patients than current treatments do.
We were pleasantly surprised to read about the remdesivir results and a bit unnerved to learn how ineffective ventilators can be for the treatment of severe coronavirus. Amidst the uncertainty over how to treat the disease, we find the conversation about ending the country’s shutdown a bit premature.
Chalk a point up for the Founding Fathers for giving the states the power to make their own reopening decisions independently.
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Enjoy the weekend,
Mrinal and Serena