June 29, 2020 COVID 19 Update
Covid 19 cases continue to increase daily here in Arizona. Not including today’s numbers, we have had over 3,000 new cases a day 7 out of the last 10 days. Today’s numbers are artificially low due to a reporting glitch per the state health department.
Hospital admissions, and especially ICU admissions, for Covid 19 continue to rise, and we are now in a crisis throughout the state. The issues remain not having enough nurses and other personnel along with fewer beds available. Please note the situation is not out of control, and for the moment the system is able to handle the demand.
Once again, most new cases continue to be in patients under 40. Anecdotally, patients admitted to the ICU now seem to spend fewer days on the ventilator compared to a few months ago. It is unclear if that is due to some of the therapies being utilized, or to relatively younger patients or to something else.
In the most severely ill patients there are several therapies being utilized with Dexamethasone being the most recently talked about. Dexamethasone is a steroid which when given to patients on ventilators has been shown to improve survival. However, it does NOT appear to help, and may even be harmful when given to less severely ill patients.
Some people who have recovered from a Covid 19 infection test positive again by nasal swab soon after recovery. We do not really know exactly what this means, yet one theory currently going around is that these individuals merely have reactivated expression of RNA, rather than recurrent infection. Remember it is the virus RNA that we are detecting when we do a nasal swab. If true, this could be good news, as the theory goes these patients are actually protected by antibodies which are not being detected on our current testing. In addition, it suggests that a vaccine could still be protective even if our usual markers are not identified. Realize though this is just a theory.
One of the challenges of Covid 19 is the vast amount of information that is flowing from various research centers and hospitals around the world. For better and for worse, scientific information now is widely publicized when released. This information is often not subject to the usual review for good methodology and errors in calculation. Part of this is due to the time urgency of discovering a treatment for Covid 19. However, it creates situations where people do not know what or who to trust. Two examples of this issue are the Dexamethasone mentioned above, which has relatively strong data and study to back its usefulness, and Hydroxychloroquine which did not. I know I have made this point in another message, yet please try to remain scientifically skeptical, asking yourself how do the sources know what they claim to.
It goes without saying everyone needs to continue to wear masks when out in public and to try to minimize going out when the number of cases is so high. In the office, we are seeing patients 4 days a week, yet I continue to do telephone follow ups with patients as well. Unfortunately, we can not fully do our annual Wellness Exams by phone or telehealth, and we are working hard to catch up since we lost 2 1/2 months when we suspended them in mid-March.
Finally, this message is coming to you on a Monday since this Friday July 3, the office will be closed for the holiday. I continue to remain available by cell phone, yet ask if you would please call the office during business hours as I am seeing patients. I wish everyone a very happy and healthy week and my next message will come out next week.
Jeff Mayer, MD