COVID-19 Update: Increases in Other States, New Studies, and More

Dr. Steven Bishop was back on Facebook Live on Wednesday, July 1, to provide another update full of information relating to COVID-19. He discussed the recent increases in Florida, Arizona, and Texas; several new studies that have come out regarding treatments; and answered questions on schools reopening, which masks are the best, air purifiers, and even the new swine flu in pigs that has been identified in China. 

Watch the full video below and read on for a recap. 

Update on Increases in Other States

As we've all seen over the last several dates, COVID-19 cases, hospitalizations, and deaths are increasing particularly in Florida, Arizona, and Texas. This is obviously an unfortunate development, and we are seeing these states make changes to try and stem the spread.

If you're looking for data on any state, you can simply google the state name and COVID-19 and get a snapshot of key data. Simply put, we need to stay vigilant about avoiding large crowds, social distancing, washing your hands, and wearing a mask until a vaccine is developed. 

New Studies

There have been some interesting new studies that have come out in the last week or so. One study related to the potential for certain blood pressure medicines, ACE inhibitors and angiotensin receptor blockers, to increase the risk of a poor outcomes with COVID-19. A recent update in the American College of the Annals of Internal Medicine indicates they are not finding any association between using those drugs and having a high risk for a bad outcome from the virus, which is great news for anyone on blood pressure medicine. 

Another study came out of Spain, and involved following patients with HIV. They then looked at antiretroviral drugs those patients were taking to help with HIV. Then, they looked at how they had done if infected with COVID-19. What they found is patients who were on certain antiretroviral drugs, in particular Truvada, had a lower incidence of ICU and lower risk of death from COVID. 

This makes some sense from a theoretical perspective, because there was some prior data that these drugs inhibit what's called the cellular docking of the virus (when the virus attaches to your cells) and there are some gene sequences in the virus that are similar to HIV, so these drugs having some activity against COVID would appear to make sense. 

That being said, there had been a couple trials of these drugs that have not shown good efficacy. I suspect this Truvada study will spawn more trials of HIV drugs as we try and find better treatments. Read the study here.

What kind of face mask is the best? 

Another study from the Annals of Internal Medicine dealt with this question. Face masks have become a huge issue. As far as studying which face mask is best, this study examined evidence of the effectiveness of N95, surgical, and cloth masks relating to COVID-19, SARS-1, MERS, and flu viruses. And, in the community setting, there still isn't a lot of good data that any kind of face mask reduces infections to date. 

That said, the data is better for other viruses, SARS-1 and MERS, than COVID-19 or the flu. So there is some evidence that the masks do help. And of course, this is relating to the community setting. The healthcare setting is a completely different beast. Any kind of N95 or surgical masks definitely reduces the transmission of the virus in that setting, and the N95 is better.

The data is lacking. That doesn't mean masks are not helpful. It just means we don't know for sure one way or the other whether they truly do significantly reduce transmission. 

So, that leaves us with the mask question being a risk-benefit analysis. On the benefit side, we don't know if the benefits are strong. We just don't have the data. There is a supposed to be a large trial coming out in the next few weeks, which should help us answer the question better.

On the risk side, the risk with masks is pretty minimal. They are harmless. They do not hurt you. They do not cause trouble with oxygen or carbon dioxide. They may make it more difficult to breathe. In general, they are a harmless intervention.

So, if you balance risk and benefits, it still makes sense, if you are going to be in crowds, especially indoors, it makes very good sense to wear a mask the vast majority of the time. If you have anything that's at least as thick as a surgical mask, a couple layers of cloth, that should be sufficient. 

You Asked. He Answered. 

• Is there any reason to expect that the renewed infection cannot spread to other states? Do you expect that these new infections will seed new infections in our region? It is certainly possible. And it's possible that we will go through cycles of peaks and troughs around the country. It might depend on travel patterns. It's common for people to leave the Northeast to head south on vacation during the summer; that could be a possible reason for spread and further mini-outbreaks.  
  
  
• Are air purifiers helpful in clearing coronavirus? Would they be good ideas for classrooms, etc? They probably would clear the air of the droplets. However, there is a little bit of controversy over whether COVID-19 is only transmitted by droplets or if it can also travel via air particles, which are technically smaller and can travel much further than droplets. Most air purifiers have filters that would capture the majority of virus particles, so in theory they would reduce the risk of transmission, if you've got them set on the right number of air changes.
  
  The key with filters is the size of the air filters and the number of air changes per hour. You should lean toward something with 3-4 air changes per hour, meaning it turns over all the air in the room 3-4 each hour. You will likely have to leave the purifier on its highest setting and ensure it has the right filter size.  
  
  Are they good ideas for classrooms? It's kind of like the masks. There isn't evidence its definitely helpful, but it's a pretty harmless thing to do. I don't think every school system should buy thousands to put them in every classroom just yet, but anyone who wanted to have one in their classroom, office, or home, than that would be fine. We are using some in our office as well, to reduce some of the burden of possible viral particles in certain parts of the office. 
  
  
• I’ve recently recovered from what I assume was my regular asthma-related bronchitis, which I catch several times each year. Does it make sense for me to get IgG tested to check whether it was COVID? I would wait at least two weeks. But if you can wait a month, that's best. Most people develop antibodies starting at about the two-week mark, but it may not be enough to detect.
  
  So, I would wait until a month after you've recovered to get the IgG test done. If you wait longer than a month, you might miss the peak antibody level as some people aren't maintaining the antibodies for very long.
   
• Any assessment of how the new outbreaks change the risk/benefit for Fall residential college? I don't know yet. It's going to depend a little bit on where the college is. If it's the Northeast or Mid-Atlantic, if the numbers stay where they are or improve in the coming weeks and months, you're probably good.
  
  If the college is in the South or Southwest, you may want to wait a bit and see how things shake out. I'm suspecting a lot of colleges are going to have a lot of online education, even if they do bring folks back to campus. 
  
  
• Do you all see fewer people getting sick with the normal colds and sore throats, etc., since most of us aren’t leaving our houses? We did see that for a bit, but we are seeing an uptick of it now with a lot more people calling in with respiratory symptoms. They are getting tested for COVID-19, but most are negative.
  
  As people are getting out more, we're seeing a rise in this. It's not a lot, but it's more than we had in April and May. It's a little bit of a surprise for the time of year, but not totally out of the norm. 
  
  
• Have you seen this? New Swine Flu with Pandemic Potential Identified by China Researchers Yes, I have. This is a new swine flu that has been identified in pigs in China. From what I've read, it has been circulating for some time. It does appear to be able to crossover to humans, as there have been some farmers and others who have antibodies. 
  
  The reality is, anywhere around the world, and China is a hotspot for this, where you have large interactions between large numbers of people and animals, you are going to have crossover. This is particularly the case with the flu virus.
  
  Flu viruses are interesting in that they can mix together. Their DNA is a little unique in that its sort of like a deck of cards and the DNA can shuffle around. Most viruses are not like this. So if you have pigs with a certain strain of flu virus, and humans with a certain strain of flu virus, and either the human virus goes to the pig or the pig virus goes to the human, than that virus' DNA can shuffle like a deck of cards and create something new or novel. Which is how pandemics, like COVID, occur.
  
  The key is to monitor these things closely, and I think its something the public health authorities will need to do a better job of. 
  
  
• When does PartnerMd expect to start giving the regular flu vaccine? We should begin in mid- to late-September.