COVID-19 Update: Latest Numbers, Phase II in Virginia, and Potential Treatments

Dr. Steven Bishop returned to Facebook Live on Wednesday, June 3, to discuss the latest information on COVID-19. He discussed the most recent data and COVID-19 numbers, moving to Phase II in Virginia, recent developments about potential treatments, and he answered questions from the audience. Watch the full video below and read on for a recap. 

Numbers in Virginia

In Virginia, the number of cases, hospitalizations, and deaths in Virginia has continued to decrease, which is great news. This is likely why most of the state is moving into Phase II starting this Friday. Overall, the data is good, including the testing numbers. The 7-day average of positive test, in particular, is a good stat to keep an eye on, and it continues to trend down. 

Phase II in Virginia

Most of the state of Virginia will move into "Phase II" on Friday. For example, social distancing guidelines limit public gatherings to 50 people instead of 10. It's important to remember it's still safer at home and to take caution when you go out. But if you are lower-risk, it is becoming easier to venture out. However, it remains important to continue wearing a mask, washing your hands, and keeping your distance when at all possible. 

Recent Developments for Potential Treatments

Be careful about information coming out and ensuring that the research is sound and legitimate. Two recent developments regarding COVID-19 treatments have proven to be less precise than they should be. 

• Remdisivir is an anti-viral medication made by Gilead. It has some potential. However, the actual research is a little more circumspect than what has maybe been reported.
  
  The study that came out on May 22 showed that it was helpful in some people. It reduced the amount of time in the hospital by patients or prevented those that were never sick enough to be in the hospital. However, the study did not show any increase or reduction in death.
  
  So the bottom line is Remdisivir is still promising. It may be helpful for some people. But we don't think we can hang our hats on it just yet as far as a breakthrough medicine for COVID-19.
  
  
• Hydroxychloroquine: Two studies published in the New England Journal of Medicine and The Lancet reported that using Hydroxychloroquine to treat COVID-19 could lead to death.
  
  However, a couple issues have come up recently about the study and its methods. Instead of an actual clinical study, the researchers did a data mining project based on available data from hospitals around the world and used algorithms and statistical modeling to mine the data for associations between bad outcomes and deaths and various characteristics of the patients.
  
  Whenever a data mining project is conducted, it is important for the researchers to be circumspect. The data conclusions may not be reflected in clinical reality. So while this study was thought to make a definitive conclusion, it may not have. It doesn't mean the information is wrong. But it doesn't mean it's definitively correct either.
  
  It simply means more research is needed and this should be treated as a hypothesis generator and should be used in future studies and evaluation. Read more about this story here. 

COVID-19 Questions & Answers

• What is your assessment of the risk of the prospect of participating in indoor group fitness classes in the relatively near future? For an average risk person, say under 60 and otherwise healthy, if you can still distance yourself from others and avoid breathing right on other people, that is probably ok.
  
  It's unclear if you may have to wear a mask while exercising indoors. That might make it a little more difficult, especially if you asthma. If you are at a higher risk, talk to your doctor. That will be a nuanced conversation at this point. 
• Are face shields effective alone or only with a face mask as well? Face shields are great. We use them in the office, with masks as well. That's probably when they are most effective, using them together. A face shield is likely better than just a cloth mask though. 
• My family will be in the Outer Banks in a few weeks. Do you have any advice in addition to using good sense, wearing masks, and practicing social distancing? If you're going to be indoors around large groups that you aren't regularly in a house with, I would wear a mask. If you're outdoors, out on the beach, and not going to be close to people, the risk is lower. 
  
  
• Can you provide a vaccine update? I wish I could. I have not seen any new developments this week, other than Merck getting involved in vaccine developments. I have not seen any more publications or information come out. I'm hoping to see more in the next few weeks with vaccine research and also antibody COVID shield treatments. They are probably in the midst of trials, and it will take a few weeks to examine data. Hopefully we'll hear more in mid-June.
•  What does it mean that we can be in groups of 50 vs. 10? Phase II is still saying you are safer at home, but that you could have a gathering of up to 50 people. It's still saying the fewer people you interact with the better. My family isn't going to be doing that anytime soon, simply because we've made the decision to take it slower. However, we will be going out to restaurants and going to 50 makes it easier in that regard, as long as the restaurants are being safe and doing reasonable things. 
• Can you speak to the COVID-19 confirmed cases? They appear to be going down. Is a rebound for sure to happen? The confirmed cases in Virginia are going down. And I believe new cases in general and elsewhere are dropping across the board. As to the question about a rebound: a rebound is not for sure.
  
  However, I worry about it. And I expect it to return in the fall, simply because it's a respiratory illness and respiratory illnesses typically return in the fall. But it's not for certain. 
• When do grandparents open up? A great question and probably one that will be up to your family. Base it on the risk level and whether you feel comfortable that everyone has been doing everything possible to limit exposure. But it is a reasonable thing to consider at this point. 
• Is co-mingling households acceptable at this point given the declining prevalence? This is probably a decision only your households can make. Is it acceptable? Only you can decide if the risk is acceptable. Is the risk lower than a couple months ago? Yes. Is it zero? No.
  
  Especially for older folks, they are in the higher risk category and I would think carefully. If the households have all been extremely good about limiting their potential exposure, the risk is lower, but still a risk.
   
• Can you comment on humidity reducing COVID-19? Theoretically it makes sense, because it would make it more difficult for the droplets to travel through the air. But I have not seen any data to confirm. 
• If there is a rebound in the fall, how much better might medication/treatment be in 4 months? I am hopeful that we will have good preliminary data on hydroxychloroquine, Remdisivir, and a few other antibody treatments by that point. I think we will have a number of different options in the toolkit.
  
  And certain treatments will be best for certain types of people. That's one of the criticisms of the current studies, is that the studies are being conducted on people that are already very sick.
  
  And it may be that the drugs are not effective by that point in the illness. So it may be better to do an outpatient study. Some medications do better at keeping you from getting sick than treating you after you get sick. I'm hopefully by September/October that we will have 2-3 things we can point to and try with some sort of confidence. 
• If you know someone who is recovering now, should they quarantine for an additional 14 days once they go home? The risk that someone is still actively shedding virus after recovering, rehab, and gone home is low. There are some concerns about people shedding the virus for a lot longer, 30 to 40 days, but that's probably not a common occurrence. I would treat that as a normal risk situation and be sure to wear a mask, wash your hands, keep your distance, etc. 
• If I'm going on vacation in a few weeks, is there value in getting one of the tests a day or two before leaving so you have some info beforehand? If so, which test? Or are the tests still flunky enough that it wouldn't be worth it? If you're symptomatic, don't go. If you're worried about asymptomatic spreading, the PCR nasal swab tests are not going to very helpful. The antibody tests will be more helpful. That being said, what you're looking for there is a positive IgM test, which is the antibody that shows up first.
  
  The problem with the test for IgM test alone is they can have false positives. Which means it could come back positive but you don't actually have the virus. That's not the same with IgG testing, but that won't tell you if you have been exposed recently. So if you're going to do a pre-vacation test, I would get an IgM test. If it comes back negative, you can be reassured. If it comes back positive, you may miss your vacation for no reason.