COVID Transmissions for 12-10-2020
Good morning! It has been 389 days since the first documented human case of COVID-19.
Just some headlines today.
As usual, bolded terms are linked to the running newsletter glossary.
Keep the newsletter growing by sharing it! I love talking about science and explaining important concepts in human health, but I rely on all of you to grow the audience for this:
Now, let’s talk COVID.
Global cases stabilizing
Globally, cases of COVID-19 are stabilizing. They remain at a high level, but they are leveling off, which is good news.
Unfortunately, the region of the Americas, led by case growth in the US but with some other countries contributing, is growing in cases against the global trend. That’s disappointing, especially because the US does not seem to have a national strategy for disease control, nor particularly much interest in developing one.
I fear that as the rest of the world gets this wave of the pandemic under control, the US will continue to see case growth and ill effects. I hope that we can try to change that story before it comes to pass.
See CIDRAP for more details: https://www.cidrap.umn.edu/news-perspective/2020/12/global-cases-stabilizing-covid-deaths-continue-climb
Tocilizumab doesn’t seem to work in COVID-19
Tocilizumab is a drug; it is what’s called a monoclonal antibody, meaning that the drug itself is a synthetic antibody that is copied many times over. This can be contrasted with a “polyclonal” antibody cocktail, which contains a mixture of antibodies against the same target but that work in subtly different ways.
Tocilizumab, which I bet I’m going to misspell at least once, targets a human protein called IL-6. IL-6 is an immune signaling protein, a cytokine, that can be inflammatory and give rise to symptoms like some of the damaging symptoms that are seen in COVID-19. For this reason, it was thought that tocilizumab might work to prevent some of the worst outcomes during COVID-19.
Yesterday, a clinical trial of tocilizumab in COVID-19 was published in The New England Journal of Medicine (technically it appears in today’s issue, but was posted yesterday): https://www.nejm.org/doi/full/10.1056/NEJMoa2028836
This was a small trial; 243 patients were enrolled. Patients with moderate disease were randomized to either tocilizumab or placebo, and then followed for whether their disease worsened. Unfortunately, tocilizumab did not seem to have an effect at preventing worsening of disease vs placebo. Rates of intubation or death was also not improved. The authors caution that due to trial design, there may be small effects, either positive or negative, that were not detected.
Still, this means that tocilizumab is probably not a viable treatment option for COVID-19, which is disappointing. Sometimes a good, science-based hypothesis doesn’t bear out in practice.
What am I doing to cope with the pandemic? This:
Pulse oximeter
This section is meant to give a break from the pandemic, but most of all to provide some peace of mind when that’s not easy to get. For this reason, we’re doing to talk about the pandemic a little bit today.
Specifically, I want to talk to you about how an immediate family member of mine recently got COVID-19. It was not a serious case, but any case can be serious, so there are some recommendations that I made, and I think there’s one I need to make sure to pass along to all of you:
You should own a pulse oximeter, just as you own a thermometer.
A pulse oximeter is a small medical device that goes on your finger and tells you the percentage of oxygen in your blood compared to the total amount that it can carry. Changes in this number can indicate problems with your lungs, heart, or circulation overall, but in the case of COVID-19, we’re interested in detecting lung problems.
If you are having problems in your lungs, you may not know it. It isn’t always obvious. A pulse oximeter offers us a way to check regularly.
This is important if you’re feeling sick during this pandemic, but it’s also important if you’re not feeling sick. A drop in blood oxygen might begin before you even notice symptoms.
This device is something to have on hand. Measurements below 95% are considered concerning. Measurements below 90% are considered extremely serious. For most people, it should be around 97 to 99%. I tend to read on the lower end of that range:
This is a small device, and it will fit in your medicine cabinet. Not only can it save your life, it can also help you relax by reassuring you that you’re not secretly developing life-threatening COVID-19. You should have one, for your peace of mind and for your health.
You might have some questions or comments of your own! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.
Join the conversation, and what you say will impact what I talk about in the next issue.
Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.
This newsletter will contain mistakes. When you find them, tell me about them so that I can fix them. I would rather this newsletter be correct than protect my ego.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
Last issue had some typos in the in-depth that I corrected online. If you read a sentence there and found it confusing, check the online edition.
See you all next time.
Always,
JS
Some phones (like my Samsung Galaxy Note 9) are able to perform the pulse oximeter function. When using the Samsung Health app, there is an option to measure your "stress level". Running that test actually provides your heart rate and oxygen level, and even provides a means of tracking your readings over time. Very convenient.
The caveat:
I compared a few readings on my phone to those I took simultaneously with an inexpensive ($35 on Amazon) pulse oximeter. In most cases, the heart rate readings were within 1% of each other, which is fine, given that heart rates can make wild swings just by doing things like looking for your pulse oximeter. However, the oximeter readings were often 2% apart, with the dedicated device showing, say, 97%, and the phone showing 95%. A few minutes later, while still simply sitting and going through emails and a good daily Covid blog, the readings were 99% and 97% respectively. Given that there is only a 5% range of acceptable percentages, a cheap pulse oximeter or your phone should only be used as a guide, and not as definitive gauge of your actual oxygen levels.