We have been sheltered and shut in for over a month now and I am sure that everyone has acquired unexpected knowledge about viral illnesses, developed opinions about societal cooperation, witnessed unexpected acts of kindness and pondered how the âGreat Pauseâ has idled much of what we do while providing us unforeseen time to reflect on your priorities.
This newsletter has three articles:
- What to do with that spare time on our hands [5 minute video]
- Labs test to detect active and past Covid 19 infection and where to get tested
- An update on hydroxychloroquine (Plaquenil) for treatment of COVID-19
We remain open and available to care for you. We are providing limited services face to face at the office – needed infusions and subcutaneous injections, joint, tendon or bursal injections, PRP and other therapeutic procedures and we are stilling seeing new patients and twice a month performing DEXA scans. We are keeping the number of people coming to the office reduced to only necessary or urgent situations.
What to do with that spare time on our hands? Watch this 5 minute video!
You think last weeks video was life changing?! wait till you see this weeks show.
Last week, I bet no one washes their hands the same after watching the hand cleansing video. Well this week, the video is how to fill some of that extra time on everyoneâs hands (no reference intended to the prior âhand washingâ video)
It is entitled, 23 ½ hours – You have 23 ½ hours to do nothing and sit on your derriere, use just 30 minutes to help yourself get healthier, remain more independent and feel better. Guess what, it may even help fight off Covid-19 infection. It is that simple and the video is life changing.
If you missed the hand washing video, the link is again presented. It is just that helpful.
https://www.youtube.com/watch?v=-LKVUarhtvE
Labs test to detect active and past CoVID 19 infection and where to get tested
There are two basic types of lab tests for the Covid-19 virus. The first are tests that detect the actual presence of the virus  and the second detects antibodies in the blood proving an infection has occurred and may mean long lasting immunity.
Viral Detecting Lab Tests:Â These all share in the detections of viral components that prove a person has an active and probably contagious infection. These are typically the nasal and throat swabs that pick up the virus proteins and RNA within minutes to days. Newer tests to do just an oral swab are in development.
These tests are still in short supply and are restricted to people with fever illnesses and are also prioritized to the following high-risk groups:
- High-risk workers (first responders, law enforcement, healthcare, mass transit)
- Critical infrastructure personnel (utilities, chemical)
- Living in a group home, nursing homes, assisted living, etc.
- Over 65 years old
- Immunocompromised
- Traveled by mass transit within the last two week
Not everyone with an upper respiratory infection needs to be tested. High-risk people and individual with more severe infections will be prioritized. Since there is no specific cure, supportive care is offered to all with a presumed or documented Covid-19 infection.
Where to get tested:Â
Hotlines
People can call the 211 hotline or the Dept. of Health Services at 1-844-542-8201. Both options allow you to speak to a specialist.
Banner Health
People can call Banner Health’s Hotline at 1-844-549-1851. A clinical team member can talk to them to determine if testing is appropriate. The hotline is open from 7 a.m. to 6 p.m. Monday through Thursday, 7 a.m. to 5 p.m. on Friday. If testing is needed, the person will be scheduled to visit a Banner drive-thru site. There are 3 in the Phoenix region and one in Tucson.
Mayo Clinic
Patients of the Mayo Clinic of Arizona can call their Mayo doctor and explain their symptoms. If their Mayo doctor writes them an order for testing, they can get tested at a Mayo drive-thru clinic.
Maready Medical in Mesa
Maready Medical, located near Power and Warner roads in Mesa, is offering drive-up testing for patients with a doctor’s order. Patients can make a virtual appointment here.
Antibody tests for Covid-19:
These test are blood test to detect antibodies directed against the CoVID-19 virus proving that the person has had a prior infection and most likely immune to contracting it again. This proves the person has had the CoVID -19 infections and presumably immune.This would permit a person to know they would not be contagious and would not be likely to get Covid 19 infection again. Can they resume a ânormalâ lifestyle â the answer is yes.
This test was just approved by the FDA 10 days ago and there are no laboratories yet offering an FDA approved test. There are several private labs that are offering non-FDA approved tests.
Where to get it:
Arcpoint labs of Scottsdale
15455 N. Greenway Hayden Loop Suite C16
Scottsdale AZ 85260
Tel: 480 939 4656
Visit:Â www.arcpointlabs.com/scottsdale-north/
Cost: $60 dollars
If you wish to get tested, go on their website, select Contacts, and then add your name, email and in the comments box put down you wish to have the Covid-19 antibody test and notify how many tests you desire. They have a first come, first serve waiting list. They will contact you when it is your turn. The current waiting time is approximately one week.
An update on hydroxychloroquine (Plaquenil) for treatment of COVID-19
Evidence continues to mount against the media popularized treatment for CoVID-19 infection, hydroxychloroquine (HCQ).
Preprints of two trials were released April 14, suggesting that HCQ is not useful in CoVID-19. A pre release study is also presented.
The first was a study out of China including a total of 150 COVID-19 infected patients. One half received HCQ plus the standard of care, the other only standard of care. Different from previous studies, a higher dosage was used and for a longer treatment duration. Mild to moderate cases received two weeks of treatment, whilst more severe cases received three weeks of treatment.
This particular study looked at viral counts as a primary endpoint and clinical parameters as a secondary endpoint. The investigators found that there was no difference in viral counts of symptom resolution between the treatment group no the control group.
In the second study, investigators examined the use of HCQ in 84 patients requiring supplemental oxygen. They extracted notes from health records of 4 different French medical centers of current patients of similar clinical status.
The intervention group was to be treated with HCQ within the first 48 hours after hospital admission for seven days. In the trial 84 patients received HCQ plus standard of care and 97 received only standard of care. Primary outcome was transfer to the ICU or death within 7 days.
In the HCQ group, 20.5% were transferred to the ICU or died. In the control group, was 22.1% were transferred to the ICU or died.
In a third article yet to be published but announced in the New England Journal of Medicine, a small study in Detroit, MI of 63 hospitalized COVID 19 patients, half receiving 5 days of hydroxychloroquine, half placebo, failed to show any benefit. In fact, the treated group has greater respiratory problems than placebo.
What about a preventative effect?
The CoVID-19 Global Rheumatology Alliance has put together a disease registry for reporting of patients with rheumatic illness and CoVID-19 infection.
The registry currently includes a few hundred patients. Hospitalization and infection appear to be occurring among the patients prescribed HCQ to manage their rheumatic disease, suggesting there is no benefit in the sense of prophylaxis.
Several clinical trials are still underway, but HCQ has not proven to be the miracle some have made it to be. Let us encourage others not to hoard or use this medication as a preventative and increase the probability that this medication is available to those that need it.
References:
- Gautret, Philippe, et al. “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.” International journal of antimicrobial agents (2020): 105949
- Mehevas, Tran, et al. âNo evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial.â https://doi.org/10.1101/2020.04.10.20060699
- Barbosa, J et. al. Preprint NEJM Manuscript # 20-08882 April 4, 2020
