COVID-19: What we Know vs What we Need to Know

As of early May, COVID-19 is still dominating the headlines.  Many states are beginning to open back up with obvious caution.  As of May 6, there have been over 3.7 million cases worldwide of COVID-19 infection and just over 250,000 deaths attributed to complications arising from COVID-19 infection.  What we don’t hear is that there are over 1.25 million people that have recovered from COVID-19 infection.  Of the 2.2 million current active cases, only 2% of the active cases are critically ill.  That means the other 98% have mild to moderate symptoms that do not require hospitalization. Although it appears we have hit the proverbial plateau, there are still approximately 80,000 new cases of COVID-19 everyday around the world and about 20,000 of the new cases are here in the U.S.  These numbers are what we know after roughly 8 weeks of isolation and the world economy coming to a complete halt.

The numbers do not lie and there have been a number of promising therapies that have turned out to be not so promising. Hydroxychloroquine has lost its favor and now Remdesivir is the latest FDA approved drug for emergency use.  Remdesivir was originally developed to treat Ebola virus disease and Marburg virus disease but was ineffective for these viral infections.  It appears to be that Gilead is just trying to repurpose one of its failed drugs for a new use.  Although the FDA approved its use for COVID-19, the numbers are not that impressive.  The clinical trial data reveal that patients taking Remdesivir took 11 days to recover rather than 15 days on a placebo with no statistically significant improvement in survival.  The most common adverse effects in studies of Remdesivir for COVID‑19 include respiratory failure and blood biomarkers of organ impairment, including low albumin, low potassium, low count of red blood cells, low count of platelets that help with clotting, and yellow discoloration of the skin.  Other reported side effects include gastrointestinal distress, elevated transaminase levels in the blood (liver enzymes), and infusion site reactions.  As I look at the risk benefits of Remdesivir treatment, I am not convinced the reported benefits outweigh the risks and side effects.

Recent reports from the U.S. database compiled by CDC reports mortality from COVID-19 to have a racial disparity.  A disproportionate number of COVID-19 fatalities among African Americans has been observed.  While this has been attributed to known disparities in health care, low economic resources, and issues associated with social distancing: occupation, crowded residential spaces and transportation crowding. Additionally, African Americans have a high incidence of pre-existing and often untreated cardiovascular conditions. However, all these issues are seen in other populations and the higher prevalence of cardiovascular conditions would not explain why African Americans would still be at higher mortal risk than Caucasians with cardiovascular risk factors.